Policy Innovation Blog

Superadopters: the unsung public service innovators

Stian Westlake - 23.10.2012

Who are the neglected heroes of public service innovation? Perhaps it's not the inventors, but the adopters.

Take healthcare, for example. When most people think of health innovation, they think of new techniques like laparoscopic surgery, new discoveries like the link between helicobacter and stomach ulcers or new services like PatientsLikeMe or Patient Opinion.

But innovation depends not just on inventing new things, but in making sure they're widely adopted.

Outside the public sector, this often happens very quickly. Ask Apple: they pioneered intuitive, windows-based operating systems, only to have them (legally) replicated and sold around the world by Microsoft. 25 years later, they made a revolutionary smart-phone, and within months their competitors were frantically seeking to emulate it. This is tough if you're an innovator, but great if you're a customer, since the price of innovative new products falls quickly.                                                                                                                            

In the public sector, things are different. The incentives to copy good ideas are often weaker. Even new ideas like Nurse-Family Partnerships, which have been shown to be effective in many rigorous tests, get taken up gradually. How you'll be treated if you get sick still varies hugely based on where you happen to live in the UK: in some places, a broken hip will put you in hospital for an average of 36 days, in other places only 16. If you want the details, the Department of Health maintains an Atlas of Variation showing how treatment varies across the country. No wonder Lord Darzi (a former health minister and, as a pioneering laparoscopic surgeon, no slouch at innovation) identified the adoption of innovation as a priority for the NHS in the twenty-first century.

We think this a problem too. So we've been thinking about a research project to understand adoption of innovations in public services a bit better.

What we'd like to do is to examine how good different public sector organisations are at adopting innovations, and whether the ones that are best at it have any characteristics in common. To put it another way, we want to know more about the Superadopters.

Here's what are thinking of doing. To begin with, we plan look at one relatively narrow area. Trying to cover the whole of the UK's public services in one go is far more than we can come with. We've settled on GP services as a first step, because they're something most of us use fairly regularly, because there's a lot of (well documented) variability between the best and worst, and because the NHS has recently released some excellent open data on them.

First of all, we're interested in whether we can develop some simple, generalisable measures for how quickly GP practices adopt new innovations. There are at least two interesting public data sources on this: the NHS Information Service's database of prescription rates by practice, and the data on how practices perform against the Department of Health's Quality and Outcomes Framework (QOF). We think from these datasets we can get a rough idea of how quickly GP practices adopt new drugs, and how quickly they adopt new care protocols (or at least, those new care protocols that find their way into QOF). It will be far from perfect as a measure of innovation adoption, but it'll be a start.

This could then be supplemented with a survey. It would be interesting to ask two sorts of questions. Firstly, when did the practices adopt particular non-drug innovations that aren't covered in QOF (perhaps the Royal College of General Practice or other GP experts could identify a top 20?). Secondly, how do the practices keep themselves abreast of new developments and what else do they do to take on board new innovations?

This could generate some fascinating results. We'd be able to identify which GP practices are Superadopters, taking up new practices quickly (to the benefit of their patients). We'd also be able to see what characteristics they have in common. And there's no reason to stop at GPs. I can imagine similar studies for libraries, payment processing centres, or adult social services departments.

There are of course a number of ways it could go wrong. It might be that the data recorded on the introduction of new drugs or the adoption of techniques covered in QOF aren't good proxies for innovation (Ben Goldacre reminds us that not all new drugs are worth prescribing, while John Seddon has long observed that not all government targets are worth implementing). It might prove difficult to find the right innovations to ask about in a survey. The people who answer the survey might not know when various innovations were adopted or might not feel inclined to answer the survey at all. But it seems worth a try.

We'd like to know what you think of this. Is adoption an interesting thing for us to look at? If so, is this a sensible way to study it? Are there clever analyses we're missing, or data we should get hold of and use?

We'd also like to know if you're interesting in working with us on this. We'd like to hear both from public sector organisation who want to understand innovation adoption better, and from researchers interested in undertaking the work itself. If you're interesting in the idea of Superadopters, or in helping us find them and celebrate them, please get touch.