Wessex AHSN Spread and adoption model webex

Spread and adoption model
Webinar for AAC Rapid Uptake Products

The aim of this webinar is to describe and introduce the work we’ve done in
Wessex over the past 9 months to research and develop a standardised, evidence
based approach to the spread and adoption of innovations in our region.
We call this the ‘spread and adoption model’.
It’s a work in progress. We are testing and refining it in the field and sharing it
more widely for comment.
The key output of our spread and adoption model is a “spread and adoption plan”.
We will introduce this as part of today’s session
It has been agreed amongst the AHSN Chief Officer’s that we will use this S&A
model and plan to support the spread of the AAC RUP’s.
Purpose of this session

Templates can be considered bureaucratic and become documents that sit on the
shelf once completed…
However – we see the creation of the S&A plan as a dynamic and ongoing process.
The first draft is just the first iteration.
The template and resulting plan comes alive when all 15 AHSN’s (and the other lead
bodies for particular products) work with partners to test and refine the responses to
the template and all feed this intelligence back.
We are then able to see patterns, learn, and adjust our support for adoption
accordingly.
The patterns might be specific to a particular product meaning we can collectively
consider a national solution/solutions.
Populating the template is itself part of creating a conversation that is more receptive
to adoption.
S&A planning template

We started by reviewing the published literature on what supports successful
spread and adoption.
A key source is How to Spread Good Ideas1, a 400 page systematic review of the
literature on spread in health services commissioned by the Department of
Health and published in 2004.
We’ve read a lot and we include some of the other key references at the end.
We have used the evidence of what supports successful spread and adoption to
design a model made up of six interconnected components.
Developing the model
1 How to Spread Good Ideas. A systematic review of the literature on diffusion, dissemination and
sustainability of innovations in health service delivery and organisation. Trisha Greenhalgh et al. April 2004.

The S&A Model
Understanding
the adopters
The method maps and
understands the potential
adopters – individuals,
organisations and systems -
and identifies key decision
makers, opinion leaders,
champions and networks.
Implementation
Planning
implementing health
technology programmes
involves a great deal of
work. The method includes
a checklist that covers the
main factors that determine
successful implementation.
Spread in
Systems
The programme builds
understanding of when and how
innovations are most effectively
spread in systems and how the
system and leaders support this.
Understanding
the Innovation
The method starts by
analysing the essential
characteristics that will
determine how the
innovation spreads
Spread through
networks
Innovations primarily
spread through the social
networks that link people
together. The method
develops targeted spread
plans for each innovation
Embedding
Innovations
Innovations are sustained
and embedded when the
advantage over the
previous technology is
measured and observable
to the adopters & their
organisation
Today will cover the innovation, adopters and network elements of the model

Different innovations spread and get adopted at different rates. Some never spread at all.
The perceptions that people have of an innovation is predicted to account for between 50% and 85%2 of the variance
in the rate of spread. Six attributes of the innovation perceived by its potential adopters seem most influential:
1) Advantage - people are more likely to adopt something that they think is going to help them. They will weigh up
the perceived gains of change with the perceived risks of the status quo. Clinicians will expect there to be good
evidence of these advantages if they are going to change their practice and adopt it. This is often thought to be
the most important attribute.
2) Compatibility - with the needs, values and beliefs of the potential adopter.
3) Complexity - simple innovations spread faster than complicated ones. When the innovation is complex, adopters
need to understand and trust that there will be enough resource and support.
4) Adaption - people are more likely to adopt an innovation when they are able refine or modify it to suit their own
needs (sometimes referred to as re-invention).
5) Observable - people are more likely to adopt an innovation when they can see it in action elsewhere and see the
benefits to them.
6) Trialling - people are more likely to adopt an innovation when they can test it on a small scale first.
Understanding the innovation

S&A model template
The template starts with a description of the innovation, the problem it solves/
opportunity it takes and reviews the underpinning evidence base.
We then analyse and record how the innovation measures up to these 6 attributes.
We try to do this from the perspective of the potential adopters – where necessary
taking different perspectives clinicians, commissioners, patients to determine the
value proposition to the user(s).
Tip: Many of the nationally prioritised innovations such as ITT/ ITP have headline
statements of advantage of possible national financial savings. We work to get
behind this and describe the quality attributes as well – and to do this at unit of
potential adoption e.g. a hospital department or GP practice.
Case study - Heartflow

Questions?

