Adopting Innovation across an NHS Ecosystem in the East of England- a realist evaluation

Adopting Innovation across an NHS Ecosystem in the East of England- a realist evaluation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Adopting Innovation across an NHS Ecosystem in the East of England- a realist evaluation Carolyn Jackson, Jessica Marshall, Emma Turner, Kate Emond, Madeleine reed, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5504858/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Innovation is critical to transforming how health services can be delivered more effectively, efficiently, and with better outcomes. In 2021, the Health Foundation launched the Adopting Innovation Programme to help stakeholders within the NHS become better adopters of innovation. The Cambridge and Peterborough Adopting Innovation Hub (CPAIH) was one of four ‘innovation hubs’ funded to act as centres of expertise and provide innovation support for organisations and their local health systems. This study describes the findings from the local evaluation of the CPAIH. Methods: A realist evaluation with a multi-method study design was conducted via three primary data sources: documentary review, thematic analysis of formative evaluation reports and data sets, and interviews with stakeholders. Using thematic analysis and realist logic of enquiry context-mechanism-outcome configurations (CMOCs) were identified. Results: The evaluation identified 6 emergent CMOCs to inform a programme theory of what works and outlined CPAIH’s principles on embedding innovation in the regional healthcare system. The themes identified from the results included: the need to establish infrastructure and mechanisms, implement system innovation governance processes, exercise strategic leadership, foster effective communication, facilitate citizen co-production, and sustainably build an innovation pipeline to streamline and standardise decision-making. Conclusions: The evaluation demonstrated that by creating a robust, collaborative, and adaptable ecosystem, the CPAIH has laid the groundwork for sustained innovation in healthcare in the East of England evidenced through its absorption into the Integrated Care System to address health inequalities faster. Through a combination of dedicated roles, shared resources, citizen involvement, and systematic decision-making processes, traditional barriers to innovation were overcome whilst creating a culture that values continuous improvement and responsiveness to patient needs. The CPAIH’s approach could serve as a model for future innovation systems. complex innovation innovation implementation innovation ecosystem innovation adoption innovation hubs catalyst partnerships realist evaluation system wide innovation citizen co-design Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 6 Figure 7 Figure 8 Background The challenges facing the National Health Service (NHS) in England are significant after years of austerity, a global pandemic, and workforce challenges [1-3]. The East of England region experiences substantial health inequalities and rapidly changing population health needs. From 2011 to 2021, England’s population grew by 6.6% while the East of England grew by 8.3%, with Cambridgeshire and Peterborough (C&P) seeing even higher growth than the regional average [4]. Projections based on these growth rates, especially in older age groups, indicate a capacity deficit across the health and social care system. For example, the number of people aged over 85 registered at GP practices is expected to increase by 87.5% by 2041 [5]. Additionally, a deficit of 379 beds by 2030, rising to 650-900 by 2040, is anticipated in acute care if no action is taken [5,6]. Within the C&P Integrated Care System (ICS), 27% of the population live with a chronic condition, with a higher proportion (30%) in the northern region compared to the southern region (24%). Inequalities are also observed in patient outcomes, with a 10-year life-expectancy gap between men in the most deprived and affluent areas of the region, driven by early deaths in cardiovascular disease (CVD) [7, 8]. Innovation is critical to transforming the landscape of how services can be delivered more effectively and efficiently with better outcomes at scale to keep pace. In recognition of these challenges, the Health Foundation launched its Adopting Innovation Programme in 2021 to create innovation hubs to act as centres of expertise, support within and for provider organisations and their local health systems, and to help people within the NHS become better adopters of innovation [9]. The Cambridgeshire and Peterborough Adopting Innovation Hub (CPAIH) The Cambridgeshire and Peterborough NHS Foundation Trust was one of four innovation hubs funded for two and a half years by the Health Foundation. Each hub had the following remit: (1) to help build innovation knowledge, skills, and confidence; (2) to create a culture in the Trust that is more supportive of innovation; and (3) to accelerate the adoption and spread of innovation in health and social care (Figure 1). The CPAIH was launched in February 2022 to coordinate key regional innovation partners 1 , including healthcare and academic stakeholders, and to understand how to successfully adapt and adopt proven innovations to reduce health inequalities. Based on the eight enablers of innovation adoption (Figure 2), the CPAIH model encompassed three pillars of work (Figure 3) that gathered data locally. These pillars were intended to map existing innovations, adapt innovations through co-production with citizens to fit the local context, and improve system-wide readiness for adopting innovation. These pillars of work were the foundation of the CPAIH’s original objectives (Figure 4). National & Local Evaluation A national evaluation of the four innovation hubs was conducted by RAND Europe [10], a not-for-profit research institute, which addressed predetermined evaluation questions based on the Health Foundation’s six principles for adopting innovation (Figure 5). Learnings and insights from the national evaluation were shared with the Hubs, the Health Foundation, and the Innovation Unit. The Innovation Unit provided support and advice to the four hubs, convened workshops to share learning and insights, and administered their own survey of innovation adoption and spread during the life span of the programme. Each hub also had a local evaluation partner that conducted a hub-level evaluation. The CPAIH local evaluation was undertaken by researchers at the University of East Anglia (UEA). This paper presents an overview of the findings, key learnings, and insights from that local evaluation. The research aim is to highlight the context (C), mechanism (M), and outcome (O) configurations observed in the CPAIH and provide an overview of what has worked on its journey from supporting small-scale innovations linked to organisations, to becoming embedded in the C&P ICS. Methods The overarching evaluation questions and methods for the local evaluation are presented in Table 1. Ethical Approval Ethical approval was provided by the Research Ethics Committee in the Faculty of Medicine and Life Sciences at the University of East Anglia. The project was classified as a ‘service evaluation’ by the UK’s Health Research Authority (HRA). Anonymised data collected by the CPAIH team was shared through a password protected portal only accessible by the two UEA researchers. Innovation leaders who agreed to be interviewed were required to provide a completed consent form to participate and their anonymity protected through assignment of a coding system known only to the research team. Realist Evaluation Approach The CPAIH sits in a complex healthcare system which necessitated a realist evaluation approach to explore what works, for whom, and in what circumstances [11,12]. This approach enabled the research team to investigate the causal mechanisms that facilitated or hindered the adoption of innovation in different contexts, shedding light on how certain outcomes were achieved. The relationships between contexts, mechanisms, and outcomes are presented as configurations (CMOCs- C+M= O) [13] and form part of an exploratory initial programme theory that describes how the intervention is expected to function and can be tested or refined in the future [11, 14]. This approach recognises that CPAIH’s activities may operate differently for individuals in varying contexts by considering the micro, meso- and macro social processes, structures, and agency that interact to influence the CPAIH’s effective implementation of its original objectives (Figure 4). Independent Evaluation Panel A regional independent evaluation steering group of experts was established as part of the successful bid to the Health Foundation. The panel was tasked with scrutinising the evaluation protocol, observing the CPAIH’s journey, and providing feedback on reports created by the UEA evaluation team. The experts in this panel came from various organisations, including the NIHR Applied Research Collaborative, NHS Innovators, university academics, and Health Innovation East. Evaluation Design The hub-level evaluation comprised two phases of formative and summative evaluation conducted over two years from February 2022 to March 2024. Detailed formative evaluation reports were created in October 2022, which was a baseline review of the set-up phase of the CPAIH, July 2023, and March 2024 2 . These formative reports highlighted the enablers and barriers to innovation adoption across C&P and were shared with the CPAIH Leadership Team, the regional evaluation steering group, and RAND Europe. The final summative evaluation report, produced in March 2024, aimed to use the findings from the formative evaluation reports to highlight the context (C), mechanism (M) and outcome (O) configurations (CMOCs) observed in the CPAIH. This report provided an overview of the CPAIH’s journey, from supporting small scale innovations linked to organisations, to becoming embedded within the C&P Integrated Care System (ICS). This paper reports the findings from the final summative evaluation. Data Collection The formative and summative evaluations employed a multi-method study design. The formative evaluations involved six monthly cycles of evidence review including document analysis related to the eight Hub enablers, observations of meetings and events, one-to-one interviews, and social engagement analysis. The summative evaluation drew from three primary data sources: documentary review, thematic analysis of the formative evaluation reports and data sets, and interviews. Nine system innovation leaders 3 , purposefully selected by the research team for their involvement with the CPAIH since its inception in the East of England, participated in semi-structured interviews lasting approximately 60 minutes. Consistent with realist research, the interview topics were informed by preliminary theories that emerged from the formative evaluation reports to serve as a basis for emerging theories. The participants were interviewed via videoconferencing after they had provided written consent. Data Analysis Interviews were audio-recorded and transcribed verbatim. Initially, interview transcripts were coded deductively using thematic analysis and focused on the broad themes highlighted in the formative evaluation reports. Further analysis involved using realist logic to inductively and retroductively code the data, drawing inferences about the underlying causal processes, or mechanisms, that shaped service outcomes. This approach led to the development of CMOCs. Data synthesis was an iterative process, as not all components of the CMOCs were always articulated in a single interview. Results We identified six CMOCs at micro, meso- and macro system level, which highlight what works, how it works, and for whom (Figure 6). It is important to note that whilst the CMOCs are often presented as linear relationships, the reality is much more complex, as many of the CMOCs are interdependent and interacting. The CMOCs presented are the major relational patterns observed across multiple contexts over a two-year period. We elaborate on each explaining the evidence interspersed with comments from our interviews with senior system innovation leaders. Please see Supplementary Material File S1 for a summary of the CMOCs. CMOC1: Infrastructure and Mechanisms The formal establishment of the CPAIH was the most significant contextual enabler with the infrastructure and mechanisms (C) to co-ordinate, monitor, track, and successfully spread innovations that could reduce health inequalities and improve health outcomes for the region. It provided a vital foundation for embedding innovation within the wider C&P ICS. “ If we hadn’t of had the Innovation Hub, I don’t think we would have incorporated this into the ICB, especially with the running costs and pressures, and an awful lot of priorities.” (R3, P11) Six mechanisms enabled the CPAIH to be effective. The first was having a clear strategy and vision (M) , co-created with the full involvement of all key stakeholders and citizens. The second related to the presence of strong and effective Innovation Hub leadership and resources (M), which included staff expertise and capacity providing both the resources for continuity planning, all of which influenced its ability to flex and adapt to changing contextual challenges over time. “ The Hub’s Strategy and vision was clear at the start, and we knew what we wanted to do but now there has been a welcome divergence and what we have ended up with is something that the system needs.” (R3 P9) The third mechanism was the CPAIH’s technical and project management support (M) for innovators working across the system landscape. This group of mechanisms included activities such as developing project proposals for funding, helping to secure funding, creating a milestone tracker, providing ongoing project management support, supporting information-sharing agreement development, reporting to