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We often aim to make changes in the healthcare system, such as adopting an innovation or a new way of working. The health and care system isn’t set up to allow change, never mind complex change and therefore it’s not surprising that innovations don’t readily spread. With a greater understanding of complexity (Spread and Complexity in the NHS and COVID-19 – A Complexity Leadership Response), we realise that we need to work with the unpredictability and emergence that is part of complex change in a complex system.

“I think we should be saying well it’s not surprising they haven’t spread now that we understand more about complexity”

Adopting a complex intervention and making it work in a new setting does not fit the traditional view that once an innovation has been piloted others will take it up. A much more distributed effort is required involving reinvention and creativity from adaptors, with the intervention sometimes undergoing substantial revision (see The Spread Challenge). There is the need to understand, through its use in the new setting, the local benefit or value offered by the innovation.

Consequently, because one innovation or change works in one setting this doesn’t mean it will work in the same way, with the same benefits, in another setting. Spreading (or scaling) doesn’t mean one exact change has to be implemented everywhere. What it does mean is that the aim needs to be to enable some kind of adaptation in the system – that adaptation can and needs to look different in different settings.

“The Power of the Local”

Mary Uhl-Bien recently joined Matthew Mezey and me via Zoom, to share her insights on the current complex challenges COVID-19 brings and illustrate these insights with examples from USA and UK. You can watch this conversation in full.

Mary explained that with complexity, such as the COVID-19 crisis, we need an adaptive response (COVID-19 – A Complexity Leadership Response). This involves a good strategic, operational response in addition to a local, entrepreneurial response that drives the adaptive changes focused at a local level which will produce local adaptations and innovations. A local response tends to be more appropriate to the situation.

Consequently, because one innovation or change works in one setting this doesn’t mean it will work in the same way, with the same benefits, in another setting.

Mary offered two US examples caused by COVID-19 which illustrate the need for central coordination with local adaptation:

  1. Opening of schools needs to be a local decisionThe different settings will need to respond differently, it is the same for organisations. What is needed is local decision making with central coordination but not central edict.
  2. Academy of Management annual conference moved to a virtual format – The different divisions of the Academy made their own decisions about what to do virtually but wanted central support e.g. registration, finances

Other blogs based on this conversation with Mary Uhl-Bien explore:

If you’re interested in learning more about how to enable the spread and adoption of innovations in healthcare, there are previous blogs and further blogs to follow. Please do subscribe to this blog and follow @DianeKetley, @HorizonsNHS, #nhsspread.

Further information and reading

NHS Horizons’ work on spread and adoption of innovation, and forthcoming online publication, is informed by Mary’s work. We identify the need for a new mindset with an increased understanding of complexity and interdependencies, the need to create a pull of innovation alongside the traditional push approach with attention to relationships and the impact of asking people to change their routines and behaviour.

The Health Foundation. The Spread Challenge, 2018

Horton T, Illingworth J, Warburton W. Overcoming Challenges In Codifying And Replicating Complex Health Care Interventions. Health Affairs 376 (2) 2018

D. Ketley. Spread and Complexity in the NHS 2019, blog

M. Uhl-Bien. How ‘Adaptive Spaces’ enable innovation in healthcare and beyond. 2019. Q community webinar.

M J Arena, M Uhl-Bien. Complexity Leadership Theory: Shifting from Human Capital to Social Capital in People + Strategy, 2016 – open access

M Arena, R Cross, J Sims, M Uhl-Bien. How to Catalyse Innovation in Your Organisation in Sloan Management Review, 2017

Professor Mary Uhl-Bien, Ph.D. is BNSF Railway Endowed Professor of Leadership at Neeley School of Business at TCU, Texas, USA.

This blog is one in a series and was originally posted on the NHS Horizons website.

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