The most common model used to understand potential
adopters is innovation diffusion curve developed by Everett
Rogers in 19622 (see figure opposite). This classifies the
population of adopters in five categories:
 Innovators. The fastest adopting group, distinguished from the rest of the population by their
adventurousness, tolerance of risk, fascination with novelty and willingness to travel to find new ideas.
They aren’t opinion leaders and may be thought of by some as mavericks.
 Early adopters. Are different from innovators – they are opinion leaders, locally well connected
socially and tend to search not quite so widely as innovators but speak with them and cross-pollinate.
Importantly to the dynamics of spread, early adopters are watched by others.
 Early majority. This group watch and learn from the early adopters experience. They are more risk
adverse and more likely to adopt an innovation if it meets their immediate needs, rather those that
are simply interesting ideas.
 Late majority. This group watch and learn from the early majority’s experience. They watch for local
proof and will adopt an innovation when it appears to be the new status quo.
 Last adopters. The last group to adopt an innovation, believe in the traditional, tried and tested
methods. The term ‘laggard’ has fallen out of favour because of its negative connotations.
Understanding the adopters

Greenhalgh et al1 feel that the 5 adopter categories are an over-simplification – that adopters are
not passive recipients of innovations:
“Rather… they seek innovations out, experiment with them, evaluate them, find (or fail to find)
meaning in them, develop feelings about them, challenge them, worry about them, ‘work around
them’, talk to others about them, develop know-how about them, modify them to fit particular
tasks, and attempt to improve or redesign them (often through dialogue with others)”
And adoption happens in organisations as well as with individuals – with multiple decisions by
multiple actors.
“The adoption process within organisations should be recognised as complex, iterative, organic
and untidy.”
Horton et al 4 make the case for a greater emphasis on adopters – that invention is only half the
story.
“People sometimes fall into the trap of thinking that when an idea has been successfully
demonstrated or piloted then the hard work is done. But exploiting the full potential of a new
idea requires successful replication at scale – and this takes time, skill, resource and imagination.”

S&A model template
The template supports the analysis of who the potential adopters are:
• The organisation (e.g. acute Trusts)
• The specialities/ departments (e.g. cardiology and radiology)
• The key decision makers (e.g. clinical director and Divisional manager)
• The groups of staff that will be required to adopt the innovation
• The commissioner perspective
• Whether patients have an influence on adoption
Case study – Home Blood Pressure Monitoring

Spread and adoption reviews with our Trusts
To deepen our understanding of the adopters in Wessex we are undertaking S&A reviews in our Trusts – to
understand the roles and processes they use to Identify; Decide; and Implement innovations and identify
ways to improve this. We’re building up a picture of what influences S&A in Trusts:
Stage Influence
Identifying
innovations
 There are clinicians/ professionals who are ‘outward looking’ and have the time to do this
 The value of doing this is recognised and encouraged in the Trust
 The organisation is receptive to new ideas when people identify potential innovations
 At Trust level, there is a person or process for holding the ring and acting as a conduit to wider nationally prioritised
innovations
 Using the wider local health and care system to identify innovations
Deciding
whether to
adopt
 A clear devolved decision-making structure e.g. Divisional Boards
 Clear decision-making processes e.g. business case guidance
 Decision making structure and processes understood and used consistently – not bypassed
 The heath and care system is able to agree and decide to roll out innovations to deliver shared system benefits
Implementing
and sustaining
innovations
 Capacity and capability to implement change at speciality, divisional or trust level
 A culture of completing change projects and giving them time to deliver results/benefits
 A review process to understand whether the innovation was implemented as planned and delivered the benefits
defined in the business case
 Teams implementing the innovation have information on the benefits they are delivering and are encouraged to
network with other teams that have adopted it
Draft
Key finding. The majority of the nationally prioritised innovations are aimed at acute Trusts. The key decision
maker is most likely to be the appropriate Speciality Lead Clinician – with the decision on whether to adopt being
made at a Divisional Board.

