The Opportunity:

Innovation - Continence Service

Tricordant works with health and care organisations and systems to deliver better outcomes, reduce total cost of care and improve customer experience. We’re always looking for new or improved ways to do this. Having worked alongside a large health and social care system we identified a selection of innovative and evidence based practices, beneficial for both health & social care including developing proactive integrated continence pathways (contrasting the current de facto approach of ‘rationing’ continence pads to control costs).

We are all aware of the financial and demand pressures on health and social care. But incontinence is:

– The second highest reason for people being admitted to care homes.

– Responsible for a significant number of admissions to hospital.

– Strongly linked to falls.

Consistent evidence shows that people who are incontinent suffer depression, social isolation and loss of independence. Active treatment positively effects over 80% of people. Moreover simple modelling shows benefits to councils [funding much personal care], NHS organisations [commissioning and providing most continence care] and not least patients and their carers. Personal dignity and carer breakdown are significant– just talk to anyone who has cared for a frail relative].

The Innovation Gap:

As the research literature points out, the gap from a new or good idea to adoption in the field is huge and fraught with dead ends and traps. The literature defines innovation as “an emergent property of a complex social system involving heterogeneous agents,” a network with many nodes, including universities, government agencies, venture capitalists plus small and large firms.

Innovations’ “hardware…..consists of inter-organisational innovation networks” with its “software…..being a set of communications, which include actions”.

The Long & Winding Road:

Innovation - Continence Services

The history of the ‘continence proposition’ is instructive in the light of the research evidence around innovation in complex systems. Four years later, client organisations are finally beginning to implement service change pilots whilst overcoming two major reorganisations within the NHS and at least one within the council.

Key steps included:

  • 2009: Concept is spotted & promoted, drawn from the Institute of Public Care [Academic Centre] research field work in Oxfordshire.
  • 2009-10: Communication and sharing of proposition – Initial rejection of idea.
  • 2011-12: Modelling and emerging evidence from Nottingham help support growth.
  • 2012: Public health function residing within the council identifies and supports proposition as part of proposed prevention and demand management approach.
  • 2012: Council scopes the evidence and current practice.
  • 2013: Individual public health consultant acts and coordinates a group of ‘the willing’ across NHS and council. Business case is developed and approved.
  • 2014: Implementation plan formed and pilots begin.


The Key Enablers:

Even though not complete, service changes within a complicated social system seem to be happening, Five key ingredients seem to be needed for such a complex innovation [or rather a simple innovation with complex cost-benefit impacts]:

  • Compelling idea: Treating rather than tolerating a major dignity issue.
  • Convincing communication: Persuading people by addressing their concerns and modelling the impacts.
  • Receptive context: Organisational alignment around reducing demand through prevention in the context of decreasing resources.
  • Champion: Willing & able public health consultants articulating the case and pursuing the cause.
  • Boundary spanning processes and roles: PH consultants and new council directors aligning to and working with each CCG – Improving articulation & work with the NHS around shared areas of interest.

Experienced or in the middle of similar, painful innovation and diffusion journeys?

Any suggestions to improve the chances of success?