In 2020, the health department in Queensland Australia piloted a novel form of government-university partnership to multiply the department's capacity for frontline clinical innovation. Building on the significant success of our pilot year, this award winning program has evolved into a dynamic ecosystem of clinicians, consumers and academic experts with an enviable track-record of diverse service transformations. This model is now being emulated by many local health services across the State.
In an era of unparalleled volatility, many government entities have found the need to reinvent themselves to better respond to emerging challenges. Nowhere has this been more acutely felt than in public healthcare. The recent emergence of new global risks (such as the COVID-19 pandemic) have compounded the challenges faced by many health systems, already straining under escalating demand pressures and limited capacity. Whilst innovation will be fundamental to addressing these and future complex challenges, the capacity to do so on demand, repeatedly and at scale has been been elusive.
A fundamental paradox is that sectors like healthcare which have prioritised highly predictable processes over flexibility for many decades have inadvertently given up creative capacities and the freedom to manoeuvre, both of which seem vital for large scale innovation. An added challenge in healthcare is the complex socio-technical nature of most clinical work - the redesign of which is often beyond the capacity of any one discipline. A final issue is that the incremental process-led innovation methods that have been favoured in healthcare seem poorly suited to deliver the multimodal transformations demanded by the current environment.
The Bridge Labs program was conceived in 2020 to overcome internal deficits in innovation capacity through novel partnerships between the system, clinical teams and academic experts. The focus and structure of the Bridge Labs program was informed by an impactful but small experiment undertaken the preceding year (Healthcare Excellence by Design Symposium 2019) that sought to interlace the healthcare and creative design communities in Queensland. That early trial provided us with crucial data that seeding an 'adhocratic' (informal and flexible) ecosystem between clinical-academic communities was both feasible and also reliably created the conditions for innovation and co-evolution.
The program commenced with three formal linkages partnering us with academic design experts, systems safety scientists and human factors researchers. These areas of expertise were targeted due to their known importance in healthcare system enhancement but also because they are largely deficient capabilities within healthcare. Each of these three Bridge Labs (HEAL, SIBL, HFNET) were structured to take advantage of the unique skills and interests of each academic partner (the QUT Design Lab, the Griffith University Safety Science Innovation Lab and the Centre for Human Factors and Socio-technical Systems at the University of the Sunshine Coast respectively). The program team served a dual purpose, setting up the collaboration structures (flexible contracts and simple rules of engagement) and as the primary sense-making and network cultivation function- that is, to create the initial micro linkages at the team and project level, in other words, ‘bridging’ communities.
The outcomes of the first year of the program are extensively detailed in our published year in review report included in the submission package. In brief, we supported a significant body of very diverse work (over 30 projects undertaken in parallel) that touched over 300 clinicians and a multitude of consumers. Several disruptive innovations emerged from the work, attracting over $4 million in external funds and winning several local and national awards (including the QUT Vice Chancellors Award in 2021, the Australian Good Design Award in both Public Service Innovation and Social Impact categories in 2021 and the Queensland Health Award for Excellence for Pursuing Innovation in 2022). In parallel, the program's many contributions to design and human factors capacity development in the health workforce have helped grow a community of practice that is on the cusp of 1000 members.
Looking to the future, we will continue seeding new streams of clinical innovation with our existing partners, and enhance innovation capacity development within our system. However, we are catalysing additional inward linkages from specialised academic groups that demonstrate convergence with emerging system priorities (for instance, the expansion of healthcare coordination hubs has seen a linkage grow with the University of Queensland Cognitive Engineering Group). The program is increasingly curating an innovation 'archipelago' as various health services (autonomous networks of hospitals in Queensland) seek to emulate/adapt our model to their local environments, scaling their own innovation partnerships with academic teams introduced to them via Bridge Labs projects. Considerable bids for research funding have also been progressed as a result of the impressive pilot outcomes which will provide greater impetus if successful. Finally, we are considering the case for retaining in-house design and human factors engineering staff given the exponential growth in demand for our services across the system and the limits of capacity in the academic sector.
What Makes Your Project Innovative?
The Bridge Labs program is innovative as a successful implementation of complex systems science in scaling innovation capacity within the public sector. The program diverges from most other case studies of its kind in that:
- It privileges networked action over linear 'pipelines' and high level strategic frameworks. We moved quickly with a focus on many-to-many linkages and forward movement rather than focusing on suites of innovation projects aligned to arbitrary strategic priorities. This rapidly created an ecology of innovation experts and frontline teams with the capacity to drive novel streams of work.
- The density and strength of networks within our innovation ecosystem are what enable identification, sense-making and project activation when opportunities and challenges arise, usually without any central control.
- As the program uses targeted funding to seed network creation, sustainability is guaranteed because networks persist (and often grow) on project completion.
What is the current status of your innovation?
The program continues to evolve and iterate in response to system needs. Macro-influences include system-wide reform and redesign efforts currently underway in the public healthcare system in Queensland. We have also prioritised advisory support for health services to take ownership and scale (Bridge Labs supported) nascent innovation projects into disruptive innovation programs in their own right. We also building formal resources to enable existing health service innovation programs wanting to pivot towards the Bridge Labs model. Finally, we seek to enhance our ability to access competitive innovation research funds and develop in-house capacity to provide even more responsive operational support in design and human factors engineering to priority departmental programs.
