Why professional networks are vital to healthcare innovation
Developing innovative healthcare practices is a big challenge, but getting doctors to adopt them once they exist is yet another barrier to improving patient healthcare.
Back in 2000, English health authorities issued guidance for an innovative form of keyhole surgery. This promised a less invasive way of treating colorectal cancer, which is the third most common cancer in the world and responsible for hundreds of thousands of deaths. For decades, doctors had treated this condition with open surgery, but the new procedure carried a better survival rate, patients tended to recover faster and it cost less.
Despite this, doctors were reluctant to adopt it. As a procedure, it required new skills and the learning curve was steep. Even when England’s National Institute for Health & Care Excellence evaluated it as a cost-effective treatment alternative in 2006, uptake among surgeons remained sluggish.
An encouraging environment is critical for new methods and techniques to spread
We interviewed surgeons in the UK's National Health Service (NHS) and, while some were enthusiastic about the new procedure, others were reluctant. “We all like to stick with things we know work,” one surgeon, who’d persisted with conventional methods, told us. “I think there’s a lot of innate conservatives and we do require… an innovation to prove itself before we adopt it.”
Crucially, there was no easy way for surgeons to learn the new technique, which requires much practice to perfect. Could more have been done to encourage and inspire doctors to adopt the new approach? What governs the speed of uptake of novel techniques such as this among medical professionals? Were some doctors more influential than others?
Spreading healthcare innovation
It’s important we understand the different ways innovation spreads, because once a doctor reaches the senior status of consultant, there is no further formal NHS training for new procedures. If doctors are to innovate, they must often take the initiative themselves.
Colleagues can be important sources of encouragement, either by sharing their perceived value of the technology or their own experiences with it. An encouraging environment is critical for new methods and techniques to spread.
Our research, carried out by a team of academics from Imperial's Centre for Health Economics & Policy Innovation, the University of Toulouse Capitole and University of Queensland, incorporates a vast quantity of data, all anonymised. These included details of all patients treated by the NHS between 2000 and 2014. We also used details on NHS doctors’ careers as they progressed to consultant level and their clinical choices, where they have practised and with whom, and their demographic and education details.
These data enabled us to characterise each consultant professional network and how it evolved as well as the uptake of the technology in each network. In all, we honed in on nearly 1,500 consultants responsible for more than nine in 10 colorectal cancer surgeries in England during the 14-year window.
These were our three key findings:
- The larger doctors’ networks are, the more likely they are to use keyhole surgery.
- The more often an innovative procedure is performed within an individual’s professional network, the more likely they are to use it too. This became more pronounced according to an individual surgeon’s experience: more experienced doctors were found to have a stronger effect on their colleagues.
- We also spotted the role of those we’ve termed "key players" – influential doctors whose use of the procedure inspired a greater share of colleagues to follow suit.
The key players
While it is the more experienced doctors or the pioneers in the uptake of the innovation who are the most influential in their network, we found less experienced doctors are more likely to adopt the innovation as a result of peer influence. This means they develop into effective innovation ambassadors themselves. We also found "key players" are more likely to be working in the kinds of hospitals with greater regulatory freedom and which are more open to innovation.
When we ran an experiment to see whether a training campaign that targeted the most influential doctors would improve uptake, our simulation found this would have boosted use of the novel surgery by 20 per cent – with substantial health benefits for patients and cost savings for the NHS.
Our work shows that guidelines, in combination with ad-hoc training programmes that don’t factor network effects in their design, are not the most effective strategies to ensure uptake of cost effective innovation.
Our work also reveals a dearth of information about doctors themselves. Our health systems know all about the demand side, such as patients’ characteristics, but almost nothing about the doctors who treat them. If authorities want to improve health and lower costs, researchers need more detailed information about the professionals who deliver care and their characteristics, as well as their attitudes towards innovation.
This article draws on findings from "Innovation Diffusion among Coworkers: Evidence from Senior Doctors" by Eliana Barrenho (Imperial College London), Eric Gautier (University of Toulouse Capitole), Marisa Miraldo (Imperial College London), Carol Propper (Imperial College London) and Christiern Rose (University of Queensland).