A pitch for Integrated Innovation Training.
A career path that integrates innovation and entrepreneurship into traditional clinical training for the healthcare workforce of the future.
What are the problems we are trying to solve?
Patients benefit enormously from research and innovation, with breakthroughs enabling prevention of ill-health, earlier diagnosis, more effective treatments, better outcomes and faster recovery. NHS Long Term Plan
We need a future workforce capable of developing creative solutions to address complex and system-wide challenges in healthcare, such as shaping transformative recoviery after COVID-19, realising the NHS digital transformation agenda, advocating sustainable economic and planetary health and closing the health inequalities gap.
The NHS Long Term Plan acknowledges the role that research and innovation can play to create better patient outcomes, create a more robust and effective healthcare service, and its contribution to the UK economy at large. However, technology adoption in healthcare remains slow, and there are multiple barriers to implementation — even in the presence of an evidence base.
If we are committed to a technological and digitally-dependent future, then we need ethical and effective engagement with industry partners and job plans that encourage clinicians to navigate across the innovation landscape. It will be this new cohort of clinicians as innovators who will drive technology adoption so that patients access the latest and best treatments and care pathways.
The Topol Review (2019) called for the development of this new and innovative workforce. However, we have yet to see an career path that acknowledges the unique skills and capabilities to participate in clinical innovation — especially one that integrates fully with traditional clinical training.
Learning from Success
…real opportunities for the development of an integrated career pathway for clinical academics and to address current major barriers, specifically: lack of both a clear route of entry and a transparent career structure; lack of flexibility (clinical and academic training/geographical) and; shortage of properly structured and supported posts upon completion of training. Walport Report (2005)
The last time an opportunity presented itself like this was back in 2005, when the Walport Report called for an integrated career path for clinical academics that addressed the major barriers at the time, including:
- Lack of a clear route of entry and transparent career structure.
- Lack of flexibility to accommodate academia alongside clinical training and within the right locations.
- Shortage of posts and defined roles after completion of training.
This seminal piece of work led to the development of the NIHR Integrated Academic Training Pathway (IATP), which has become a global exemplar in producing world-class scholars in some of the most challenging healthcare research areas, including obesity, chronic pain, mental health and antimicrobial resistance to name a few.
And so, we must learn from this success. Our vision is that integrated innovation training will offer a career path with the scope, geographic distribution and seamless integration with clinical training for healthcare innovation leaders of the future.
Entrepreneurship Competencies (EntreComp)
To create an evidence-based career path for future clinical innovators, we opted for the EU EntreComp framework. It is an internationally validated competency framework that standardises education and professional development in entrepreneurship. It includes 15 competencies in three areas:
Ideas and Opportunities: Trainees should demonstrate the ability to search the landscape for opportunities to create value, solve unmet clinical needs whilst working responsibily towards an imagined future that reflects long-term sustainable goals.
Resources: Trainees should also demonstrate self-awareness, self-efficiency and resilience whilst managing the material, financial and digital resources around them. They should also have the tenacity to mobilise others and inspire relevant stakeholders to turn their ideas into action.
Into Action: We know that innovation is hard work. So, trainees should be self-motivated individuals who can take initiative and act independently to manage their goals, cope with uncertainty, and learn through experience by working with others.
If these entrepreneurial competencies seem familiar to you, then this is because many of them are already included in our daily clinical practice. Hence, I would like to challenge you to take a few moments and use the EntreComp framework to reflect on your experiences, and identify where you excel and where you have room for improvement.
To build the integrated innovation training pathway, the EntreComp framework provides a series of steps that illustrate how you can grow professionally throughout your career. As a result, we used the well established NIHR IATP for doctors-in-training as a platform to build from.
Integrated Innovation Training Pathway
Starting at the foundation level, trainees will focus on understanding context and discovering how they can use their innate talents to solve problems around them.
This should be something for everyone, regardless of how interested you are in an innovation career.
Within undergraduate medical education, we envision the integration of healthcare technology, innovation and entrepreneurship subjects into the main spiral curriculum to ensure that medical graduates are prepared to enter a rapidly evolving healthcare industry. Students who want to take their studies further can achieve this through selected study modules, intercalated degrees and student societies.
At this point, newly qualified doctors who wish to integrate innovation into their clinical training can apply for Specialised Foundation posts, where they have 4 months dedicated time (either as a block or split training) to take on supervised innovation projects. An example of this could be a quality improvement project designing and reviewing digital tools to manage the NHS backlog.
As clinicians transition into intermediate level training, they should strive to build independence, experiment with ideas to create value and take responsibility for turning them into action.
Trainees should aspire to be digitialy capable clinicians, who make data-driven decisions.
This is very much in line with the current NHS digital transformation agenda. However, the challenge will be to ensure that this phase of training integrates with the various opportunities already available. With 9 months dedicated innovation time, these trainees could identify innovation needs, build their entrepreneurship networks, run pilot studies at NHS test beds, and generate business cases.
