Intrapreneurship can get innovation in the NHS unstuck

Innovation is the most exhausted word in the health care vernacular. Everyone seems to be doing it, but who’s doing it right? Historically, the NHS has taken Schumpeter’s later view of ‘big is better’, creating an Institute of Innovation and national innovation challenges. Despite these grand attempts to encourage innovation, opinion leaders argue that we still aren’t doing it effectively.

I recently spoke at the Royal Society of Medicine’s ‘Excellence in the NHS’ conference, recounting the story of the serial innovator Thomas J Fogarty. As a medical student in the late 1950s he witnessed the poor outcomes from surgical procedures to remove blood clots; the prolonged and open surgery was causing loss of life and limbs.

Fogarty focused his efforts on creating a less invasive procedure. His tinkering with a plastic glove and urethral catheter led to the creation of the Fogarty catheter; a device that is now used in over 300,000 procedures every year and is estimated to have saved over 15 million limbs. The catheter took six weeks from prototype to surgical use, all while Fogarty was still a trainee.

Fogarty defied the status quo; he was an archetypal ‘intrapreneur’. With access to the latent entrepreneurial spirit of 1.4 million employees in the NHS, it’s surprising that almost no mention has been made of intrapreneurship as being integral to better innovation.

Inspired by Fogarty, I had a few ideas on how we can generate and unlock ideas within our own workforce:

Focus those useful corridor conversations by creating a relaxed environment where multidisciplinary team members can get together to discuss problems they’ve encountered and potential solutions. Generating ideas should be encouraged and, similarly to current clinical audit afternoons, these meetings should be protected time.  

I’ve been impressed with the ‘Onion’ at West Hertfordshire Hospitals NHS Trust and 3M’s Time to Think as models for this.

2. Start-up grants 

National innovation prizes could be redistributed to form smaller local start-up funds for staff with an idea to disrupt health care delivery. The current trend for large awards is counterproductive as they are usually reserved for established organisations and often stifle innovation as individuals become paralysed by the fear of failure.

Smaller internal venture capital could be awarded at regular funding rounds by a panel of business experts, patients and clinicians at an intra-hospital ‘Dragon’s Den’. Funding should include provision for local implementation of the idea in order to provide intrapreneurs with an invaluable proof-of-concept.  

3. Appoint an innovator-in-residence

Each trust should appoint someone with start-up experience who can act as an advisor and focal point for innovation where staff members can take their ideas. This facilitator would assist budding intrapreneurs in navigating the system, advise on scalability and signpost useful opportunities. 

4. Incentivise innovation

Clinicians-in-training are required to demonstrate ‘commitment to specialty’ usually in the form of a clinical audit or research, but why not innovation? A budding endocrinologist collaborating with coders to produce a diabetes monitoring smartphone app should be rewarded and recognised for their efforts. The competitive nature of medical training could be harnessed as a driver for innovation.  

The health reforms have transformed the NHS into a complex ecosystem. Within the ‘new NHS’, foundation trusts are the most likely engines for innovation and where the described ideas can be implemented. Trusts could create innovation hubs within their organisations – an internal incubator – to ensure intrapreneurs are mentored and supported. The role of national bodies should be to primarily to support scaling, act as a central repository and circulate disruptive ideas.

To fix innovation in the NHS we need to commit to the entrepreneurial mindset and make it central to our organisation’s mission. Leaders must convince their workforce that ideas for change are welcome and not just an after-thought. Great ideas should be sparked on the frontline, catalysed by trusts and then disseminated nationally by NHS England. 

Dr Na’eem Ahmed is a ST1 in Radiology in London and Clinical Fellow to Professor Sir Bruce Keogh at NHS England, www.twitter.com/DrNaeemAhmed