Spread through networks
There is a consensus in the literature that top-down pressure and mandating adoption of an
innovation rarely works:
“While mandatory participation might ensure that organisations join a programme, it does not by
itself achieve acceptance of a new intervention or the motivation to implement it.” 4
Decisions to adopt an innovation are context specific and have strong social and psychological
aspects.
There is a consensus of the importance of networks in the diffusion of innovations:
“It is a key principle of diffusion of innovations theory that most innovations spread primarily
through interpersonal influence, and that the ‘channels’ through which such influence flows are the
social networks that link individual members of a social group.” 1
We can think of these networks as being the principle way that the different populations of adopters
watch what each other are doing – how the early majority find out what the early adopters are doing
and so on. Important roles operate in networks, that can influence spread and adoption:
 Opinion leaders – are the highly respected people in organisations and networks who influence
others.
 Champions – are the key individuals who use their belief, commitment and relationships to keep
pushing adoption in their own organisation and finding ways around organisational barriers.
They are often found outside of formal structures or authority.

S&A model template
The template supports the analysis of the networks that bring our potential adopters
together, where they can explore the attributes of the innovation.
There are a number of formal networks that are helpful e.g. STP groups; Clinical
Senate; Deanery.
But we are really looking for the informal clinical networks that clinicians and
professionals instigate and maintain themselves as part of how the professional
development of their service and speciality. There a lot of these – but finding them
can take some detective work.
We look for the opinion formers and champions in these networks.
Case Study – Home blood pressure monitoring
The importance of horizontal networks that bring together the key decision makers
and potential users of the innovation to explore its attributes is a major part of the
model.
Spread through networks

Detail surrounding the final three elements of the
S&A Model
Understanding
the adopters
The method maps and
understands the potential
adopters – individuals,
organisations and systems -
and identifies key decision
makers, opinion leaders,
champions and networks.
Implementation
Planning
implementing health
technology programmes
involves a great deal of
work. The method includes
a checklist that covers the
main factors that determine
successful implementation.
Spread in
Systems
The programme builds
understanding of when and how
innovations are most effectively
spread in systems and how the
system and leaders support this.
Understanding
the Innovation
The method starts by
analysing the essential
characteristics that will
determine how the
innovation spreads
Spread through
networks
Innovations primarily
spread through the social
networks that link people
together. The method
develops targeted spread
plans for each innovation
Embedding
Innovations
Innovations are sustained
and embedded when the
advantage over the
previous technology is
measured and observable
to the adopters & their
organisation

Thank you for listening
Discussion

RUP 1
(Lead AHSN [x])
RUP 2
(Lead AHSN [x])
RUP lead 5 RUP lead 6 RUP lead 7
AHSN
1
AHSN
2
AHSN
3
AHSN
4
AHSN
5
AHSN
N+1
AHSN
1
AHSN
2
AHSN
3
AHSN
4
AHSN
5
AHSN
N+1
AHSN
1
AHSN
2
AHSN
3
AHSN
4
AHSN
5
AHSN
N+1
AHSN
1
AHSN
2
AHSN
3
AHSN
4
AHSN
5
AHSN
N+1
AHSN
1
AHSN
2
AHSN
3
AHSN
4
AHSN
5
AHSN
N+1
AHSN
1
AHSN
2
AHSN
3
AHSN
4
AHSN
5
AHSN
N+1
AHSN
1
AHSN
2
AHSN
3
AHSN
4
AHSN
5
AHSN
N+1
RUP 3
(Lead AHSN [x])
RUP 4
(Lead AHSN [x])
Reporting and document update mechanism