NHSE, and leading contract extension negotiations. The fourth key mechanism was how the CPAIH helped to manage networks and relationships (M) by convening key stakeholders together introducing new innovators to relevant support networks to help manage their innovation adoption progress as well as helping to manage relationships with providers. CPAIH acted as a positive disruptor across the C&P system helping to improve system wide communication and sowing the seeds for new ways of working. It achieved its original objective (Figure 4) of helping bring together and coordinate key regional innovation through a range of education activities, workshops and innovation showcase events helping to align innovation with wider commercial partnerships and opening the door to greater potential for collaboration. “A barrier for any sort of system innovation is system communication and getting everybody on the same page to start with. I think whether it is directly through the activities of the Hub or the fact the Hub was a new player within the patch has sown the seeds nicely for a new way of working and a desire from everyone in the system to make it work and some good news stories” (R3, P29) Developing relationships and networks helped the CPAIH to fund innovation projects (M) by catalysing people together, helping to find solutions and alternative strategies to help projects be successful, investing small amounts of funding, and coordinating and supporting innovation bids. These activities were underpinned by a robust framework to assess, review and approve funding. The sixth mechanism relates to the CPAIH’s ability to evidence impact (M) in and on practice and services through timely impact evaluation. This enabled the CPAIH to provide a much-needed front door for innovation across the health and social care system, improving navigation through the innovation landscape and signposting people more effectively. “One of the biggest gains and learnings from the Hub has been that we now better understand our innovation landscape and all our activities going forward take that learning and implement it effectively. We needed a clearer process on how decisions could be made, how we prioritise what, and how to get the biggest benefits for the population (with health inequalities in mind). “(R 3, P13) The impact of the CPAIH at a macro level across the system has been to channel innovation resources to the local area in line with local priorities (O), resource and fund local innovation projects to address health inequalities (O), build sustainable relationships, partnerships and networks across innovation partners (O) and create the foundations for the CPAIH to be integrated into the ICS creating system wide architecture for innovation (O). CMOC2: System Innovation Governance Central to the efficacy of the CPAIH are contexts in which system innovation governance processes (C) are well developed and effective at scaling innovation for maximum impact, standardising the innovation process by making it systematic with a single front door for coordination, providing a shared language for talking about innovation adoption across the region (M) , sharing learning and insights into existing innovation assets, models, methods, resources and expertise available (M), clarifying expectations, decision points and key innovation governance arrangements (M) . System innovation governance processes that helped to build strong connections, consensus, buy in and commitment to the CPAIH strategy and vision (M) for adopting innovation across the ICS footprint, provide clarity of expectations and standardised systematic innovation decision making processes in place (M) and equity of opportunity for all stakeholders to get involved. Being nimble and able to flex and adapt to changing health and social care contexts (M) is an important mechanism as funding and workforce issues remain a key challenge in the commissioning and delivery of services to meet population health needs across England. This is recognised as more of a challenge for system leaders where the context is more challenging with multiple provider organisational relationships to manage. An effective system governance model would provide a clear map of existing adopting innovation strengths and challenges (M) at system level. The outcomes of effective system innovation governance impacted both micro and macro levels of the system respectively. Our analysis shows that it is easier for people to access innovation resources and expertise (O) and has removed barriers to innovation adoption (O), helped to reduce duplication of effort (O), sped up the scaling of innovations for maximum impact and made small gains for population health improvements (O). Most importantly it has created the conditions for enabling system readiness for adopting innovation (O). “A proper innovation pipeline with systematic prioritisation is essential. And moving forward it is these things that need to be addressed and implemented in the new ICB innovation paradigm. We need to have a proper systematic innovation prioritization process, and we need a proper innovation pipeline.” (R3 P33) CMOC3: System Strategic Leadership Contexts in which there is evidence of strong system strategic leadership (C) formalised through a leadership concordat (M), helps to set the direction, and buy in from senior innovation system leaders shaping the focus for innovation activity (M) and providing clear operational and strategic oversight (M) for CPAIH efficacy and core activities. This in turn provided a mechanism that forms an integral vehicle of support and encouragement to the CPAIH (M) and a wider system recognition and willingness to work together to find solutions to enable all parts of the system to fully engage in innovation (M). “ The leadership concordat was probably the nugget that started people coming together and obviously the leadership of people …. who carried a lot of weight and were able to kind of convene people around it, that was powerful” (R3 P21) The outcomes of effective system strategic leadership for innovation were felt at meso- and macro levels of the system through strong working relationships (O) and an effective strategic steer for innovation activity (O) . It has also ensured that the work for the CPAIH has become embedded in the ICS through its system wide innovation infrastructure (O) ensuring that innovation momentum is maintained, and impact sustained (O) and public and system interest in innovation is peaked (O). CMOC4: System Effective communication. A key contextual enabler for innovation is a strong model for system convening and a conduit for effective communication (C) built on a strong commitment to the principles of authentic collaboration, inclusion, and participation (M). Getting the right people around the table at the start of an initiative early on is an important mechanism for facilitating effective communication (M), encouraging cross organisational collaboration (M), building relationships and commitment from a range of partners with the expertise in a range complementary approach (M) (innovation, improvement, evaluation, and co- production) . “What surprised me is the Hub’s success in managing to convene people who have never met before who you would have expected to have met. It is that relationship stuff that we need to hold on to and not underestimate the amount of time and effort that takes to those people engaged and involved. Unless we do things collaboratively it will always end up being a silo.” (R3 P32) Activities that help to initiate wider conversations with the public (M), provide clear communication channels to facilitate feedback (M) and a system wide conversation about innovation (M) enabling people to navigate around the innovation system more readily and easily (M) through a shared understanding. Outcomes and impacts were identified at meso- and macro system level. At a meso- level participants reported more effective system wide communication and knowledge sharing about innovation (O) and the development of relationships w hich overcome the barriers to implementation (O) making the chances of sustainable change more likely to improve services. “Relationships were key in overcoming the barriers of implementation.” (R3 P28) At a system level we saw evidence of new ways of working (O), stakeholders and the public reporting that they are well informed about innovation opportunities (O) and changes to how the C&P ICS develop system wide navigation for innovation (O). CMOC5 :Citizen participation and co-production One of the most powerful contextual enablers for the CPAIH was its absolute commitment to ensure that citizens played a central role in its evolution and activities. This was a consistent theme across all three formative evaluation reports and the Citizen Participation Group (CPG) was identified at the outset as one of the key enablers for success. To this end, the project fulfilled its original objective (Figure 4) to have citizen co-production at the core of its activities involving the CPG across all stages of CPAIH activity: from strategic direction setting and adapting innovations to the local context, through to evaluation of the project. The mechanisms that helped to ensure that citizen co-production was embedded into the fabric of the CPAIH included having an authentic collaborative inclusive approach (M) and co-design model (M), enabling the citizen voice to shape and influence CPAIH governance structures, processes, and core activities (M). Central to this approach has been ensuring that citizens in the CPG had role clarity concerning innovation selection and the core work of the CPAIH (M) through shared learning experiences (M) and events, strong citizen leadership from the voluntary sector (M) through the CPG, and a commitment to develop staff capacity and capability for developing skills in co-design methodology (M) . We witnessed where successful innovation project teams described the impact of working with citizens at the heart of their projects. The impact of the co-production approach was evidenced at both micro and macro system levels. At a local level citizens reported feeling empowered to take a more active role in their own health (O), and felt that their voice has been valued, heard, and included (O) leading to feelings of greater self-confidence and satisfaction (O) and that no one is left behind (O). Combined this helped citizens to feel a sense of pride in the impact of the innovations (O ) they have been involved with. At system level although innovations in the first two years were relatively small scale, citizens felt as though health inequalities were being addressed focused on what matters to them (O). Solutions are co-designed with patients and citizens according to their health interests (O) . Other outcomes include innovations benefitting from public involvement and insight (O) and being better understood by the public and by staff (O ), avoidance of duplication of effort (O) meaning that scarce resources could be used more effectively and overall, the local population feeling empowered to take a more active role in the future of their own health and care provision (O) in C&P. “ Co-production has been the most effective and everyone at a system level is now recognising that – that didn’t happen two years ago. We can’t transform without the community at the front, so I think that has been a really powerful outcome” (R3 P25) CMOC6: Building and sustaining an innovation pipeline The sixth contextual enabler was the CPAIH’s commitment to building and sustaining an innovation culture and pipeline (C) . It was very clear that the CPAIH leadership team has taken considerable care and due attention to building the mechanisms for culture change across the C&P landscape. Not without its challenges in terms of the NHS risk-averse culture and the impact of the pandemic and workforce shortages, there are a few key mechanisms that have been effective in creating a system wide opportunity to develop the innovation landscape for the future. The first mechanism is the role the CPAIH has played in facilitating culture change and understanding the role of context in innovation adoption (M). “The Hub has been effective in creating culture change. An innovation function without culture change within the work force is going to be ineffective. If we want to get a culture change and engagement from the top, we need to model the importance of it and making sure it flows down through the teams . .” (R3 P26) Over time CPAIH provided a range of activities and events that helped to cultivate an appetite for innovation adoption (M) , getting more people inspired and talking about innovation (M), addressing people’s varied understanding of the definition of innovation culture (M) and investing in measurement, evaluation and shared learning opportunities (M). The CPAIH modelled the way for encouraging staff to take risks and provided a positive disruptive force (M) to the NHS innovation landscape, supporting coordination of implementation projects through innovation champions and link workers (M) at a local level. “We have seen a change in the Hub’s efficacy from being this nimble, effective disruptor that has achieved a lot of activities (e.g. the innovation showcase) to now being immortalised in the system through legitimate processes. The ICS Head of Innovation recognises that the ICS is never going to be agile, but it can be efficient through cemented processes and governance.” (R3 P14) Another successful mechanism was the shared learning events and resources (M) offered by the CPAIH, particularly webinars, the Innovation Showcase event, and workshops with commercial and system partners. It played a key role in the selection and resourcing of innovation (M) by aligning with ICB strategic priorities, modelling a joint approach for innovation selection (M), and helping the system make decisions about resource allocation so that no one is left behind (M). The CPAIH also helped to identify and overcome barriers