It’s difficult to innovate in the NHS

The title of this post comes from a recent story on the CSP's website, celebrating the success of a physiotherapist, Lucy Cassidy, who took the main prize at this year’s Advancing Healthcare awards.  Her prize was for the development of a virtual fracture clinic at Brighton and Sussex University Trust.  In responding to the prize, Lucy commented that "It’s difficult to innovate in the NHS because of financial constraints, and entrepreneurship is often about trying to find a win-win situation with the private sector to support new services."  This got me thinking about why it is that the public sector should so often be thought of as such a moribund place for innovation and creativity.

Some years ago, I undertook a research project looking at 'bleeding edge' physiotherapy practices.  A bleeding edge practice is one that takes significant risks and attempts to disrupt convention in order to pursue a radically different way of working.  They're reasonably common in business and enterprise, where they can attract significant venture capital or crowd funding.  They have a high failure rate (hence the idea that they're on the 'bleeding edge'), but can be game-changing if they succeed.  Think of Uber, Microsoft or Xero, and you get the idea.

Bleeding edge practices are more modest in physiotherapy, primarily because there's not as much money at stake and the gains are harder to quantify.  The profession has a professional code and protective legislation that can limit the ability of an individual practitioner or group to be too creative, and its often not in the physiotherapist's nature to think too unconventionally.

So we undertook the study with a simple idea of looking at two dimensions of bleeding edge practice: the location and nature of the practice itself (see diagram below).

What we wanted to find were practices that occupied the top right hand corner of this grid. Sadly, we didn't find any.

We began our trawl with some snowball sampling to find practitioners and practice areas that we thought might fit the bill, but it became increasingly obvious that our data would be skewed.  Seven of the eight participants were in private practice, and only one was in the public health system.  Try as we might, we couldn't find anyone in the public health system who was really doing something innovative and interesting.

Now at this point, I should say that I realise know that there will be some physiotherapists reading this who will say; "Well you just didn't look hard enough Dave.  I've been innovating in my practice for the last five years!  I've introduced pole dancing/yogalates-light/anti-gravity vibration training* (delete as appropriate), and my patients love it!"  Which may be true, but these did not constitute either a bleeding edge practice or location, since they still utilise the same set of activity-related, biomechanical principles that have underpinned physiotherapy for years.  They often just do so with a new piece of expensive equipment.

We certainly came across examples of people who had taken conventional practices and relocated them in a different locality (as with physiotherapists working in orthopaedic triage clinics).  And there were people who had changed some of their practices while operating from the same locality (exercised-based rehab in ICU, for example), but no-one we could find was combining the two together; doing something radically different in a different location.

In the end we abandoned the study, which was a real shame, but it pointed to the problem of how restrictive professions like physiotherapy can be.  Part of this restriction is built into the nature of physiotherapy itself, but another big part is a feature of the immensely controlling bureaucracy that is publicly funded health care system; a point made all too clearly by Lucy in claiming her prize.

I love the fact that my tax dollar goes towards supporting the health of the whole population, but I do wonder whether it also constrains as much as it enables some times.