Generally Innovation is defined as a new method and/ or practice device. Practice is regarded as a practising; habit or custom, repeated action for gaining skill, the resulting condition of being skilled, knowledge put into action and the exercise of a profession (Collins 1986). Collectively we would define the term Innovation in Practice (IiP) as

the encouragement of professionals to utilize their acquired knowledge and skills to creatively generate and develop new ways of working, drawing on technologies, systems, theories and associated partners/stakeholders to further enhance and evaluate practice. Innovation in practice is imperative in order to improve patient safety and quality care; IiP does not and will not occur in isolation requiring investment, support and resource allocation from managers, leaders and governments.

Boyd (2011) a recognized authority on IiP makes claims to leaders and managers to see innovation not as a gift, but a skill that everyone in the organization can master. Boyd (2011a) further argues that IiP also requires Innovation in Management which is founded on three primary principles. Creating innovative competencies, allocating resources to innovative projects, and managing an innovative pipeline from idea to market launch (Boyd 2011). The National Health Service (NHS) Institute for Innovation and Improvement (2011)

state innovation is about doing things differently or doing different things to achieve large gains in performance. It is a myth that most innovations come from laboratories, policy makers or senior leaders. Most innovations, whether in the public sector or the private sector, come from staff working within those organizations.

Similarly the NHS National Innovation Centre (2011) works nationally and internationally with innovators in industry, academia and the NHS to speed the development and diffusion of healthcare technology innovations. Taking both the NHS Institute for Innovation and the Improvement and National Innovation Centre (2011) overviews of innovation into account, it is evident that as suggested by Gibson and Kelly (2010) innovation is about change and organizations and individuals tend to resist change. Furthermore is it realistic and indeed optimistic to expect nurses and midwives working at the frontline to innovate and change practice, given the enormous challenges they face in the future.

The challenges facing innovation in nursing practice

Without nurses and midwives, health and social care would come to a standstill because nurses and midwives are fundamental to high-quality healthcare. There is hardly an intervention, treatment or healthcare programme in which we do not play a significant part (Department of Health (DoH) 2010a). A truly global, indisputable acknowledgement and testimony of the facts that nurses and midwives play a key role in determining the quality of health and social care and enabling people to make choices, and in public heath, health promotion, and illness prevention – crucial elements of future health care – but they cannot build this capital unaided (DoH 2010b P32). Despite the recognition of the fact that nursing and midwifery is a highly complex, demanding profession requiring knowledgeable, skilled and critical thinkers and doers coupled with huge amounts of dedication, commitment and hard work (Brechin 2000). However, regardless of this recognition, there is a growing perception reported in the news and media (Telegraph, Smith, 2010, The Guardian, Boseley, 2009, Nursing Times 2009), that the quality of nursing is diminishing and that nurses and midwives sometimes do not care or are lacking in compassion to care (Firth-Cozen & Cornwell 2009). This unsatisfactory image and growing public perception is surely a misconception originating from a small minority that cannot and should not be allowed to affect the majority of nurses and midwives who deliver safe, confident, competent and compassionate quality care.

In trying to eradicate the misperceptions above, nurses and midwives need to be also mindful of the fact, that globally the future of nursing will be challenged by major economic crisis, climatic disasters, changes in healthcare politics/policies and societal factors where rationing, spending reviews, efficiency savings and resource allocation are the thing of the future and not the past. Nurses, midwives and nurse leaders and managers like other public sector workers and professions will need to ensure the professionals are developed and sustained. Sustainability at the frontline of care delivery will only occur by educating and training nurses and midwives to unlock the potential associated with IiP. Liberating nurses and midwives to embrace innovation will undoubtedly be difficult because providing high quality care for patients will always be a key priority for nurses; but so often doing the ‘‘day job’’ can become all consuming, we can lose sight of the fact that part of the job is to identify and deliver improvements (NHS Institute for Innovation and Improvement 2010).

Liberating nurses and midwives to embrace innovation in nursing practice.

Liberating nursing and nurses/midwives to innovate and enhance practice through transformation and change will not and does not occur in isolation. Successful and sustained innovation and change(s) in practice as suggested by McSherry and Warr (2008, 2010), Bettencourt (2010) and Gibson and Kelly (2010) requires organizations like the NHS and individuals working within to create the following: an organizational culture and working environment founded on ensuring a sound vision, strategy, goals and insightfulness of people to generate and evaluate ideas, make links and network with external partner companies/stakeholders in developing robust structures and systems for sharing and communication of information. Boyd (2011) like McSherry and Warr (2008, 2010) indicates that excellence in practice and innovation requires leadership teams [that] must take the responsibility for training and development, recruitment, and reward systems that elevate the innovation. For nurses and midwives to become sound innovators and entrepreneurs in the future (The Nursing and Midwifery Council (NMC) (2008) The Code: Standards of conduct, performance and ethics for nurses and midwives, NMC, London) their education and associated roles and responsibilities must be aligned to contracts of employment and job descriptions which, reflect and support them in leading innovation in practice. Professional bodies responsible for reviewing and commissioning nursing roles of the future should also ensure clarity concerning career pathways, educational requirements along with incorporating where and how innovation and enterprise will be recognized and rewarded. However whilst acknowledging that innovation in practice is complex, challenging and rewarding, successful and sustained innovation as argued by Gibson and Kelly (2010) regardless of the size, requires support and resources.

Improving patient safety and quality: the importance of supporting nurses and midwives to engage with innovation in practice

Every successful organization began as a nimble, innovative start up with the ability to grow-correct and quickly adapt to the needs of its customers (Gibson & Kelly 2010). The provision of quality nursing care across the world started the journey in this way. Today nursing and midwifery and associated providers of services by the nursing profession play a vital and pivotal role in the development, delivery and sustainability of huge, varying and dynamic healthcare markets and systems across the globe. To innovate and change within these organizations requires support and the utilising of the various toolkits or frameworks to aid the process and evaluate the impact of change. Innovation requires vision, structure, strategy and engagement with associated partners and stakeholders to evaluate the impact of care and services in order to improve care and services. The introduction by the United Kingdom government into the NHS of the ‘‘NHS Quality, Innovation, Productivity and Prevention’’ (QIPP) framework (DoH 2010c) is designed to support innovation in our clinical practice and develop pathways that improve effectiveness and enhance the patient experience as well as providing value for money. The challenge for nurses, midwives and nurse leaders and managers is in using the QIPP framework to support quality and governance initiatives in the future. Encouraging nurses and midwives to innovate, share and disseminate the findings will be imperative in the drive to improving the imagery of nursing, the quality of nursing and in maintaining patient safety along with achieving efficiency and effective savings.

Extracted From:Journal of Nursing Management, 19,



Lead Nurse Africa is a Pan-African nursing organization dedicated to public health promotion and professional development.

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