Telehealth Soapbox: Do something great!

Roy Lilley, the UK media’s highest-profile commentator on the NHS, telehealth supporter and previously chair (twice) of the TSA conference, writes a several-times-a-week newsletter commenting on events and developments in the UK that affect the NHS. It is required reading for anyone, including private sector suppliers, who need to understand what is happening in the NHS. (Sign up here) His newsletter article today, although not about telehealth, touched a particular nerve because the ‘i’ word he excoriates in the NHS context is frequently bandied about in the telehealth context. The article is reproduced here, with permission, and our thanks.

It’s annoying. Everywhere I turn it’s there; inappropriate, the wrong context and unsuitable. It’s stuck to my shoe. I can’t scrape it off. Over the last two weeks wherever I’ve been, PowerPoint presentation after PowerPoint presentation misused it and misrepresented its intent…

I’m talking ‘innovation’.

I saw an ‘innovative diabetes pathway’ that was bog-standard and simply tarted-up a clapped out process. I was not impressed by an ‘innovative approach to procurement’. No; it was the same-old, same-old. From bunions to bog-rolls the NHS seems to think it is doing good stuff if they manage to shoe-horn in the word ‘innovation’, like it is some form of magic. ‘The very sound of the word will make everything better‘. Err, no…

Innovation; the second letter of the quartet that will save us from austerity and frugality! Err, no; the NHS is wandering around the valley of death, armed only with QIPP!*

Quality is merely consistency. If we can’t do that we should go home. Performance, measured retrospectively, is a window on the past; we should be real-time benchmarking with live data. Prevention? Prevent what? Bad health, accidents, errors, costs, waste? I give up. The only word that resonates is ‘innovation’ but it has become devalued, degraded and corrupted.

The NHS clutches to ‘innovation’ like a drowning man grabs at passing flotsam. There is even the ultimate management oxymoron; The NHS ‘Institute of Innovation’. You cannot institutionalise innovation. Words like ‘a package of tried and tested products, learning and support’ are not in the lexicon of the innovator but they are on the NHSII’s website.

Innovation has to be dicey, dangerous, wasteful, dodgy, precarious, hazardous, chancy and perilous. To innovate you must cycle through, try-fix-try, fix-try-fix. Risky; it needs a mind-set to allow for failure.

Innovation is not about changing the way services are provided. Innovation is about uprooting them. If the foundations of a business aren’t right all the innovation in the world won’t fix it. On-line shopping is wiping out the high street not because of innovation but because the rent, rates and labour costs in the high street are unaffordable. This is force-majeure; using technology to stay afloat.

Innovation is confusing and must leverage off the base of an innovative business model. Apple provides that, so does Dyson. New Windows 8 is product development, not innovation. Google ChromeBook is. Models built on risk, providing the public with goods they never thought they wanted; the development of new customer value created by invention. The UK is ranked 5 in the Global Innovation Index (Slide 7).

The NHS is not like any of that; its work is risk averse and has no money to waste on innovation flops like the Sinclair C5 and magnetic trains. The NHS dare not take chances like banks took a chance on financing innovative sub-prime loans and their derivatives. Innovation is supposed to be disruptive; the NHS dare not risk disruption.

Doing things better, or properly, is not innovative but is what the NHS must achieve. Re-engineering to deliver more for no-more should be the NHS’s basic mission. Innovation with the attendant risks of waste and failure, trying to deliver more for less, is insane. There is a confusing relationship between innovation and efficiency.

In the same way customers seldom buy what companies think they sell, understanding the ‘job’ customers want from the product is something the NHS is yet to realise. Getting through the processes of diagnosis, treatment, maintenance or discharge, swiftly, safely and conveniently is a reasonable ‘patient ask’. The building blocks are mostly there and it doesn’t need ‘innovation’. It needs system design and red hot management.

QIPP will not be delivered by the NHS, it will be delivered by its customers using innovations that will be hustled into the service when patients realise, to improve quality and performance, they have the the power to Tweet their #NHSexperience every time they have contact, Facebook pictures of dirty lavatories, crappy food and Mobile-YouTube-videos of staff not washing their hands. When they steamroller the NHS with demands for results, appointments and records by email and the NHS is left, flat-foot, when there are thousands of apps based on NHS data that will inform real choice and shape our lives.

Stunning management will deliver an NHS built to last but its response to customer-led innovation could deliver an NHS re-built to do something great!


Roy Lilley

29 October 2012

QIPP “Quality, Innovation, Productivity and Prevention – is a large scale transformational programme for the NHS, involving all NHS staff, clinicians, patients and the voluntary sector. It will improve the quality of care the NHS delivers while making up to £20billion of efficiency savings by 2014-15, which will be reinvested in frontline care.” Department of Health

Categories: Soapbox.