Improving service delivery

Achallenge facing the NHS is how to transfer innovations and improvements from one organisation to another and thereby reduce variations in service delivery (Horton et al, 2018). Sometimes, this merely reflects the slow spread of successful innovations, but at others, factors such as culture, staff skills and established habits affect their successful replication in another setting (Horton et al, 2018). It is not simply the innovation and its implementation but also the context and interaction between these elements that influence success.

Context is a set of factors that affect improvement efforts and may not be easily modifiable. Bate (2014) argued that it has four measurable dimensions—strategic, cultural, technical and structural—and inadequacy in any one affects prolonged significant improvements and sustained learning. Robert and Fulop (2014) identified multiple levels of context (micro, meso and macro) and examined how they combine to affect the sustained success of quality improvement. Following up, Ovretveit (2014) identified critical conditions for an improvement to be successful; these vary depending upon the innovation, and different elements of the context affect different types of innovations. Horton et al (2018) suggested that the ‘replicability problem’ can be solved if teams adapt and implement innovations to work in their own settings. Thus, new technologies, practices and models of care must be sympathetically adapted to the specific context with the engagement of all those affected if they are to be successfully implemented and sustained. Perhaps it would be helpful if there were ‘spread programmes’ to enable the successful cascade of innovations.