Promoting and Embedding Innovation

Reflections
The literature on innovation diffusion and
spread is vast but suffers from a number of
gaps and weaknesses (Greenhalgh et al 2004,
Länsisalmi et al, 2006, Leeman et al 2007,
Mitton et al 2007). It is important to outline
these briefly before summarising the literature.
Much of the empirical evidence relates to
traditional, medical innovations and as a
consequence there is less learning to draw on
in relation to more complex interventions.
It is only relatively recently that researchers
have sought to understand the organisational
and system factors that impede or facilitate
innovation (Fitzgerald et al, 2001). Longerstanding
literature is geared towards analysis
of the individual innovation adopter.
Studies employ different definitions of terms
such as „innovation,‟ „adoption‟ and „spread‟.
This makes comparison of findings difficult
(Fleuren et al 2004, Ellis et al 2005, Williams &
Dickinson 2008).
The literature on innovation in healthcare is
couched in sometimes divergent language. It
is therefore important to clarify some of the
major schools of thought and their perspective
on, and contribution to, the topic. Appendix 2
outlines core theories and frameworks
surrounding innovation.
Sustaining and de-commissioning (as opposed
to adopting and diffusing) are the least well
understood stages of the innovation pathway
(Greenhalgh et al 2004, Buchanan et al 2005).
No formal reviews of the evidence on
innovation in social care were identified.
Although some case study data covers social
care settings (Osborne 1996, Henderson
2001, Stevens et al 2005) this remains a
significant gap.
Few studies employ a systematic design and
even fewer explore underpinning theories (or
models) of change (Faulkner et al 2003,
Haines et al 2005).
“Critical research is key for
improving what we know about
the impact of innovations on
healthcare delivery and people’s
lives and for using them in the
most appropriate way. That
implies clarifying the contexts in
which innovation proves
clinically and socially valuable or
not.” (www.hinnovic.org)
The literature underpinning this review is thus
partial and limited. There is a need to
extrapolate learning from contexts which in
some instances are quite different from the
NHS. The identification of lessons for
innovation within the NHS are thus tempered
by these considerations of rigour and
relevance.
7 Learning from experience