There is a consensus in the literature that implementing innovations is hard. To be successful we
need:
• The individuals and teams to be motivated to change
• Support from the right levels (e.g. approved business case, senior sponsor, commissioner
support)
• Resources – the time and skills required to implement the change
• Measurement and review of the expected benefits of the change
There is an additional challenge that we need to be aware of – the ‘replicability problem’ 4.
That when an individual or team take up a new innovation, it doesn’t work as well as it did first
time around. We don’t just want uptake – we want successful and sustained uptake – and this is
more likely to happen when:
• Implementation is based upon local context and the innovation can be be adapted to fit this.
• There is recognition of the need for cultural change, relationship building and new ways of
working (and these don’t lend themselves to compulsion)
• There is an ongoing role for peer networks to support change and share experiences.
Implementation planning

S&A model template
The spread and adoption planning template contains a checklist to begin the process
for planning the implementation and sustained use of an innovation. This can be
simultaneously used for multiple organisations.
Impact modelling
Understanding the need for an innovation is essential – are we solving a real
problem? As part of our work with the Wessex maternal medical network, we have
determined the extent of the opportunity, and applied this to the local population,
as hospital and regional level. As a result of this, we can begin to them model the
opportunity, and potential benefits resulting.
Business Case
Our innovation reviews of provider Trusts has identified the importance of clear
business case and decision making processes that is designed to be timely and make
sure that the innovation is right for the Trust, is funded properly, will be
implemented well and will deliver a set of benefits that can be measured and
reviewed. We are currently exploring the potential to develop common business
cases for innovations that can be used by multiple Trusts.
Implementation planning

Embedding innovations
The literature describes how innovations are more likely to be sustained and
embedded when:
• The benefits of the innovation are observed, measured and reviewed by the
adopters and their organisation/ system ongoingly
• Adopters continue to share their experience and results in their peer
networks
• The innovation is accepted as “this is how we do things” as a result of
continued work to normalise the innovation

Spread in Systems
The S&A Model supports our long-term commitment to improving the spread and
adoption of innovations in Wessex that improve health and care.
The literature describes the key determinants that make some organisations and
systems more readily adopt innovations.
For organisations, three determinants are identified:
• Structural – mature organisations with effective devolved structures and
decentralised decision making
• Knowledge capability – systematically identifying, interpreting and sharing new
knowledge
• Receptive to change – strong leadership, clear strategic vision, good managerial
relations, visionary staff in key positions, prepared to experiment and effective
monitoring and feedback mechanisms
Systems more readily adopt innovations when they have effective networks and their
organisations look externally for ideas.
The S&A Model aims to support these key determinants across Wessex. The
S&A reviews with our Trusts directly support their capability to innovate. Our
work to map and develop relationships with the peer networks create the
conditions for a culture of innovation.

Key references supporting our work
1. Greenhalgh, T., Robert, G., Bate., How to Spread Good Ideas. A systematic review of the literature
on diffusion, dissemination and sustainability of innovations in health service delivery and
organisation. April 2004.
2. Rogers EM. Diffusion of Innovations. 4th Ed. 1995.
3. Tim Horton et al. The Spread Challenge. How to support the successful uptake of innovations and
improvements in health care. The Health Foundation. September 2018
4. Greenhalgh, T., How to implement evidence based health care, 2018.
5. Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P. & Kyriakidou, O., Diffusion of innovations in
service organizations: systematic review and recommendations. The Milbank Quarterly, 2004.
6. The Nuffield Trust, Falling short: Why the NHS is still struggling to make the most of new
innovations, 2017.
7. European Commission, Expert Panel On Effective Ways Of Investing In Health (EXPH): Disruptive
Innovation - Considerations for health and health care in Europe, 2016.
8. Berwick, D., Disseminating Innovations in Health Care, 2003.
9. McCannon, J., Massoud, M.R. and Zier Alyesh. A., Many Ways to Many, 2016.
10. Greenhalgh, T., Wherton, J., Papoutsil, C., Lunch, J., Hughes, G., A’Court, C., Hinder, S., Procter, R.
& Shaw, S., Analysing the role of complexity in explaining the fortunes of technology programmes:
empirical application of the NASSS framework, 2018.

Wessex AHSN Spread and adoption model webex

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