to innovation (M) and maintain system visibility with clear signposting to an innovation pipeline (M). These mechanisms for building and sustaining an innovation culture have impacted all levels of the system. More people know what innovation is and how to access help with their innovations (O) , teams are more innovative and adaptable (O), and staff express a greater degree of satisfaction (O) with their role in innovation. At a system level there was evidence of greater system readiness for innovation adoption (O) and an effective innovation pipeline (O) with some evidence emerging about system improvements in the adoption and spread of innovation (O) as well as greater efficiencies in services and patient outcomes (O) . Discussion This study aimed to capture what has worked on the CPAIH’s journey from supporting small-scale innovations to becoming embedded in the C&P ICS. Since the hub-level evaluation was completed the CPAIH-ICB collaboration has made significant progress, with the CPAIH becoming fully embedded into the ICB. The Lessons Learned section below summarises the key developments undertaken by the ICB and their impacts into principles, mapped to the Health Foundation’s Six Principles for Adopting Innovation (Figure 7). Building on the Lessons Learned from the evaluation: The Cambridgeshire and Peterborough ICS approach to fostering innovation in healthcare In 2024, the transition into the ICB has provided a valuable opportunity to overcome barriers encountered by the CPAIH and establish more robust processes for adopting innovative solutions. Principle 1: Cultivating a Culture for Innovation The ICB has focused on creating an environment where innovation is not only encouraged but systematically supported. Innovation has been embedded into the governance structures of the Strategic Commissioning Unit (SCU), enhancing interdisciplinary collaboration and aligning efforts with strategy, health economics, and outcome-focused insights. The ICB has recognized the importance of roles dedicated to innovation, to allow personnel the necessary time and responsibility to engage deeply with collaborative projects. For example, the Head of Innovation, jointly funded by Health Innovation East and the C&P ICB, fosters innovation across the Eastern region. This role facilitated partnerships with the InSites teams, the Cancer Alliance, and the Clinical Entrepreneurs Programme, creating a regional network that pools shared learning and resources. Cambridge University Health Partners has established innovation landing zones in C&P, creating supportive environments for innovation. A case study example of how this works is illustrated below. Case Study To address the inequity, experience and impact of cardiovascular disease (CVD) on the population and healthcare providers, the ICB has developed a CVD Innovation Landing Zone. This programme will introduce innovations into the CVD pathway, aiming to make novel therapies, re-purposed drugs, risk identification approaches and digital monitoring tools more widely and rapidly available to address risk factors and improve management of CVD in the community. From an innovation perspective, the programme aims to demonstrate success in shortening the innovation adoption pathway for patients who need it most, leveraging local partnerships with innovation catalysts, such as the Cambridge Biomedical Campus. The ICB has launched the two-year Your Healthier Future CVD pilot program; a prototype for the ICB’s health optimisation approach under its new strategy, the New Care Model. The pilot will implement innovative population health management approaches to identify people at risk of CVD, to enable GPs to better support patients, reduce the number of Major Adverse Cardiovascular Events and premature mortality. This programme highlights the success and impact of embedding an innovation culture at the ICB, with strategic programmes aiming to improve patient outcomes and reduce health inequalities via innovation driven approaches, thinking and interventions. These efforts are further strengthened by the formation of the Innovation Working Group (IWG), a networked governance body for innovation across system partners (Figure 8). This group implements a systematic, health economics-informed decision-making approach, utilising a Multiple Criteria Decision Analysis tool to prioritise innovations. As a result, the ICB has collaborated on funding bids with considerable success and recommended system-wide innovations to the System Innovation Panel. Supported innovations now join the innovation pipeline, which guides financial planning and directs funding opportunities. This system-based collaborative decision-making process encourages the development of shared goals and enables the ICB to ensure evidence-based decisions with collective system-wide support. Looking forward, the ICB is exploring implementation of an "Innovation Passport", to help spread successful innovations across the system, based on proven results from pilot projects at any single partner. This process aims to standardize innovation adoption policies, such as intellectual property and procurement, and encourage consortia-building efforts that generate system-wide benefits beyond what any single organization could achieve. Principle 2: Empowering People Supporting individuals and teams across the network is essential for cultivating an ecosystem where innovation thrives. The ICB's innovation network engages with over ten organizations, incorporating specialists across multiple disciplines and local academic partners. The network’s commitment to citizen-led decision-making, with multiple citizen voices actively participating in the innovation process, strengthens its value for both innovators and project teams, ensuring initiatives respond to real community needs. The IWG facilitates shared learning across the network, identifying opportunities for collaboration and simplifying the often-complex innovation ecosystem. For example, the group developed a unified Innovation Framework that standardises resources, simplifies access points, and provides a clear roadmap for innovators. The Innovation Portal, built from this framework, serves as a centralised platform that streamlines resource-sharing and aligns innovation efforts across the system. Principle 3: Adopting Best Ideas and Sharing Learning The Innovation Portal represents a pivotal step in the ICB’s commitment to adopt the best ideas and promote shared learning across the system. By providing a transparent view of the innovation landscape, system-wide priorities, and specific objectives, this collective approach minimizes duplication of efforts, ensuring that resources are used efficiently, and innovations are spread effectively across the system. Initiatives like a recent Health Foundation Q-visit have garnered strong engagement and positive feedback beyond the immediate region. These visits demonstrate the value of connecting with external networks to gain fresh perspectives, share successes, and learn from the experiences of other healthcare systems. Such exchanges reinforce the ICB’s commitment to continual learning and improvement within the innovation network. Principle 4: Focusing on Impact and Outcomes Integration of the CPAIH within the ICB structure has enabled the innovation team to address macro-level barriers more effectively, such as implementing innovations at a population level and managing competing organizational interests. Through the use of systematic selection processes and an established governance framework, the ICB reports it is better positioned to support system-wide innovation. The IWG reduces siloed efforts, promoting collaborative projects and funding bids that yield tangible benefits, including income generation, coordinated projects, and expanded learning opportunities. A clear decision-making process has provided a structured pathway for engagement, fostering transparency and accountability in decision-making. Aligning individual organizational strategies with a unified innovation strategy, the ICB supports collaborative efforts that enhance the system's capacity for innovation. To ensure the innovation journey is transparent and accessible, the ICB is developing a collective Innovation Pathway. Building on the Innovation Framework, this includes an enhanced Innovation Portal to improve navigation and transparency for all stakeholders. Additionally, aligned with system goals the SCU has developed an Outcomes Framework to measure the success of innovation projects, providing a consistent approach for tracking progress and evaluating impact. Principle 5: Engaging People Who Will Use the Innovation Active involvement of people who will benefit from innovation is integral to the ICB’s innovation strategy. The CPG, now called the Citizen Innovation Group (CIG), has been instrumental in this effort. CIG members contribute to the development of innovation tools and processes, and the selection and evaluation of innovations for the system. Their participation ensures innovations are aligned with patient needs and preferences. Insights from the CIG shape patient and public involvement plans within funding applications, ensuring projects are responsive to the needs of diverse populations. Additionally, this group is a key partner in the ICS-wide Patient and Public Involvement Network, further enhancing the alignment between innovation projects and public expectations. Principle 6: Maintaining Flexibility in Managing Change The innovation journey requires adaptability and a willingness to modify processes based on real-world feedback. To support strategic decision-making on commissioning and decommissioning, the ICB is developing a health economics and evaluation function in partnership with organizations across the ecosystem; leveraging diverse expertise to create a system-wide approach that balances costs with benefits and outcomes. Moreover, the ICB Innovation team actively collaborates with provider organizations to identify best practices to adapt across the system. Sharing policy changes and insights across organizations promotes alignment and accelerates system-wide progress. The System Transformation Group, supported by the NHS Impact initiative, is also exploring ways to enhance change-management capabilities across the system, further embedding innovation and flexibility within the organizational culture. so. Researcher Reflection The evaluation of the CPAIH has provided a unique opportunity to observe what happens when a novel innovation approach is implemented at a local level. One of the original goals of the Health Foundation programme was to promote the accelerated adoption of innovation. In reality, it took two years for the CPAIH to set up, establish its focus, and work on its sustainability plans. Due to its initial location within a single NHS organisation, innovations tended to be local rather than system-focused. However, the CPAIH played a vital role in coordinating, informing, and convening the work of individuals, groups, and organisations in Cambridgeshire and Peterborough which paid off as the Hub was integrated into the ICB by October 2023 and was the first to do so. Existing literature on innovation at a systems level largely aligns with the CPAIH’s approach to adopting innovation. Clear strategy and vision in combination with resourced leaders who actively managed relationships were critical in building sustainable partnerships and integrating the CPAIH into the ICS architecture. Strategic leadership in the context of innovation is an under-researched domain, but there is a paucity of health research on how leadership can foster a culture of innovation [15] with ‘leadership clarity’ concerning roles and responsibilities being a key mechanism to increasing propensity to innovation [16]. The CPAIH demonstrated how effective leaders, skilled in navigating the system, could develop streamlined system innovation governance, whilst striking a balance between top-down and bottom-up approaches that included advocating a culture of citizen participation. Using co-production was a key enabler of the CPAIH and is proven to have positive impacts on innovation sustainability [17]. This combination of resourced strategy-focused leaders and co-production contributed to creating a system culture that was more supportive of innovation and could serve as a model for future innovation systems. Going forward, this evaluation provides policymakers and clinical practitioners with valuable insights and a roadmap to enhance innovation service delivery at a regional level. Furthermore, this evaluation supports policies that adopt a citizen-participatory approach to innovation, emphasising empowerment and the need to maintain flexibility across all levels (micro, meso, and macro). Future research in evaluating innovation systems should focus on developing appropriate metrics to assess innovation effectiveness at a systems level, which is crucial for facilitating broader implementation of effective strategies within the wider healthcare system. Limitations This evaluation adopted an exploratory realist approach to understanding the context, mechanisms, and outcomes of the CPAIH. Although the findings may have limited generalisability, as the CPAIH operates in a unique context, the research provides a detailed case study of the key components that contribute to sustaining healthcare innovation in the East of England. As the evaluation was limited to two years, we were unable to see metrics that could evidence the impact of innovations on population health outcomes in the timescale although it is evident that the ICB has taken significant steps to address this since. Conclusion The evaluation provided a unique opportunity to observe what happens when a novel catalyst for innovation, in the form of an innovation hub, is introduced into an existing, complex innovation-implementation ecosystem. By creating a robust, collaborative, and adaptable ecosystem, the ICB has laid the groundwork for sustained