Social franchising and licensing A helpful tool to support the spread of good ideas?

I have just come back from the launch of the fifth round of our Innovating for Improvement programme. As ever, it was inspiring to spend the day with front line teams passionate about improving health care. Many spent the day sharing ideas and enthusiasm as well as the challenges they had already identified ahead of them. Probably chief among them was how they were going to sustain their projects at the end of their grant funding, within what feel like increasingly cash-strapped organisations.

Several ambitious teams were already thinking beyond this immediate challenge and making plans to give themselves the best chance of not only sustaining their ideas, but spreading them as well. Some of the challenges will come as no surprise to most people involved in improvement projects. Measuring the right data, understanding the priorities and interests of key stakeholders, and building in time to create a narrative rich with powerful patient stories were all central components of project plans. However despite this focus, planning and determination, our experience is that there are too many occasions where we see a successful project which, even with compelling evidence of outcomes, does not spread widely beyond its originator site.

We have been grappling with this challenge alongside the teams we fund for several years. We want to understand better why some good ideas spread widely and also how we can support teams to make this happen more often. As part of this, we are exploring whether social franchising and licensing might be helpful approaches to achieve this.  While these techniques have proven effective in many sectors, such as international development, they are relatively underused (and under tested) in health care. Social franchising enables another team to deliver a proven intervention to agreed standards under a franchise agreement, while social licensing involves turning an innovation into intellectual property that can be licensed for use by others. In both cases the primary aim is to maximise social benefit, distinguishing them from the conventional commercial use of these methods.

There are several reasons to think that these techniques offer real potential for scaling health care innovations and improvements. They offer greater levels of support to implementers replicating an intervention than other methods of scaling through ongoing training and support, as well as creating a source of sustainable financial support for the programme itself. They also offer more control to the innovator to ensure fidelity to a particular model where this is necessary for improved outcomes, as well as supporting local flexibility in implementation. The work has potential to build on learning from previous evaluations of spread that the Health Foundation has supported, which have found that clarification of what is essential to an intervention - in terms of a ‘hard’ core and the ‘softer’ surrounding elements - is a key stage in successfully replicating it in other contexts.  Deepening our understanding of the interaction between an intervention and its context is essential if we are to better support the spread of innovation and improvement in the NHS.

We have developed an innovative partnership with the International Centre for Social Franchising (ICSF) to understand the potential of these approaches. They met with ten of our previous award holders to explore the practicalities of applying these techniques to health care interventions and to help them analyse whether social franchising or licensing might be an appropriate spread mechanism for their projects. The results of this first exploration phase have been promising and we are excited to now be broadening the invitation to take part in this scoping work. Teams across the country with a proven intervention and an ambition to spread it further will be able to apply for consultancy support from ICSF, including a one-day workshop to explore whether social franchising or licensing might be a promising model for them.

We’re aiming to identify a small number of teams who have real potential to trial this further through taking part in a larger programme towards the end of 2017. This larger programme will provide funding for teams to work intensively with ICSF to develop and pilot their replication strategies, with the aim of achieving financially sustainable models for spreading their interventions throughout the health service.

Although an exciting prospect to test, we know that social franchising and licensing won’t be the answer for every project. Through rigorous evaluation of successful teams’ experience of these mechanisms, we want to understand better when and where these techniques can best be deployed. There will never be a simple answer to the question of how to spread good ideas, but having another tool for innovators to try out – alongside the more traditional approaches our grant holders already focus on – would certainly help.  

Express your interest in our new social franchising opportunity.

Sarah Henderson is Associate Director of Improvement Programmes at the Health Foundation