Rob Hurd, Chief Executive of NW London ICB, and Matthew Chisambi, Interim Director of Strategy at Imperial College Health Partners (ICHP), share learning and methods used to prioritise innovation efforts as part of the NW London Missions.
Innovation has the potential to solve identified problems and priorities across our health and care systems. Whether it’s a digital technology, model of care, or pathway redesign. But with an ever-growing list of challenges and finite resources - time, people, and money - how do we decide where to focus?
This blog - the third in a series exploring our Mission-led approach to research and innovation in North West London - shares learning and evidence-based frameworks applied to prioritising innovation opportunities across each of the NW London Missions.
Current NW London Missions include optimising care for long-term conditions (starting with cardiovascular disease); enabling more days at home; and supporting children and young people’s mental health.
Read more about the NW London Missions:
- Moving to Missions: an ambition to make NW London ICB the most research and innovation friendly in the country
- Driving networked innovation to create more impact in NW London
A discovery phase across each Mission has previously allowed us to gain a full picture of system-wide challenges, and where innovation has the potential to make the biggest difference. From a longlist of these innovation opportunities, we needed to decide where and how to focus our energies as a local system. Working within cash-constrained systems, we know there isn’t a magic money tree to fund new things, and any solutions we implement must prioritise products/processes that we know work. Conversely, we also know that we should stop practices that don’t support better outcomes, or are less cost-effective.
So, how do we collectively make these decisions in an objective way that ensures best use of available resources to support the adoption and spread of innovation that’s going to make a real difference to our NW London population?
Evidence-based frameworks to support prioritisation
Different methodologies were applied by the Missions to shortlist innovation opportunities - each using an evidence-based framework to consider change initiatives in the context of suitability, feasibility and acceptability. This enabled us to answer key questions:
- Which solutions actually address the challenges that are most important?
- Is there evidence it works?
- Do we have the right resources to do it here in NW London?
- Do the people this will affect (whether targeted patient cohorts, the wider population, or our workforce) think this really is a better way of doing things?
Using this approach across each Mission enabled us to score each innovation opportunity, ensuring that this prioritisation process was objective, quantifiable, and evidence-based. Equally, it ensured that these opportunities resonated with the wider system by involving key stakeholders (including patients and service users). The process was collaborative and decision-making was collective.
Ultimately the employed methodologies meant we would prioritise the innovation opportunities with the potential for greatest impact on patient care, workforce experience and population health.
This approach - including scoring based on suitability, feasibility and acceptability - also allows the removal (as much as possible) of personal bias, and ensures that decision-making is informed definitively by prospective impact. Indeed, in this way, it has the potential to be deployed beyond shortlisting innovation opportunities, and the ICB is looking at where else this approach could be utilised.
Further to this rigorous prioritising process, the three Missions have shortlisted innovation opportunities as follows.
Mission to enable more days at home: application of the RICE framework
The RICE framework, a product management framework for scoring and prioritising features based on Reach, Impact, Confidence, and Effort, was employed in the Mission to enable more days at home. Using this framework, the team measured 12 longlisted innovation opportunities against:
- Reach: The size of the cohort with the potential to benefit from the innovation
- Impact: How much transformation could this effect, both quantitively and qualitatively
- Confidence: How confident are we this innovation could be deployed to deliver positive impact for our population and workforce
- Effort: What are the timescales and resources needed to implement and embed this solution to deliver the anticipated impact?
As a result, three clear priorities emerged:
- Proactive urgent and emergency care demand prevention: Using a Population Health Management approach to identify specific patient cohorts who can benefit from preventative management and intervention.
- Predictive long length of stay: Using data science and AI to predict people most likely to be at risk of long length of stay (and readmission to hospital), to implement proactive and intervening support.
- Discharge coordination optimisation: Implementation of technology solutions to optimise discharge coordination by, (i) supporting the collaboration of teams across multiple settings, and (ii) providing an improved pathway which connects patient need with the most suitable care provider.
Mission to optimise care for long-term conditions: a quintuple aim approach
The team applied a scoring criteria based on the Quintuple aims of healthcare to shortlist where they would focus. This considered clinical effectiveness, inequalities, patient experience, clinical experience, and cost effectiveness. Analysis against these measures, again in conjunction with further stakeholder engagement and public and patient involvement, identified the following innovation opportunities:
- Prioritising prevention: Taking a coordinated, system level approach to tackling the environmental, psychological, and social determinants of CVD, and focus on targeting the most at-risk population groups.
- Closing the detection gap: Reducing unwarranted variation in the detection of the disease by integrating services to ensure that case finding and detection are not completed in isolation.
- Treatment optimisation: Increasing the number of residents being treated to target, and increase appropriate monitoring for the five priority cardiac workstreams across the sector.
Mission to support CYP mental health: application of a bespoke framework
A bespoke framework was designed to best measure anticipated impact and to align with system stakeholders’ existing priorities - again, ensuring the suitability, feasibility and acceptability of all identified innovation opportunities. This shortlisting framework was used collaboratively with key system stakeholders to score and confirm two top focus areas:
- Crisis care: preventing CYP in NW London from experiencing avoidable mental health crises due to inequality, stigma, or inaccessible care, and improving outcomes for CYP in crisis.
- Neurodevelopmental disorders: enabling early equitable access and shrinking waiting times to assessment for ADHD and Autistic Spectrum Condition using data-driven insights and innovations.
What’s next?
As a local system, we’ve worked hard to identify and prioritise the innovation opportunities across each Mission where adoption and spread can create greatest impact for our patients and population. Next, is starting to test, iterate, and evaluate innovation within the most appropriate real-world settings with the aim of supporting sustained adoption and spread. For example, selected Discharge Hubs will act as ‘Implementation Sites’ to test innovation to support discharge coordination optimisation - one of the prioritised innovation opportunities to enable more days at home.
Initiating similar Implementation Sites to test, iterate and evaluate innovation in line with the opportunities identified and prioritised by each Mission, will enable us to understand what’s working and what’s not, and where we should seek to scale/spread so that more of NW London can benefit. This includes sharing learning and best practice across current and developing Innovation Networks.
Learn more about the NW London Missions here.
If you’re interested in becoming a part of emerging innovation networks for the NW London Missions, email communications.engagement@imperialcollegehealthpartners.com or get in touch with ICHP’s Mission Leads:
Mission 1: Optimising care of long-term conditions (starting with CVD)
NHS North West London Senior Responsible Officer: Toby Lambert
ICHP Mission Lead: Clare Thomson
Mission 2: Enabling more days at home
NHS North West London Senior Responsible Officer: Rob Hurd
ICHP Mission Lead: Adam Ashworth
Mission 3: Supporting children and young people’s mental health
NHS North West London Senior Responsible Officer: Charlotte Benjamin
ICHP Mission Lead: Kenny Ajayi