Exclusive: Understaffing and bureaucracy blocking nurse innovation

The poll of more than 300 health staff carried out by innovation charity Nesta in partnership with Nursing Times found understaffing and bureaucracy were among the key barriers stopping creativity on the frontline being harnessed.

“The layers of hierarchy above nurses need to be genuinely open to the contribution that nurses can make”

Halima Khan

As challenges facing the health and social care system mount, the survey found that a massive 88% of respondents – most of whom were nurses – had ideas for how to make the service in which they worked better.

However, only 24% felt the system had a culture of listening to the ideas of those on the frontline, while just 17% felt it had a culture of acting upon them.

“The survey results do point to something that shows that there’s a huge amount more that the system should be doing to get the untapped knowledge of the frontline,” Halima Khan, executive director of health, people and impact at Nesta, told Nursing Times.

“It’s no good for the system for this knowledge to go untapped because it is missing out on all of this system intelligence that nurses have.

“It’s bad for nurses because obviously it’s frustrating if you’ve got an idea and you don’t feel like people are listening or acting on it. 

halima khan

halima khan

Source: Nesta

Halima Khan, executive director of health, people and impact at Nesta

“And obviously it’s bad for patients because you’ve got less motivated, frustrated staff and then you’ve also got a system that’s missing out on all of this critical knowledge.”

When staff were able to innovate, benefits reported by respondents to the survey included improvements to the health or wellbeing of patients (43%), more efficient use of staff time (30%), better collaboration with other professionals or parts of the system (31%) and improved team wellbeing (27%).

In addition, 23% said the implementation of their idea had improved patient flow, 21% were able to give patients more control over their own health, and 18% said it helped cut down on paperwork or admin.

However, the survey showed that there were currently many barriers standing in the way of frontline innovation.

The top one was understaffing with almost a third reporting that rota gaps meant there was no time for them to try out new ideas.

Meanwhile, 28% of respondents said bureaucratic processes got in the way.

Ms Khan said this showed that more funding alone would not be enough to establish a culture in which frontline nurses were able to innovate.

“I think what we would say, yes absolutely funding needs to be looked at and taken very seriously, but even if more funding was found, what this survey shows that it’s also ways of working that need to change as well,” noted Ms Khan.

On the question about barriers, surveyed staff were also given the option to write in their own comments about what had stopped them from coming forward with new ideas, which unveiled concerns about hierarchy in nursing.

One nurse wrote that innovation was not seen as part of the job of band 5 nurses and only higher-level nurses were supported to come up with new ideas.

Another added: “My immediate managers are very keen to try new ideas but there is no support from more senior managers especially if the ideas come from band 5 nurses regardless of their experience or life skills.”

“Healthcare settings, by their very nature, can be quite hierarchical and based on rules”

Steve Ford

While one nurse said: “Our specialist centre is led by senior nurses who do not want change and evolutionary care and reject ideas and innovations from frontline staff every day.”

Other respondents reported issues around financial constraints, competing priorities, an “overwhelming focus on performance” and resistance to change from other staff or managers.

Ms Khan told Nursing Times: “The layers of hierarchy above nurses need to be genuinely open to the contribution that nurses can make and genuinely value their contribution.

“They should be willing to act out things and have the trust and the confidence that people on the frontline are the closest to delivery and are actually in a brilliant position to know exactly what’s working and what’s not working and problem solve those and come up with better ways of doing things.”

steve ford index

steve ford index

Steve Ford, editor of Nursing Times

Steve Ford, editor of Nursing Times, said he hoped the survey results could be used as an evidence base for campaigning in the future to make it easier for nurses to innovate.

“We at Nursing Times understand how important it is for the nursing profession to innovate; this vital work ultimately improves patient care and makes life better for nurses themselves,” he added.

“But we also realise that innovation isn’t easy. A host of factors can prevent a good idea – that famous lightbulb moment – from becoming reality – such as lack of time, staff shortages or organisational cultures that stifle innovation.

“Healthcare settings, by their very nature, can be quite hierarchical and based on rules. However, without innovation little progress can be made and care cannot improve.”

In total, 309 people filled out the innovation survey all of whom said they worked directly in the health and social care system.

Of those who gave their job role, 87% said they were nurses.

Nesta will present the findings of the survey at a conference it is hosting in London today called The future of people powered health: Reimagining leadership.