innovation in healthcare in the East of England. Through a combination of dedicated roles, shared resources, citizen involvement, and systematic decision-making processes, traditional barriers to innovation were overcome whilst creating a culture that values continuous improvement and responsiveness to patient needs. The journey toward building a flexible, resilient, and impactful healthcare system continues, and these initiatives represent foundational steps toward a future where innovation is an integrated part of healthcare delivery. Abbreviations CIG Citizen Innovation Group C&P Cambridgeshire and Peterborough CMOC Context Mechanism Outcome Configurations CPAIH Cambridge and Peterborough Adopting Innovation Hub CPG Citizens’ Participation Group CVD Cardiovascular Disease HIN Health Innovation Network HRA Health Research Authority ICB Integrated Care Board ICS Integrated Care System IP Innovation Portal IWG Innovation Working Group NHS National Health Service NIHR ARC National Institute for Health Research Applied Research Collaborative SCU Strategic Commissioning Unit UEA University of East Anglia Declarations Ethics approval and consent to participate Ethical approval for “A Service Evaluation of the Health Foundation Adopting Innovation Programme- Cambridgeshire and Peterborough Adopting Innovation Hub Locality” was provided by the UEA Faculty of Medicine and Health Sciences Research Ethics Sub Committee 13 July 2022-February 2024 ETH2122-2363 and with amendments to summative evaluation interview schedule ETH2223-2201. This approval is in accordance with the ESRC Framework for Research Ethics and their core principles. A data sharing agreement ensured that data was anonymised at source by the CPAIH leadership team before being shared in a password protected file seen only by the two UEA researchers. Consent for Publication Not applicable Availability of Data and Materials The formative evaluation reports developed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare they have no competing interests. Funder This project was funded by the Health Foundation Adopting Innovation Fund and the UEA evaluation team recruited by Health Innovation East to undertake the independent evaluation of the CPAIH journey over two years from set up to implementation. The evaluation has been undertaken by researchers working in the Norfolk initiative for Coastal and Rural Health Equalities (NICHE Anchor Institute) in the School of Health Sciences at UEA. Authors' contributions CJ was the principal investigator for the evaluation of the CPAIH and lead author for this paper. JM was the research assistant for the evaluation of the CPAIH and developed the Figures ET wrote the lessons learned section of the discussion. KE and MR contributed to an edit and review of the paper and wrote the Case Study. SH is the academic sponsor for the evaluation and contributed to a review of the paper prior to submission. All authors have read and approved the final manuscript. Acknowledgements Not applicable References Dunn P, Ewbank L, Alderwick H. Nine Major Challenges Facing Health and Care in England. The Health Foundation. 2023. https://www.health.org.uk/publications/long-reads/nine-major-challenges-facing-health-and-care-in-england. Accessed 19 th November 2024. National Health Service England. The NHS Long Term Plan. 2019. https://www.longtermplan.nhs.uk. Accessed 17 th August 2024. National Health Service England. Building strong integrated care systems everywhere ICS implementation guidance on working with people and communities V1 2 September. 2021.https://www.england.nhs.uk/wp-content/uploads/2021/06/B0661-ics-working-with-people-and-communities.pdf. Accessed 13 th October 2024. Cambridgeshire and Peterborough County Council. Census 2021 first outputs: Cambridgeshire and Peterborough population and household estimates. 2022.https://cambridgeshireinsight.org.uk/wp-content/uploads/2022/07/Census-2021-first-results-report-040722.pdf. Accessed 17 th November 2024. Cambridge Council Research Group. Local Population Estimates and Forecasts. https://cambridgeshireinsight.org.uk/population/population-forecasts/ Accessed online 20 th November 2024 NHS England Strategic Data Collection Service https://datacollection.sdcs.digital.nhs.uk/ Accessed 23rd August 2024. NHS England 2023. Population and Person Insight (PaPI) Dashboard. https://apps.model.nhs.uk/report/PaPi Accessed 23rd August 2024. Office for Health Improvement and Disparities 2023. Mortality Profile: March 2023 https://fingertips.phe.org.uk/profile/mortality-profile Accessed 8th February 2024. The Health Foundation Adopting Innovation Programme 2020. https://www.health.org.uk/sites/default/files/2021-01/Adopting%20Innovation%20Call%20for%20applications%20-%20UPDATED%2012.01.21.pdf . Accessed 14 November 2020. Romanelli RJ, Dawney J, Adams A, Moriarty S, Wong HS, Ling T. Strengthening Local Innovation- Implementation Ecosystems: Learning from Four Innovation Hubs Across England. A Final Report. RAND Europe 2024, 5 th July. Embargoed. Pawson R, and Tilley N. Realistic Evaluation. 1997. London: Sage publications. Pawson R, Greenhalgh T, Harvey G, Walshe K. Realist review - a new method of systematic review designed for complex policy interventions. Journal of Health Services Research & Policy. 2005;10(1_suppl):21-34. doi:10.1258/1355819054308530. Pawson R, Manzano-Santaella A. A realist diagnostic workshop. Evaluation. 2012 Apr;18(2):176–91. Pawson R, and Tilley, N. Realistic Evaluation. 2004. London: British Cabinet Office. Weintraub P, McKee M. Leadership for Innovation in Healthcare: An Exploration. Int J Health Policy Manag. 2019; doi: 10.15171/ijhpm.2018.122. West MA, Borrill CS, Dawson JF, Brodbec F, Shapiro DA, Haward B. Leadership clarity and team innovation in health care. Leadersh Q. 2003; doi: 10.1016/s1048-9843(03)00044-4 Overton C, Tarrant C, Creese J, et al. Role of coproduction in the sustainability of innovations in applied health and social care research: a scoping review BMJ Open Quality 2024. doi: 10.1136/bmjoq-2024-002796 Footnotes Industry e.g. SMEs, wider innovation organisations, local government, charities and voluntary sector organisations Our timelines for reporting were impacted by changes in personnel within the CPAIH Leadership team and a transition of the CPAIH into the Cambridgeshire and Peterborough Integrated Care Board. Participants held senior leadership innovation roles in the NHS, Innovation Networks, wider system and community settings. Three participants identified as male and six as female. Table Table 1 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files SupplementaryMaterialFileS1CMOCsSummaryTable.docx CPAIHPaperTablesV2.0.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5504858","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":425817924,"identity":"18cdc83d-abed-43a8-b7b0-32e27b806fd1","order_by":0,"name":"Carolyn 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Focus\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5504858/v1/09ec1d2a140ce49092a08404.png"},{"id":78319483,"identity":"c5b62a91-6bae-420e-98c2-f326e7c80b8e","added_by":"auto","created_at":"2025-03-12 04:50:12","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":346153,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCambridgeshire and Peterborough Innovation Hub Model of the 8 Enablers for Adopting Innovation\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5504858/v1/10001e2330d86972f78765df.png"},{"id":78319482,"identity":"0e1d182e-2937-461d-bbf9-02ce3956b554","added_by":"auto","created_at":"2025-03-12 04:50:12","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":95234,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCambridgeshire and Peterborough Adopting Innovation Hub Pillars of Work\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5504858/v1/fa827e57e7303bf2c4b38646.png"},{"id":78320330,"identity":"faff7e55-6850-4e54-ab00-84796b71a449","added_by":"auto","created_at":"2025-03-12 04:58:11","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":130273,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCambridgeshire and Peterborough Adopting Innovation Hub Original Objectives in 2021\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-5504858/v1/425194f807d9602098efffb1.png"},{"id":78320336,"identity":"4b5826c7-3484-42fb-abdc-df2b215d6ff6","added_by":"auto","created_at":"2025-03-12 04:58:12","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":409480,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eContext-Mechanism-Outcome Configurations\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-5504858/v1/9f02269fec1d863b193b065a.png"},{"id":78319490,"identity":"9f79ec8c-a8de-4de3-9391-f2109aebfb97","added_by":"auto","created_at":"2025-03-12 04:50:12","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":184725,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCPAIH-ICB Key Developments\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"7.png","url":"https://assets-eu.researchsquare.com/files/rs-5504858/v1/8e933c88ebd46f8ec241ef8d.png"},{"id":78320617,"identity":"3baf4b2b-6516-42e0-a268-d06da12deba1","added_by":"auto","created_at":"2025-03-12 05:06:12","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":205931,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eICS Innovation Governance\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"8.png","url":"https://assets-eu.researchsquare.com/files/rs-5504858/v1/6ee089c3e00d7ba4dcad443a.png"},{"id":78320331,"identity":"bb63587a-7c28-4ab4-a316-e7d3715b0a4b","added_by":"auto","created_at":"2025-03-12 04:58:12","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":36007,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterialFileS1CMOCsSummaryTable.docx","url":"https://assets-eu.researchsquare.com/files/rs-5504858/v1/6e75061e00899eb2496c2052.docx"},{"id":78320332,"identity":"c2a01b4a-4d12-461d-9a8f-780d6eab8a67","added_by":"auto","created_at":"2025-03-12 04:58:12","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":21337,"visible":true,"origin":"","legend":"","description":"","filename":"CPAIHPaperTablesV2.0.docx","url":"https://assets-eu.researchsquare.com/files/rs-5504858/v1/02ad16f9a368ec5c01ba45d6.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eAdopting Innovation across an NHS Ecosystem in the East of England- a realist evaluation\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eThe challenges facing the National Health Service (NHS) in England are significant after years of austerity, a global pandemic, and workforce challenges [1-3]. The East of England region experiences substantial health inequalities and rapidly changing population health needs. From 2011 to 2021, England\u0026rsquo;s population grew by 6.6% while the East of England grew by 8.3%, with Cambridgeshire and Peterborough (C\u0026amp;P) seeing even higher growth than the regional average [4]. Projections based on these growth rates, especially in older age groups, indicate a capacity deficit across the health and social care system. For example, the number of people aged over 85 registered at GP practices is expected to increase by 87.5% by 2041 [5]. Additionally, a deficit of 379 beds by 2030, rising to 650-900 by 2040, is anticipated in acute care if no action is taken [5,6]. Within the C\u0026amp;P Integrated Care System (ICS), 27% of the population live with a chronic condition, with a higher proportion (30%) in the northern region compared to the southern region (24%). Inequalities are also observed in patient outcomes, with a 10-year life-expectancy gap between men in the most deprived and affluent areas of the region, driven by early deaths in cardiovascular disease (CVD) [7, 8]. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInnovation is critical to transforming the landscape of how services can be delivered more effectively and efficiently with better outcomes at scale to keep pace. \u0026nbsp;In recognition of these challenges, the Health Foundation launched its Adopting Innovation Programme in 2021 to create innovation hubs to act as centres of expertise, support within and for provider organisations and their local health systems, and to help people within the NHS become better adopters of innovation [9].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe Cambridgeshire and Peterborough Adopting Innovation Hub (CPAIH)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Cambridgeshire and Peterborough NHS Foundation Trust was one of four innovation hubs funded for two and a half years by the Health Foundation. Each hub had the following remit: (1) to help build innovation knowledge, skills, and confidence; (2) to create a culture in the Trust that is more supportive of innovation; and (3) to accelerate the adoption and spread of innovation in health and social care (Figure 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;Insert Figure 1\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAdopting Innovation Hubs\u0026rsquo; Areas of Focus \u0026gt;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe CPAIH was launched in February 2022 to coordinate key regional innovation partners\u003ca href=\"#_ftn1\" name=\"_ftnref1\" title=\"\"\u003e\u003c/a\u003e\u003csup\u003e1\u003c/sup\u003e, including healthcare and academic stakeholders, and to understand how to successfully adapt and adopt proven innovations to reduce health inequalities. Based on the eight enablers of innovation adoption (Figure 2), the CPAIH model encompassed three pillars of work (Figure 3) that gathered data locally. These pillars were intended to map existing innovations, adapt innovations through co-production with citizens to fit the local context, and improve system-wide readiness for adopting innovation. These pillars of work were the foundation of the CPAIH\u0026rsquo;s original objectives (Figure 4).