Methods that involve governing and assuring provide clarity on what is expected and required, and range from regulation, inspection and contracts to national mandates, to encourage the spread and scale of innovations or improvements.
Five methods have been identified in this category and are summarised below.
Effectiveness
The effectiveness of these methods will vary depending on context, but key strengths of methods which utilise governing and assuring include:
- Provides clarity for system on expectations and requirements[i]
- Can support peer learning between different systems [ii]
- Can provide intelligence to support local decision making and prioritisation
- Can support exit from more intensive processes to achieve spread and promote sustainable scale
However, there will be limitations to these methods which may include:
- May be unpopular or meet resistance
- Risk of losing nuance and varied local priorities and characteristics between different places
- May not change or create culture of innovation and improvement, focus on compliance rather than commitment.
- Benchmarking or comparative data may create unintended consequences (e.g. for high performers where it may impact effort)
- Distracts from other local priorities
Methods and Levers
Regulation, inspection and clinical audit
Included within inspection frameworks. This involves monitoring and feedback but also shared perceptions that this is taking place, which can have notable impact. Examples include:
- Improvement Partnership Clinical Audit
- CQC Inspection Frameworks
- National Quality Improvement (inc Clinical Audit) Network
Contractual obligation
Inclusion of individual interventions (or related duties) within standard contracts or legislative underpinnings. Examples include:
- NHS standard contracts
- ICS guidance
- AHSN Network Transfer of Care Around medicine programme now forming part of Community Pharmacy contracts (Discharge Medicines Service).
High level national signals or campaigns
Government or NHSE set overarching long-term priority areas which then flow through into longer term priorities (and thus help reduce barriers) in local system commissioning and national funding allocation. Support behaviour change to spread simple, well-developed change. Examples include:
- Life Sciences Vision Missions, e.g. Early Cancer Diagnosis targets in Long Term Plan and as focus area in Life Sciences Vision
- Covid vaccination campaign
Specific product signal
List of products set out as specific signal to local systems. Examples include
National mandates on product availability
Requirement for systems to make certain products (as designated by a national body) available to patients (either through legislation or standard contracts). Examples include:
- NICE processes (technology appraisals and Highly specialised technology (HST) evaluations add hyperlink)
- MedTech Funding Mandate
Practical considerations for use
| Method or Lever | Stage of development * | Audience and scale ** | Resources needed | Timeframe | |||
| Regulation, inspection and clinical audit | Spread | National, local | Support from partner organisations leading inspections or clinical audit. | 1-3 years | |||
| Contractual obligation | Spread | Local | Contractual/monitoring systems and support for ‘reluctants’ | 1-2 years | |||
| High level national signals or campaigns | Spread | National, can be cross-cutting or targeted to clinical specialty | National consensus / buy in; resources aligned to delivery | Months to years | |||
| Specific product signal | Spread | National or regional; targeted to product | National consensus / buy in; resources aligned to delivery | Months to years | |||
| National mandates on product availability | Spread | Local; targeted to product | Evidence requirement; resources aligned to delivery | 6-18 months | |||
* Stages of intervention development – Ideation, Proof of concept, Prototype/Testing, Spread
** Audience and scale – national/regional/local, targeted by clinical speciality / product/ problem
[i] Nuffield Trust. Achieving scale and spread: learning for innovators and policy-makers. Available from:https://www.nuffieldtrust.org.uk/research/achieving-scale-and-spread-learning-for-innovators-and-policy-makers
[ii] The Health Foundation. The Spread Challenge: How to support the successful uptake of innovations and improvements in health care. Available from: https://www.health.org.uk/publications/the-spread-challenge