Promoting and Embedding Innovation

Case study 7: „quality improvement‟ clubs
Innovation overview
The Institute for Clinical Systems Improvement was set up in Minnesota for the explicit purpose of
spreading innovation and improvement. The Institute is funded by large hospitals and HMOs. These
organisations realised that often with innovation, a champion comes up with a new idea, it is
implemented in one clinic or hospital to good effect, but then no other units or sites adopt it. The
Institute was set up to overcome this, fostering spread both within and between organisations. It is
an organisation that hospitals and clinics voluntarily sign up to join – and in order to join groups
must pledge to focus on innovation and spread.
Adoption and spread
The Institute concentrated on developing protocols, clinical best practice guidelines and concrete
metrics to measure every organisation in the state. The initial spread strategy was to start with the
highest performing and most well known organisations and challenge other providers to emulate
them. Clinics and hospitals became Institute members in order to associate with other high profile
organisations in the region.
In order to join the Institute, providers must adhere to certain quality standards, commit to
undertaking four quality improvement projects each year (two on topics selected by the Institute),
and demonstrate senior leadership buy in. The Institute acts like a „quality improvement club‟
whereby members must make a commitment to adopting and spreading innovation as part of their
membership.
Key lessons
The Institute developed clear performance measures.
The Institute rewards attempts to improve, not just improved performance measures. If
there is no change in performance measures, organisations are not penalised. They just
have to demonstrate ongoing attempts at improvement and innovation.
There is mandatory training for all „improvement leaders‟ in organisations that become
members. Training involves a one day meeting three times each year, monthly
teleconferences, coaching sessions and „homework.‟
NHS applicability
It is uncertain whether such an initiative would work within the NHS. There may be little impetus to
join a quality improvement network or institute of this nature, especially as substantial time and
funds may need to be committed to innovative projects. The NHS does not necessarily have the
same focus on prestige so joining an improvement initiative just to be alongside the „big players‟
may not be applicable.
One important learning point for SHAs is the value of champions for adoption and spread. To
ensure that innovations tested at one site were rolled out to others, organisations used a „sales
model‟ whereby each pilot site had a champion who went to other sites to persuade others to adopt
the innovation. This approach was found to work well in organisations with strongly autonomous
physicians who resist change mandated from central leadership, and may have some applicability in
the NHS. The organisations found that in order to ensure spread, changes must be prioritised and
promoted by clinicians and other frontline staff and that these staff must be released from their day
to day duties in order to spread the value of their innovations via word of mouth.
More info: www.icsi.org
29 Learning from experience