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;Insert Figure 2: Cambridgeshire and Peterborough Innovation Hub Model of the 8 Enablers for Adopting Innovation\u003c/strong\u003e\u003cstrong\u003e\u0026gt;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026lt;\u003cstrong\u003eInsert Figure 3: Cambridgeshire and Peterborough Adopting Innovation Hub Pillars of Work\u0026gt;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;Insert Figure 4: Cambridgeshire and Peterborough Adopting Innovation Hub Original Objectives in 2021\u0026gt;\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNational \u0026amp; Local Evaluation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA national evaluation of the four innovation hubs was conducted by RAND Europe [10], a not-for-profit research institute, which addressed predetermined evaluation questions based on the Health Foundation\u0026rsquo;s six principles for adopting innovation (Figure 5). Learnings and insights from the national evaluation were shared with the Hubs, the Health Foundation, and the Innovation Unit. The Innovation Unit provided support and advice to the four hubs, convened workshops to share learning and insights, and administered their own survey of innovation adoption and spread during the life span of the programme. Each hub also had a local evaluation partner that conducted a hub-level evaluation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;Insert Figure 5: The Health Foundation Six Principles for Adopting Innovation\u0026gt;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe CPAIH local evaluation was undertaken by researchers at the University of East Anglia (UEA). This paper presents an overview of the findings, key learnings, and insights from that local evaluation. The research aim is to highlight the context (C), mechanism (M), and outcome (O) configurations observed in the CPAIH and provide an overview of what has worked on its journey from supporting small-scale innovations linked to organisations, to becoming embedded in the C\u0026amp;P ICS. \u0026nbsp;\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe overarching evaluation questions and methods for the local evaluation are presented in Table 1.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;Insert Table 1 Summary of evaluation methods used to address evaluation questions\u0026gt;\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was provided by the Research Ethics Committee in the Faculty of Medicine and Life Sciences at the University of East Anglia. \u0026nbsp; The project was classified as a \u0026lsquo;service evaluation\u0026rsquo; by the UK\u0026rsquo;s Health Research Authority (HRA). \u0026nbsp; Anonymised data collected by the \u0026nbsp;CPAIH team was shared through a password protected portal only accessible by the two UEA researchers. Innovation leaders who agreed to be interviewed were required to provide a completed consent form to participate and their anonymity protected through assignment of a coding system known only to the research team. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRealist Evaluation Approach\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe CPAIH sits in a complex healthcare system which necessitated a realist evaluation approach to explore what works, for whom, and in what circumstances [11,12]. This approach enabled the research team to investigate the causal mechanisms that facilitated or hindered the adoption of innovation in different contexts, shedding light on how certain outcomes were achieved. \u0026nbsp;The relationships between contexts, mechanisms, and outcomes are presented as configurations (CMOCs- C+M= O) [13] and form part of an exploratory initial programme theory that describes how the intervention is expected to function and can be tested or refined in the future [11, 14]. This approach recognises that CPAIH\u0026rsquo;s activities may operate differently for individuals in varying contexts by considering the micro, meso- and macro social processes, structures, and agency that interact to influence the CPAIH\u0026rsquo;s effective implementation of its original objectives (Figure 4).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIndependent Evaluation Panel\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA regional independent evaluation steering group of experts was established as part of the successful bid to the Health Foundation. The panel was tasked with scrutinising the evaluation protocol, observing the CPAIH\u0026rsquo;s journey, and providing feedback on reports created by the UEA evaluation team. The experts in this panel came from various organisations, including the NIHR Applied Research Collaborative, NHS Innovators, university academics, and Health Innovation East.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEvaluation Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe hub-level evaluation comprised two phases of formative and summative evaluation conducted over two years from February 2022 to March 2024. Detailed formative evaluation reports were created in October 2022, which was a baseline review of the set-up phase of the CPAIH, July 2023, and March 2024\u003ca href=\"#_ftn1\" name=\"_ftnref1\" title=\"\"\u003e\u003c/a\u003e\u003csup\u003e2\u003c/sup\u003e. These formative reports highlighted the enablers and barriers to innovation adoption across C\u0026amp;P and were shared with the CPAIH Leadership Team, the regional evaluation steering group, and RAND Europe. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe final summative evaluation report, produced in March 2024, aimed to use the findings from the formative evaluation reports to highlight the context (C), mechanism (M) and outcome (O) configurations (CMOCs) observed in the CPAIH. This report provided an overview of the CPAIH\u0026rsquo;s journey, from supporting small scale innovations linked to organisations, to becoming embedded within the C\u0026amp;P Integrated Care System (ICS). This paper reports the findings from the final summative evaluation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe formative and summative evaluations employed a multi-method study design. The formative evaluations involved six monthly cycles of evidence review including document analysis related to the eight Hub enablers, observations of meetings and events, one-to-one interviews, and social engagement analysis. The summative evaluation drew from three primary data sources: \u0026nbsp;documentary review, thematic analysis of the formative evaluation reports and data sets, and interviews. Nine system innovation leaders\u003ca href=\"#_ftn2\" name=\"_ftnref2\" title=\"\"\u003e\u003c/a\u003e\u003csup\u003e3\u003c/sup\u003e, purposefully selected by the research team for their involvement with the CPAIH since its inception in the East of England, participated in semi-structured interviews lasting approximately 60 minutes. Consistent with realist research, the interview topics were informed by preliminary theories that emerged from the formative evaluation reports to serve as a basis for emerging theories. The participants were interviewed via videoconferencing after they had provided written consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInterviews were audio-recorded and transcribed verbatim. Initially, interview transcripts were coded deductively using thematic analysis and focused on the broad themes highlighted in the formative evaluation reports. Further analysis involved using realist logic to inductively and retroductively code the data, drawing inferences about the underlying causal processes, or mechanisms, that shaped service outcomes. \u0026nbsp;This approach led to the development of CMOCs. Data synthesis was an iterative process, as not all components of the CMOCs were always articulated in a single interview.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eWe identified six CMOCs at micro, meso- and macro system level, which highlight what works, how it works, and for whom (Figure 6). It is important to note that whilst the CMOCs are often presented as linear relationships, the reality is much more complex, as many of the CMOCs are interdependent and interacting.\u0026nbsp;The CMOCs presented are the major relational patterns observed across multiple contexts over a two-year period. We elaborate on each explaining the evidence interspersed with comments from our interviews with senior system innovation leaders. Please see Supplementary Material File S1 for a summary of the CMOCs.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;Insert Figure 6: CMOCs\u0026gt;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCMOC1: Infrastructure and Mechanisms\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe formal establishment of the CPAIH was the most significant contextual enabler with the \u003cstrong\u003einfrastructure and mechanisms (C)\u003c/strong\u003e to co-ordinate, monitor, track, and successfully spread innovations that could reduce health inequalities and improve health outcomes for the region. It provided a vital foundation for embedding innovation within the wider C\u0026amp;P ICS.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003eIf we hadn\u0026rsquo;t of had the Innovation Hub, I don\u0026rsquo;t think we would have incorporated this\u0026nbsp;\u003c/em\u003e\u003cem\u003einto the ICB, especially with the running costs and pressures, and an awful lot of\u0026nbsp;\u003c/em\u003e\u003cem\u003epriorities.\u0026rdquo; (R3, P11)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSix mechanisms enabled the CPAIH to be effective. The first was having \u003cstrong\u003ea clear strategy and vision (M)\u003c/strong\u003e, co-created with the full involvement of all key stakeholders and citizens. The\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003esecond related to the presence of \u003cstrong\u003estrong and effective Innovation Hub leadership and resources (M),\u003c/strong\u003e which included staff expertise and capacity providing both the resources for\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003econtinuity planning, all of which influenced its ability to flex and adapt to changing contextual\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003echallenges over time.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003eThe Hub\u0026rsquo;s Strategy and vision was clear at the start, and we knew what we wanted to do but now there has been a welcome divergence and what we have ended up with is something that the system needs.\u0026rdquo; (R3 P9)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe third mechanism was the CPAIH\u0026rsquo;s \u003cstrong\u003etechnical and project management support (M)\u003c/strong\u003e for innovators working across the system landscape. This group of mechanisms included activities such as developing project proposals for funding, helping to secure funding, creating a milestone tracker, providing ongoing project management support, supporting information-sharing agreement development, reporting to NHSE, and leading contract extension negotiations. The fourth key mechanism was how the CPAIH helped to\u003cstrong\u003e\u0026nbsp;manage networks and relationships\u003c/strong\u003e \u003cstrong\u003e(M)\u0026nbsp;\u003c/strong\u003eby convening key stakeholders together introducing new innovators to relevant support networks to help manage their innovation adoption progress as well as helping to manage relationships with providers. CPAIH acted as a positive disruptor across the C\u0026amp;P system helping to improve system wide communication and sowing the seeds for new ways of working. It achieved its original objective (Figure 4) of helping bring together and coordinate key regional innovation through a range of education activities, workshops and innovation showcase events helping to align innovation with wider commercial partnerships and opening the door to greater potential for collaboration.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;A barrier for any sort of system innovation is system communication and getting\u0026nbsp;\u003c/em\u003e\u003cem\u003eeverybody on the same page to start with. I think whether it is directly through the\u0026nbsp;\u003c/em\u003e\u003cem\u003eactivities of the Hub or the fact the Hub was a new player within the patch has sown the seeds nicely for a new way of working and a desire from everyone in the system to make it work and some good news stories\u0026rdquo; (R3, P29)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eDeveloping relationships and networks helped the CPAIH to \u003cstrong\u003efund innovation projects (M)\u0026nbsp;\u003c/strong\u003eby catalysing people together,\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ehelping to find solutions and alternative strategies to help projects be successful, investing small amounts of funding, and coordinating and supporting innovation bids. These activities were underpinned by a robust framework to assess, review and approve funding. The sixth mechanism relates to the CPAIH\u0026rsquo;s ability to \u003cstrong\u003eevidence impact (M)\u003c/strong\u003e in and on practice and services through timely impact evaluation. This enabled the CPAIH to provide a much-needed front door for innovation across the health and social care system, improving navigation through the innovation landscape and signposting people more effectively.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;One of the biggest gains and learnings from the Hub has been that we now better\u0026nbsp;\u003c/em\u003e\u003cem\u003eunderstand our innovation landscape and all our activities going forward take that\u0026nbsp;\u003c/em\u003e\u003cem\u003elearning and implement it effectively. We needed a clearer process on how decisions could be made, how we prioritise what, and how to get the biggest benefits for the population (with health inequalities in mind).