Improving Innovation in England’s NHS: The Potential of Behavioural Change Theory
In recent years, England’s National Health Service (NHS) has faced difficulties encouraging the rapid and widespread adoption of technological and technical innovations to improve medical and cost outcomes. In response to this challenge, and on behalf of NHS England’s Innovation division, Polygeia is evaluating the potential use of Behavioural Change Theory (BCT) to improve innovation uptake in the NHS. In particular, BCT may be well suited for overcoming reluctance towards change at the local level among individual clinicians and community leaders, which has historically hampered innovation spread.
In November 2014, the UK government commissioned a report intended to assess how the NHS could “speed up access to innovative drugs, devices, diagnostics, and digital products to NHS patients”. Financial hurdles are among the largest barriers to the adoption of new and more effective technologies in the medical field. However, even when well-funded interventions are in place, innovation faces further challenges such as a lack of the right personnel to implement change, the necessity to change organisational structure within local NHS branches, and personal reluctance from physicians and practitioners. Highlighting the difficulty to overcome individual resistance to change, a review of case studies on innovation uptake success and failure, produced by the King’s Fund, noted that “the attitudes of local leaders and the working environment within provider organisations have a significant impact on the speed of innovation and spread”.
For example, the use of Episcissors-60®, a type of surgical scissor aiding physicians in determining the angle of the surgical cut during episiotomies, has been shown to improve clinical outcomes. Episcissors-60 can reduce the rate of obstetric and sphincter muscle injuries by 43% compared to typical scissors, consequently reducing costs for the NHS associated with patients’ injuries. However, even if the cost for the more expensive Episcissors-60® is normally covered by the NHS, and despite the clear benefits to the patient, hospitals and surgeons are reluctant to adopt the new technology.
More broadly, although Innovation and Technology Payments are available to support the cost of new technologies such the Episcissors-60®, shifting clinicians’ habits remains difficult in a fragmented system. For example, the previously mentioned King’s Fund’s report argues that “local health services are complex, interconnected systems with […] different challenges […] external bodies are ill placed to determine which service innovations would deliver greatest value within a local system”. Innovation uptake tends to occur at the local level, so it is difficult for centralised policy commitments to improve uptake.
Given these institutional challenges, Behavioural Change Theory (BCT) and associated techniques have been implicated as a potential starting point to guide future efforts at improving physician adoption of new technologies. Behavioural Change Theory is premised upon the idea that in order to enact change, one must first understand why people do (or do not) engage in a certain behaviour, both at the individual and the aggregate level. Behavioural Change Theory has been shown to be effective in circumstances such as control of communicable diseases, physical activity and smoking cessation through techniques such as ex-ante conditional rewards, information provision, and self-monitoring.
In spite of the numerous health-related applications of BCT, there is limited work using BCT to change physician behaviour, which has broadly shown that active education and monitoring is more effective than more passive techniques. Therefore, we intend to investigate whether and how BCT could be most effectively utilised to improve innovation uptake by physicians and local leaders. As the pace of technological change continues to accelerate, it will only become more pressing for healthcare systems to quickly and efficiently adopt novel practices. Given the historical challenges posed by the behavioural, institutional rigidity to change, by focusing on the importance of uptake at the local level through individual actors, BCT offers a promising solution to the current and future challenges of innovation uptake.
Special thanks to our project’s commissioners, Kathy Scott and Alex Ganzerla from NHS England’s Innovation Division. You can read more about the great work they do here: https://www.england.nhs.uk/ourwork/innovation/
Additional thanks to branch editor Mariangela Panniello for her help composing this piece.
About the author:
Jeffrey Sload is a first year MPhil student in Comparative Social Policy at Oxford University, focusing his thesis on healthcare policy and the politics of healthcare reform. He pursued his undergraduate studies at Williams College in the U.S. where he majored in Biology.