Collaborations & Partnerships
The Healthcare Improvement Unit in Clinical Excellence Queensland (Queensland Department of Health) created the program. Key external partners have included the Queensland University of Technology (QUT) Design Lab, the Griffith University Safety Science Innovation Lab and the Centre for Human Factors & Sociotechnical Systems at the University of the Sunshine Coast. More recently, we have extended linkages with the University of Queensland's Cognitive Engineering Research Group.
Users, Stakeholders & Beneficiaries
The program has benefited hundreds of citizens (consumers), several hundred public hospital staff (clinicians), leadership at hospitals and health services and the health department at large. The program has a cross-cutting interdisciplinary multi-service footprint. Given the inclusive model of innovation pioneered by the program, all projects are undertaken as co-owned by the 'problem owners' which are represented by the clinical teams, representative consumer groups and health leaders.
Results, Outcomes & Impacts
Two overarching reports have been produced from this work that detail in excess of thirty completed innovation projects. These are the HEAL Bridge Lab projects handbook and the subsequent Bridge Labs 20/21 year in review report.
In brief, the program has:
- Successfully delivered on over thirty different clinical and system innovation projects,
- Attracted over a $100 thousand dollars in clinician-led grants,
- Engaged directly with over 300 hundred clinicians and healthcare colleagues,
- Catalysed a tripling of our improvement community of practice (HICOP),
- Contributed to over $4 million of external funding success,
- Delivered high-impact capacity development programs in design thinking and human factors engineering,
- Won several local and national accolades.
Challenges and Failures
An increasing challenge is to resist the natural inclination of hierarchical public sector organisations to seek to structure innovation programs into 'packaged forms’, potentially eroding the self-organising 'free agency' of the ecosystem that fuels its capacity to innovate. The absence of well-developed governance models suited to harnessing and managing ecological (rather than programmatic) capacities, presents the program with many complexities to navigate.
The program has experienced a multitude of small and medium setbacks but mostly at the project level where some ideas proved premature or where teams were less innovation-ready than initially assessed. However, project success was a welcome byproduct to the main focus of understanding how to build productive linkages quickly. Thus, all setbacks were treated as instructive learnings that were folded immediately back into subsequent activities.
Conditions for Success
Building from existing strengths: A critical factor for the success of our model was the program lead's extensive familiarity with key academic groups with leading expertise in desired areas and correspondingly large networks within the public healthcare system. While not insurmountable, the strength of linkages achieved in the first year of the program would have been difficult had those links not already been in place. Thus other programs may choose to take a different path - focusing on building from their unique profile of strengths.
Leadership with a willingness to experiment: The program received a vital funding injection from the Healthcare Improvement Unit to test the model (as envisioned) for a year in advance of solid evidence. This calculated risk by HIU’s senior leadership has yielded dividends to the whole system and will continue to into the future. The importance of early organisational support cannot be overstated.
We do not advocate replication of the program itself because many unique characteristics emerged in response to the context and opportunities out of which the program grew. However, the principles of network building, ceding control to agents within the system, cultivating ecosystems that self-select and drive innovation programs, drawing in expertise to provide your system with greater capability et cetera, are all widely applicable. We have seen two Queensland health services reconfigure their innovation programs to better account for these dynamic processes - even formalising inter-agency partnerships with academic groups that we brought into contact with their clinical teams on specific projects. Critically, innovation linkages between partners are catalysed by us but they are structured to grow independently of our intervention. Thus, each of the many programs we have 'seeded' can be regarded as 'extensions' of our model (replication in a sense) after they take root.
In volatile and uncertain times, organisations cannot rely on command and control strategies to drive innovation in the areas where they are needed most. Rapid sense-making and innovation has to occur close to where problems emerge and capacity development efforts must allow for these more natural ecological forms of innovation if they are to be successful and sustainable.
The Bridge Labs program is a tangible example of such a model in action. It adds further insights that capacity building does not need to precede innovation activity. Rather, partnered innovation programs can rapidly generate embedded innovation advocates who then lend substantial credibility for innovation capacity building amongst their peers.
Yielding control into the system is a critical aspect of successfully building a distributed and thriving innovation capacity. This can be a major barrier to adoption for organisations in the public sector that are highly hierarchical in orientation and structure.
The program was the topic of an opening keynote talk at the 2021 Resilience Engineering Association Conference in Toulouse, France - titled 'Graceful Disruptability': Is the capacity to innovate critical to sustaining healthcare operations?'
The Bridge Labs report itself captures the program's ethos of pushing boundaries - a short write up on the evolving visual identity of the report can be read here.
https://research.qut.edu.au/heal/projects/; https://good-design.org/projects/re-designing-healthcare-the-value-of-a-design-led-approach/; https://research.qut.edu.au/designlab/2021/09/10/crc-p-success-designed-led-advanced-manufacturing-of-smart-orthotics-for-remote-australia-%E2%9E%A4-a-prof-marianella-chamorro-koc/
- Evaluation - understanding whether the innovative initiative has delivered what was needed
- Diffusing Lessons - using what was learnt to inform other projects and understanding how the innovation can be applied in other ways
- Bridge labs report - digital (reduced size) A Year-in-Review report outline the impacts in our inaugural year (2020)
16 November 2022