\u0026nbsp;\u003c/em\u003e\u0026ldquo;(R 3, P13)\u003c/p\u003e\n\u003cp\u003eThe impact of the CPAIH at a macro level across the system has been to \u003cstrong\u003echannel innovation resources to the local area in line with local priorities (O),\u003c/strong\u003e \u003cstrong\u003eresource and fund local innovation projects to address health inequalities (O), build\u003c/strong\u003e \u003cstrong\u003esustainable relationships, partnerships and networks across innovation partners (O)\u003c/strong\u003e and \u003cstrong\u003ecreate the foundations for the CPAIH to be integrated into the ICS creating system\u003c/strong\u003e \u003cstrong\u003ewide architecture for innovation (O).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCMOC2: \u0026nbsp;System Innovation Governance\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCentral to the efficacy of the CPAIH are contexts in which\u003cstrong\u003e\u0026nbsp;system innovation governance\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eprocesses (C)\u0026nbsp;\u003c/strong\u003eare well developed and effective at scaling innovation for maximum impact, standardising the innovation process by making it systematic with a single front door for coordination, \u003cstrong\u003eproviding a shared language for talking about innovation adoption across the region (M)\u003c/strong\u003e, \u003cstrong\u003esharing learning and insights into existing innovation assets, models, methods, resources and expertise available (M),\u003c/strong\u003e \u003cstrong\u003eclarifying expectations, decision points and key innovation governance arrangements\u003c/strong\u003e \u003cstrong\u003e(M)\u003c/strong\u003e. System innovation governance\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eprocesses that helped to \u003cstrong\u003ebuild strong connections, consensus, buy in and commitment to the CPAIH strategy and vision (M)\u0026nbsp;\u003c/strong\u003efor adopting innovation across the ICS footprint, \u003cstrong\u003eprovide clarity of expectations and standardised systematic innovation decision making processes in place (M)\u0026nbsp;\u003c/strong\u003eand equity of opportunity for all stakeholders\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eto get involved.\u003cstrong\u003e\u0026nbsp;Being nimble\u003c/strong\u003e and\u003cstrong\u003e\u0026nbsp;able to flex and adapt to changing health and social care contexts (M)\u0026nbsp;\u003c/strong\u003eis an important mechanism as funding and workforce issues remain a key challenge in the\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ecommissioning and delivery of services to meet population health needs across England. This\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eis recognised as more of a challenge for system leaders where the context is more challenging\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ewith multiple provider organisational relationships to manage. An effective system governance\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003emodel would provide \u003cstrong\u003ea clear map of existing adopting innovation strengths and challenges (M)\u0026nbsp;\u003c/strong\u003eat system level.\u003c/p\u003e\n\u003cp\u003eThe outcomes of effective system innovation governance impacted both micro and macro levels of the system respectively. Our analysis shows that it is\u003cstrong\u003e\u0026nbsp;easier for people to access innovation resources and expertise (O) and has\u003c/strong\u003e \u003cstrong\u003eremoved barriers to innovation adoption (O), helped to reduce duplication of effort (O),\u003c/strong\u003e \u003cstrong\u003esped up the scaling of innovations for maximum impact and made small gains for\u003c/strong\u003e \u003cstrong\u003epopulation health improvements (O).\u0026nbsp;\u003c/strong\u003eMost importantly it has created the conditions for enabling\u003cstrong\u003e\u0026nbsp;system readiness for adopting innovation (O).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;A proper innovation pipeline with systematic prioritisation is essential. And moving\u0026nbsp;\u003c/em\u003e\u003cem\u003eforward it is these things that need to be addressed and implemented in the new ICB\u0026nbsp;\u003c/em\u003e\u003cem\u003einnovation paradigm. We need to have a proper systematic innovation prioritization\u0026nbsp;\u003c/em\u003e\u003cem\u003eprocess, and we need a proper innovation pipeline.\u0026rdquo; (R3 P33)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCMOC3: System Strategic Leadership\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eContexts in which there is evidence of strong \u003cstrong\u003esystem strategic leadership (C)\u003c/strong\u003e formalised through a \u003cstrong\u003eleadership concordat (M), helps to set the direction, and buy in\u003c/strong\u003e from senior innovation system leaders \u003cstrong\u003eshaping the focus for innovation activity (M)\u003c/strong\u003e and providing \u003cstrong\u003eclear\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eoperational and strategic oversight (M)\u003c/strong\u003e for CPAIH efficacy and core activities. This in turn provided a mechanism that forms an \u003cstrong\u003eintegral vehicle of support and encouragement to\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ethe CPAIH (M)\u0026nbsp;\u003c/strong\u003eand a \u003cstrong\u003ewider system recognition and willingness to work together to find\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003esolutions to enable all parts of the system to fully engage in innovation\u003c/strong\u003e \u003cstrong\u003e(M).\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003eThe leadership concordat was probably the nugget that started people coming\u0026nbsp;\u003c/em\u003e\u003cem\u003etogether and obviously the leadership of people \u0026hellip;. who carried a lot of weight and\u0026nbsp;\u003c/em\u003e\u003cem\u003ewere able to kind of convene people around it, that was powerful\u0026rdquo; (R3 P21)\u0026nbsp;\u003c/em\u003eThe outcomes of effective system strategic leadership for innovation were felt at meso- and macro levels of the system through\u003cstrong\u003e\u0026nbsp;strong working relationships (O) and\u003c/strong\u003e \u003cstrong\u003ean effective\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003estrategic steer for innovation activity (O)\u003c/strong\u003e. It has also ensured that the work for the CPAIH has become \u003cstrong\u003eembedded in the ICS through its system wide innovation infrastructure\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(O)\u003c/strong\u003e ensuring that \u003cstrong\u003einnovation momentum is maintained, and impact sustained (O)\u003c/strong\u003e and \u003cstrong\u003epublic and system interest in innovation is peaked (O).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCMOC4: System Effective communication.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA key contextual enabler for innovation is a strong model for\u003cstrong\u003e\u0026nbsp;system convening and a\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003econduit for effective communication (C)\u0026nbsp;\u003c/strong\u003ebuilt on a strong commitment to the principles of authentic\u003cstrong\u003e\u0026nbsp;collaboration, inclusion, and participation (M). Getting the right people around\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ethe table at the start of an initiative\u0026nbsp;\u003c/strong\u003eearly on is an important mechanism\u003cstrong\u003e\u0026nbsp;for facilitating\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eeffective communication (M), encouraging cross organisational collaboration (M),\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ebuilding relationships and commitment from a range of partners with the expertise in a\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003erange complementary approach (M) (innovation, improvement, evaluation, and co-\u003c/strong\u003e\u003cstrong\u003eproduction)\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;What surprised me is the Hub\u0026rsquo;s success in managing to convene people who have\u0026nbsp;\u003c/em\u003e\u003cem\u003enever met before who you would have expected to have met. It is that relationship stuff that we need to hold on to and not underestimate the amount of time and effort that takes to those people engaged and involved. Unless we do things collaboratively it will always end up being a silo.\u0026rdquo; (R3 P32)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eActivities that help to\u003cstrong\u003e\u0026nbsp;initiate wider conversations with the public (M), provide clear\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ecommunication channels to facilitate feedback (M)\u0026nbsp;\u003c/strong\u003eand a\u003cstrong\u003e\u0026nbsp;system wide conversation\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eabout innovation (M) enabling people to navigate around the innovation system\u0026nbsp;\u003c/strong\u003emore readily and easily\u003cstrong\u003e\u0026nbsp;(M)\u0026nbsp;\u003c/strong\u003ethrough a shared understanding.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOutcomes and impacts were identified at meso- and macro system level. At a meso- level participants reported more \u003cstrong\u003eeffective system wide communication and\u003c/strong\u003e \u003cstrong\u003eknowledge sharing about innovation (O)\u003c/strong\u003e and the development of \u003cstrong\u003erelationships w\u003c/strong\u003ehich \u003cstrong\u003eovercome the barriers to implementation (O)\u0026nbsp;\u003c/strong\u003emaking the chances of sustainable change more likely to improve services.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Relationships were key in overcoming the barriers of implementation.\u0026rdquo; (R3 P28)\u0026nbsp;\u003c/em\u003eAt a system level we saw evidence of \u003cstrong\u003enew ways of working (O), stakeholders and\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ethe public reporting that they are well informed about innovation opportunities (O)\u003c/strong\u003e and changes to how the C\u0026amp;P ICS develop\u003cstrong\u003e\u0026nbsp;system wide navigation\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003efor innovation (O).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCMOC5 :Citizen participation and co-production\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOne of the most powerful contextual enablers for the CPAIH was its absolute commitment to ensure that citizens played a central role in its evolution and activities. This was a consistent theme across all three formative evaluation reports and the Citizen Participation Group (CPG) was identified at the outset as one of the key enablers for success. To this end, the project fulfilled its original objective (Figure 4) to have citizen co-production at the core of its activities involving the CPG across all stages of CPAIH activity: from strategic direction setting and adapting innovations to the local context, through to evaluation of the project.\u003c/p\u003e\n\u003cp\u003eThe mechanisms that helped to ensure that citizen co-production was embedded into the fabric of the CPAIH included having an authentic \u003cstrong\u003ecollaborative inclusive approach (M)\u003c/strong\u003e and \u003cstrong\u003eco-design model (M),\u0026nbsp;\u003c/strong\u003eenabling the \u003cstrong\u003ecitizen voice to shape and influence CPAIH governance structures, processes, and core activities (M).\u003c/strong\u003e Central to this approach has been ensuring\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ethat citizens in the CPG had \u003cstrong\u003erole clarity concerning innovation selection and the\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ecore work of the CPAIH\u003c/strong\u003e \u003cstrong\u003e(M)\u003c/strong\u003e through \u003cstrong\u003eshared learning experiences\u003c/strong\u003e \u003cstrong\u003e(M)\u003c/strong\u003e and events, \u003cstrong\u003estrong\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ecitizen leadership from the voluntary sector (M)\u003c/strong\u003e through the CPG, and a commitment to develop \u003cstrong\u003estaff\u0026nbsp;\u003c/strong\u003ecapacity and capability for \u003cstrong\u003edeveloping skills in co-design methodology (M)\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eWe witnessed where successful innovation project teams described the impact of working with citizens at the heart of their projects.\u003c/p\u003e\n\u003cp\u003eThe impact of the co-production approach was evidenced at both micro and macro system levels. At a local level citizens reported feeling \u003cstrong\u003eempowered to take a more active role in their own\u003c/strong\u003e \u003cstrong\u003ehealth (O),\u003c/strong\u003e and felt that \u003cstrong\u003etheir voice has been valued, heard, and included (O)\u003c/strong\u003e leading to feelings of \u003cstrong\u003egreater self-confidence and satisfaction\u003c/strong\u003e \u003cstrong\u003e(O)\u003c/strong\u003e and that \u003cstrong\u003eno one is left behind (O).\u003c/strong\u003e Combined this helped citizens to feel \u003cstrong\u003ea sense of pride\u0026nbsp;\u003c/strong\u003ein the impact of the innovations \u003cstrong\u003e(O\u003c/strong\u003e) they have been involved with. At system level although innovations in the first two years were relatively small scale, citizens felt as though \u003cstrong\u003ehealth inequalities were being addressed focused on what matters to them (O).\u003c/strong\u003e \u003cstrong\u003eSolutions are co-designed with patients and citizens according to their health interests\u003c/strong\u003e \u003cstrong\u003e(O)\u003c/strong\u003e. Other outcomes include \u003cstrong\u003einnovations benefitting from public involvement and insight\u003c/strong\u003e \u003cstrong\u003e(O)\u003c/strong\u003e and being \u003cstrong\u003ebetter\u003c/strong\u003e \u003cstrong\u003eunderstood by the public and by staff (O\u003c/strong\u003e), \u003cstrong\u003eavoidance of duplication of effort\u003c/strong\u003e \u003cstrong\u003e(O)\u003c/strong\u003e meaning that scarce resources could be used more effectively and overall, the \u003cstrong\u003elocal population feeling\u003c/strong\u003e \u003cstrong\u003eempowered to take a more active role in the future of their own health and care\u003c/strong\u003e \u003cstrong\u003eprovision (O)\u0026nbsp;\u003c/strong\u003ein C\u0026amp;P.