Up until this point, we felt it was necessary for trainees to spend more time cultivating their clinical knowledge rather than navigating the healthcare innovation landscape. This is because it is the clinician’s deep understanding of healthcare provision that makes them valuable assets to industry, academia and government. However, in order to transition into healthcare innovation leaders of the future, it is crucial that these same trainees spend a dedicated length participating in innovation. Hence, with up to 3 years of time out of programme, trainees can gain further experience learning through an MBA, working in a leadership capacity across the health sector, undertaking a clinical innovaiton fellowship, or (for the brave of us) founding their own startup.
Nevertheless, we need to ensure that we bring back promising talent into the NHS by acknowledging the unique skills that advanced trainees bring to our evolving innovation landscape. Hence, the next phase of training is arguably the most important leverage point to training clinicians who can innovate.
We need to build opinion leaders of the future.
Through 2 years of dedicated innovation time, these trainees will not only develop the critical awareness of barriers to implementation, but will also play a critical role in assessing new technologies so that only the best ever reach our patients. Opportunities to develop these skills should take place within their clinical area of interest by offering associate clinical innovation director schemes or knowledge-eschange and consultancy work with medical technology SMEs.
Finally after completion of training, clinicians can grow into the role of a clinical innovator. A visionary and (intra)entrepreneur who brings their ideas to life and develops the leadership, financial literacy and commercial strategy to be an active participant in NHS innovaiton.
A clinician capable of driving change, growth and innovation in healthcare.
Through allocated programmed activities, these clinical innovators would become the next clinical directors of innovation, industry or technology experts, and lead strategists for NHS trusts, academia or govermnent.
Trainees would also have access to support through the NIHR Academy, Health education England, the GMC, Royal Colleges, NHS Trusts and Universities. While also having access to funding opportunities through the NIHR or externally through industry and government.
Implementation Strategy
Integrated innovation training has been a journey in the making. We have engaged with several stakeholders from academic trainees to senior ledership across the NHS innovation ecosystem who share our vision for the future. They have kindly offered their feedback and constructive criticism. Some important questions for furhter exploration include: how do we cater for those individuals who want to become innovation leaders of the future, whilst also upskilling others who do not; how does this overlap with existing workforce development plans in digital health; how should training be funded; and how is financial value acquired from trainee participation with industry partners distributed fairly and ethically?
We are looking for partners to be part of a consensus network to ensure the curriculum delivers high quality clinical innovators of the future.
In order to answer some of these questions, we need ongoing strategic input from an expert advisory group to generate a consensus (e.g. modified Delphi) around curriculum items, training routes , and outcomes using the EU EntreComp framework and best evidence.
We are looking for funding, support and a willingness to develop innovation training beyond fixed-term positions and fellowships.
Following this, we can progress to develop pilot training sites and evaluating its feasibility in the real-world. We have identified 3 regions of interest including Leeds, Liverpool and London where we can examine different stages of the pathway.
We want to connect with allied healthcare professionals who want to tailor this training pathway to their needs.
Finally, we want demonstrate this vision as a unique and forward-thinking innovation to workforce development; thus, we will disseminate our progress through targeted series of reports, publications and subject our vision to peer-review.
In doing so, we hope to undergo an interative process as we move the needle twaords making this career a reality.
Conclusion
The need for a future workforce capable of developing creative solutions to address complex and system-wide healthcare challenges has never been more urgent. This is echoed in several national reports including the NHS Long Term Plan, Topol Review and Health Education England’s Future Doctors. Nevertheless, the strategies listed in these reports have focussed on digital literacy, interdiscplinary learning and flexible working with little mention of innovation and entrepreneurship training. Instead, the policies only rely on clinical academics and scholars to lead research an drive innovation.
If we are to build a workforce who can act upon ideas and opportunities, and transform them into value for the health service, then we should recognise entrepreneurship as a part of life-long learning. This is further emphasised in a review commissed by the UK government exploring 21st century skills, which recognised that entrepreneurial capabilities are directly linked to individual autonomy and social empowerment.
The overall shape of the technology and innovation ecosystem doesn’t necessarily reflect an intentional design. Tim Horton, Associate Director at The Health Foundation
If we do not allow clinicians to harness this capacity at each stage of their career, then it would be reasonable to suggest that clinicians who want to innovate will seek opportunities elsewhere. In their absence, the state of the healthcare innovation ecosystem is likely to remain, as described by the Health Foundation, a patchwork of opportunities with no coherent structure.
Hence, our vision is to create an integrated innovation training pathway that provides a route for all healthcare professionals who want to make healthcare technology, innovation and transformational change part of their primary career, whilst maintaining their uniqueness as trained clinicians.
Acknoweldgements
I would like to thank the rest of the team Mr William Bolton, Dr Diana Velazquez-Pimentel, Dr Angela Lam and Mr Joshua Burke for their ongoing commitment to this truly essential cause.
I would like to thank our various mentors and senior leadership who share our vision and have supported us with the necessary strategic direction.