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003eCo-production has been the most effective and everyone at a system level is now\u0026nbsp;\u003c/em\u003e\u003cem\u003erecognising that \u0026ndash; that didn\u0026rsquo;t happen two years ago. We can\u0026rsquo;t transform without the\u0026nbsp;\u003c/em\u003e\u003cem\u003ecommunity at the front, so I think that has been a really powerful outcome\u0026rdquo; (R3 P25)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCMOC6: Building and sustaining an innovation pipeline\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sixth contextual enabler was the CPAIH\u0026rsquo;s commitment to building\u003cstrong\u003e\u0026nbsp;and sustaining an\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003einnovation culture and pipeline (C)\u003c/strong\u003e. It was very clear that the CPAIH leadership team has taken considerable care and due attention to building the mechanisms for culture change across the C\u0026amp;P landscape. Not without its challenges in terms of the NHS risk-averse culture and the impact of the pandemic and workforce shortages, there are a few key mechanisms that have been effective in creating a system wide opportunity to develop the innovation landscape for the future. The first mechanism is the role the CPAIH has played in \u003cstrong\u003efacilitating culture change and\u003c/strong\u003e \u003cstrong\u003eunderstanding the role of context in innovation adoption (M).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;The Hub has been effective in creating culture change. An innovation function without culture change within the work force is going to be ineffective. If we want to get a culture change and engagement from the top, we need to model the importance of it and making sure it flows down through the teams\u003c/em\u003e.\u003cem\u003e.\u0026rdquo; (R3 P26)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eOver time CPAIH provided a range of activities and events that helped to\u003cstrong\u003e\u0026nbsp;cultivate an\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eappetite for innovation adoption (M)\u003c/strong\u003e, \u003cstrong\u003egetting more people inspired and talking about\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003einnovation (M), addressing people\u0026rsquo;s varied understanding of the definition of\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003einnovation culture\u003c/strong\u003e \u003cstrong\u003e(M)\u003c/strong\u003e and \u003cstrong\u003einvesting in measurement, evaluation and shared learning\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eopportunities (M).\u003c/strong\u003e The CPAIH \u003cstrong\u003emodelled the way for encouraging staff to take risks and provided a\u003c/strong\u003e \u003cstrong\u003epositive disruptive force\u003c/strong\u003e \u003cstrong\u003e(M)\u003c/strong\u003e to the NHS innovation landscape, \u003cstrong\u003esupporting coordination\u003c/strong\u003e \u003cstrong\u003eof implementation projects through innovation champions and link workers (M)\u0026nbsp;\u003c/strong\u003eat a local level.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;We have seen a change in the Hub\u0026rsquo;s efficacy from being this nimble, effective\u0026nbsp;\u003c/em\u003e\u003cem\u003edisruptor that has achieved a lot of activities (e.g. the innovation showcase) to now\u0026nbsp;\u003c/em\u003e\u003cem\u003ebeing immortalised in the system through legitimate processes. The ICS Head of\u0026nbsp;\u003c/em\u003e\u003cem\u003eInnovation recognises that the ICS is never going to be agile, but it can be efficient\u0026nbsp;\u003c/em\u003e\u003cem\u003ethrough cemented processes and governance.\u0026rdquo; (R3 P14)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAnother successful mechanism was the \u003cstrong\u003eshared learning events and resources\u003c/strong\u003e \u003cstrong\u003e(M)\u0026nbsp;\u003c/strong\u003eoffered by the CPAIH, particularly webinars, the Innovation Showcase event, and workshops with commercial and system partners. It played a key role in the \u003cstrong\u003eselection and resourcing\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eof innovation (M)\u003c/strong\u003e by aligning with ICB strategic priorities, \u003cstrong\u003emodelling a joint approach for\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003einnovation selection (M),\u0026nbsp;\u003c/strong\u003eand \u003cstrong\u003ehelping the system make decisions about resource\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eallocation so that no one is left behind (M).\u0026nbsp;\u003c/strong\u003eThe CPAIH also helped to\u003cstrong\u003e\u0026nbsp;identify and overcome barriers to innovation (M)\u0026nbsp;\u003c/strong\u003eand \u003cstrong\u003emaintain system visibility with clear signposting to an innovation pipeline (M).\u0026nbsp;\u003c/strong\u003eThese mechanisms for building and sustaining an innovation culture have impacted all levels\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eof the system. \u003cstrong\u003eMore people know what innovation is and how to access help with their innovations (O)\u003c/strong\u003e, \u003cstrong\u003eteams are more innovative and adaptable (O),\u003c/strong\u003e and \u003cstrong\u003estaff express a greater degree of satisfaction (O)\u003c/strong\u003e with their role in\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003einnovation. At a system level there was evidence of \u003cstrong\u003egreater system readiness for innovation adoption (O)\u003c/strong\u003e and \u003cstrong\u003ean effective innovation pipeline (O)\u003c/strong\u003e with some evidence emerging about\u003cstrong\u003e\u0026nbsp;system improvements in the adoption and spread of innovation (O)\u003c/strong\u003e as well as \u003cstrong\u003egreater efficiencies in services and patient outcomes (O)\u003c/strong\u003e.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to capture what has worked on the CPAIH\u0026rsquo;s journey from supporting small-scale innovations to becoming embedded in the C\u0026amp;P ICS. Since the hub-level evaluation was completed the CPAIH-ICB collaboration has made significant progress, with the CPAIH becoming fully embedded into the ICB. The Lessons Learned section below summarises the key developments undertaken by the ICB and their impacts into principles, mapped to the Health Foundation\u0026rsquo;s Six Principles for Adopting Innovation (Figure 7).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;Insert Figure 7: CPAIH-ICB Key Developments\u0026gt;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBuilding on the Lessons Learned from the evaluation: The Cambridgeshire and Peterborough ICS approach to fostering innovation in healthcare\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn 2024, the transition into the ICB has provided a valuable opportunity to overcome barriers encountered by the CPAIH and establish more robust processes for adopting innovative solutions. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrinciple 1: \u0026nbsp;Cultivating a Culture for Innovation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe ICB has focused on creating an environment where innovation is not only encouraged but systematically supported. \u0026nbsp;Innovation has been embedded into the governance structures of the Strategic Commissioning Unit (SCU), enhancing interdisciplinary collaboration and aligning efforts with strategy, health economics, and outcome-focused insights.\u003c/p\u003e\n\u003cp\u003eThe ICB has recognized the importance of roles dedicated to innovation, to allow personnel the necessary time and responsibility to engage deeply with collaborative projects. For example, the Head of Innovation, jointly funded by Health Innovation East and the C\u0026amp;P ICB, fosters innovation across the Eastern region. This role facilitated partnerships with the InSites teams, the Cancer Alliance, and the Clinical Entrepreneurs Programme, creating a regional network that pools shared learning and resources.\u003c/p\u003e\n\u003cp\u003eCambridge University Health Partners has established innovation landing zones in C\u0026amp;P, creating supportive environments for innovation. \u0026nbsp;A case study example of how this works is illustrated below.\u0026nbsp;\u003c/p\u003e\n\u003ctable style=\"width: 100%;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 100.0000%;\"\u003e\u003cstrong\u003e\u003cem\u003eCase Study\u003c/em\u003e\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 100.0000%;\"\u003e\u003cem\u003eTo address the inequity, experience and impact of cardiovascular disease (CVD) on the population and healthcare providers, the ICB has developed a CVD Innovation Landing Zone. This programme will introduce innovations into the CVD pathway, aiming to make novel therapies, re-purposed drugs, risk identification approaches and digital monitoring tools more widely and rapidly available to address risk factors and improve management of CVD in the community. From an innovation perspective, the programme aims to demonstrate success in shortening the innovation adoption pathway for patients who need it most, leveraging local partnerships with innovation catalysts, such as the Cambridge Biomedical Campus. The ICB has launched the two-year Your Healthier Future CVD pilot program; a prototype for the ICB\u0026rsquo;s health optimisation approach under its new strategy, the New Care Model. The pilot will implement innovative population health management approaches to identify people at risk of CVD, to enable GPs to better support patients, reduce the number of Major Adverse Cardiovascular Events and premature mortality. This programme highlights the success and impact of embedding an innovation culture at the ICB, with strategic programmes aiming to improve patient outcomes and reduce health inequalities via innovation driven approaches, thinking and interventions.\u0026nbsp;\u003c/em\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThese efforts are further strengthened by the formation of the Innovation Working Group (IWG), a networked governance body for innovation across system partners (Figure 8). This group implements a systematic, health economics-informed decision-making approach, utilising a Multiple Criteria Decision Analysis tool to prioritise innovations. As a result, the ICB has collaborated on funding bids with considerable success and recommended system-wide innovations to the System Innovation Panel. Supported innovations now join the innovation pipeline, which guides financial planning and directs funding opportunities. This system-based collaborative decision-making process encourages the development of shared goals and enables the ICB to ensure evidence-based decisions with collective system-wide support.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;Insert Figure 8: ICS Innovation Governance\u0026gt;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLooking forward, the ICB is exploring implementation of an \u0026quot;Innovation Passport\u0026quot;, to help spread successful innovations across the system, based on proven results from pilot projects at any single partner. This process aims to standardize innovation adoption policies, such as intellectual property and procurement, and encourage consortia-building efforts that generate system-wide benefits beyond what any single organization could achieve.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrinciple 2: Empowering People\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSupporting individuals and teams across the network is essential for cultivating an ecosystem where innovation thrives. The ICB\u0026apos;s innovation network engages with over ten organizations, incorporating specialists across multiple disciplines and local academic partners. The network\u0026rsquo;s commitment to citizen-led decision-making, with multiple citizen voices actively participating in the innovation process, strengthens its value for both innovators and project teams, ensuring initiatives respond to real community needs. The IWG facilitates shared learning across the network, identifying opportunities for collaboration and simplifying the often-complex innovation ecosystem. For example, the group developed a unified Innovation Framework that standardises resources, simplifies access points, and provides a clear roadmap for innovators. The Innovation Portal, built from this framework, serves as a centralised platform that streamlines resource-sharing and aligns innovation efforts across the system.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrinciple 3: Adopting Best Ideas and Sharing Learning\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Innovation Portal represents a pivotal step in the ICB\u0026rsquo;s commitment to adopt the best ideas and promote shared learning across the system. By providing a transparent view of the innovation landscape, system-wide priorities, and specific objectives, this collective approach minimizes duplication of efforts, ensuring that resources are used efficiently, and innovations are spread effectively across the system. Initiatives like a recent Health Foundation Q-visit have garnered strong engagement and positive feedback beyond the immediate region. These visits demonstrate the value of connecting with external networks to gain fresh perspectives, share successes, and learn from the experiences of other healthcare systems. Such exchanges reinforce the ICB\u0026rsquo;s commitment to continual learning and improvement within the innovation network.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrinciple 4: \u0026nbsp;Focusing on Impact and Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIntegration of the CPAIH within the ICB structure has enabled the innovation team to address macro-level barriers more effectively, such as implementing innovations at a population level and managing competing organizational interests. Through the use of systematic selection processes and an established governance framework, the ICB reports it is better positioned to support system-wide innovation. The IWG reduces siloed efforts, promoting collaborative projects and funding bids that yield tangible benefits, including income generation, coordinated projects, and expanded learning opportunities. A clear decision-making process has provided a structured pathway for engagement, fostering transparency and accountability in decision-making. Aligning individual organizational strategies with a unified innovation strategy, the ICB supports collaborative efforts that enhance the system\u0026apos;s capacity for innovation.\u003c/p\u003e\n\u003cp\u003eTo ensure the innovation journey is transparent and accessible, the ICB is developing a collective Innovation Pathway. Building on the Innovation Framework, this includes an enhanced Innovation Portal to improve navigation and transparency for all stakeholders.\u003c/p\u003e\n\u003cp\u003eAdditionally, aligned with system goals the SCU has developed an Outcomes Framework to measure the success of innovation projects, providing a consistent approach for tracking progress and evaluating impact.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrinciple 5: \u0026nbsp;Engaging People Who Will Use the Innovation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eActive involvement of people who will benefit from innovation is integral to the ICB\u0026rsquo;s innovation strategy. The CPG, now called the Citizen Innovation Group (CIG), has been instrumental in this effort. CIG members contribute to the development of innovation tools and processes, and the selection and evaluation of innovations for the system. Their participation ensures innovations are aligned with patient needs and preferences.\u003c/p\u003e\n\u003cp\u003eInsights from the CIG shape patient and public involvement plans within funding applications, ensuring projects are responsive to the needs of diverse populations. Additionally, this group is a key partner in the ICS-wide Patient and Public Involvement Network, further enhancing the alignment between innovation projects and public expectations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrinciple 6: Maintaining Flexibility in Managing Change\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe innovation journey requires adaptability and a willingness to modify processes based on real-world feedback. To support strategic decision-making on commissioning \u003cstrong\u003eand\u003c/strong\u003e decommissioning, the ICB is developing a health economics and evaluation function in partnership with organizations across the ecosystem; leveraging diverse expertise to create a system-wide approach that balances costs with benefits and outcomes.\u003c/p\u003e\n\u003cp\u003eMoreover, the ICB Innovation team actively collaborates with provider organizations to identify best practices to adapt across the system. Sharing policy changes and insights across organizations promotes alignment and accelerates system-wide progress. The System Transformation Group, supported by the NHS Impact initiative, is also exploring ways to enhance change-management capabilities across the system, further embedding innovation and flexibility within the organizational culture.\u003c/p\u003e\n\u003cp\u003eso.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearcher Reflection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe evaluation of the CPAIH has provided a unique opportunity to observe what happens when a novel innovation approach is implemented at a local level.\u0026nbsp;\u0026nbsp;One of the original goals of the Health Foundation programme was to promote the accelerated adoption of innovation. \u0026nbsp;In reality, it took two years for the CPAIH to set up, establish its focus, and work on its sustainability plans. Due to its initial location within a single NHS organisation, innovations tended to be local rather than system-focused. However, the CPAIH played a vital role in\u0026nbsp;coordinating, informing, and convening the work of individuals, groups, and organisations\u0026nbsp;in Cambridgeshire and Peterborough which paid off as the Hub was integrated into the ICB by October 2023 and was the first to do so. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eExisting literature on innovation at a systems level largely aligns with the CPAIH\u0026rsquo;s approach to adopting innovation. Clear strategy and vision in combination with resourced leaders who actively managed relationships were critical in building sustainable partnerships and integrating the CPAIH into the ICS architecture. Strategic leadership in the context of innovation is an under-researched domain, but there is a paucity of health research on how leadership can foster a culture of innovation [15] with \u0026lsquo;leadership clarity\u0026rsquo; concerning roles and responsibilities being a key mechanism to increasing propensity to innovation [16]. The CPAIH demonstrated how effective leaders, skilled in navigating the system, could develop streamlined system innovation governance, whilst striking a balance between top-down and bottom-up approaches that included advocating a culture of citizen participation. Using co-production was a key enabler of the CPAIH and is proven to have positive impacts on innovation sustainability [17]. This combination of resourced strategy-focused leaders and co-production contributed to creating a system culture that was more supportive of innovation and could serve as a model for future innovation systems.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGoing forward, this evaluation provides policymakers and clinical practitioners with valuable insights and a roadmap to enhance innovation service delivery at a regional level. Furthermore, this evaluation supports policies that adopt a citizen-participatory approach to innovation, emphasising empowerment and the need to maintain flexibility across all levels (micro, meso, and macro). Future research in evaluating innovation systems should focus on developing appropriate metrics to assess innovation effectiveness at a systems level, which is crucial for facilitating broader implementation of effective strategies within the wider healthcare system.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis evaluation adopted an exploratory realist approach to understanding the context, mechanisms, and outcomes of the CPAIH. Although the findings may have limited generalisability, as the CPAIH operates in a unique context, the research provides a detailed case study of the key components that contribute to sustaining healthcare innovation in the East of England. As the evaluation was limited to two years, we were unable to see metrics that could evidence the impact of innovations on population health outcomes in the timescale although it is evident that the ICB has taken significant steps to address this since.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe evaluation provided a unique opportunity to observe what happens when a novel catalyst for innovation, in the form of an innovation hub, is introduced into an existing, complex innovation-implementation ecosystem. By creating a robust, collaborative, and adaptable ecosystem, the ICB has laid the groundwork for sustained innovation in healthcare in the East of England. Through a combination of dedicated roles, shared resources, citizen involvement, and systematic decision-making processes, traditional barriers to innovation were overcome whilst creating a culture that values continuous improvement and responsiveness to patient needs. The journey toward building a flexible, resilient, and impactful healthcare system continues, and these initiatives represent foundational steps toward a future where innovation is an integrated part of healthcare delivery.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17.5676%;\"\u003e\n \u003cp\u003eCIG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82.4324%;\"\u003e\n \u003cp\u003eCitizen Innovation Group\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17.5676%;\"\u003e\n \u003cp\u003eC\u0026amp;P\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82.4324%;\"\u003e\n \u003cp\u003eCambridgeshire and Peterborough\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17.5676%;\"\u003e\n \u003cp\u003eCMOC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82.4324%;\"\u003e\n \u003cp\u003eContext Mechanism Outcome Configurations\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17.5676%;\"\u003e\n \u003cp\u003eCPAIH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82.4324%;\"\u003e\n \u003cp\u003eCambridge and Peterborough Adopting Innovation Hub\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17.5676%;\"\u003e\n \u003cp\u003eCPG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82.4324%;\"\u003e\n \u003cp\u003eCitizens\u0026rsquo; Participation Group\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17.5676%;\"\u003e\n \u003cp\u003eCVD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82.4324%;\"\u003e\n \u003cp\u003eCardiovascular Disease\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17.5676%;\"\u003e\n \u003cp\u003eHIN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82.4324%;\"\u003e\n \u003cp\u003eHealth Innovation Network\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17.5676%;\"\u003e\n \u003cp\u003eHRA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82.4324%;\"\u003e\n \u003cp\u003eHealth Research Authority\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17.5676%;\"\u003e\n \u003cp\u003eICB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82.4324%;\"\u003e\n \u003cp\u003eIntegrated Care Board\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17.5676%;\"\u003e\n \u003cp\u003eICS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82.4324%;\"\u003e\n \u003cp\u003eIntegrated Care System\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17.5676%;\"\u003e\n \u003cp\u003eIP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82.4324%;\"\u003e\n \u003cp\u003eInnovation Portal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17.5676%;\"\u003e\n \u003cp\u003eIWG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82.4324%;\"\u003e\n \u003cp\u003eInnovation Working Group\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17.5676%;\"\u003e\n \u003cp\u003eNHS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82.4324%;\"\u003e\n \u003cp\u003eNational Health Service\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17.5676%;\"\u003e\n \u003cp\u003eNIHR ARC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82.4324%;\"\u003e\n \u003cp\u003eNational Institute for Health Research Applied Research Collaborative\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17.5676%;\"\u003e\n \u003cp\u003eSCU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82.4324%;\"\u003e\n \u003cp\u003eStrategic Commissioning Unit\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17.5676%;\"\u003e\n \u003cp\u003eUEA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82.4324%;\"\u003e\n \u003cp\u003eUniversity of East Anglia\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for \u003cem\u003e\u0026ldquo;A Service Evaluation of the Health Foundation Adopting Innovation Programme- Cambridgeshire and Peterborough Adopting Innovation Hub Locality\u0026rdquo;\u003c/em\u003e was provided by the UEA Faculty of Medicine and Health Sciences Research Ethics Sub Committee 13 July 2022-February 2024 ETH2122-2363 and with amendments to summative evaluation interview schedule ETH2223-2201. \u0026nbsp;This approval is in accordance with the ESRC Framework for Research Ethics and their core principles. \u0026nbsp;A data sharing agreement ensured that data was anonymised at source by the CPAIH leadership team before being shared in a password protected file seen only by the two UEA researchers.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe formative evaluation reports developed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunder\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis project was funded by the Health Foundation Adopting Innovation Fund and the UEA evaluation team recruited by Health Innovation East to undertake the independent evaluation of the CPAIH journey over two years from set up to implementation. \u0026nbsp;The evaluation has been undertaken by researchers working in the Norfolk initiative for Coastal and Rural Health Equalities (NICHE Anchor Institute) in the School of Health Sciences at UEA.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCJ was the principal investigator for the evaluation of the CPAIH and lead author for this paper.\u003c/p\u003e\n\u003cp\u003eJM was the research assistant for the evaluation of the CPAIH and developed the Figures\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eET wrote the lessons learned section of the discussion.\u003c/p\u003e\n\u003cp\u003eKE and MR contributed to an edit and review of the paper and wrote the Case Study.\u003c/p\u003e\n\u003cp\u003eSH is the academic sponsor for the evaluation and contributed to a review of the paper prior to submission.\u003c/p\u003e\n\u003cp\u003eAll authors have read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eDunn P, Ewbank L, Alderwick H. Nine Major Challenges Facing Health and Care in England. The Health Foundation. 2023. https://www.health.org.uk/publications/long-reads/nine-major-challenges-facing-health-and-care-in-england. Accessed 19\u003csup\u003eth\u003c/sup\u003e November 2024.\u003c/li\u003e\n \u003cli\u003eNational Health Service England. The NHS Long Term Plan. 2019. https://www.longtermplan.nhs.uk. Accessed 17\u003csup\u003eth\u003c/sup\u003e August 2024.\u003c/li\u003e\n \u003cli\u003eNational Health Service England. Building strong integrated care systems everywhere ICS implementation guidance on working with people and communities V1 2 September. 2021.https://www.england.nhs.uk/wp-content/uploads/2021/06/B0661-ics-working-with-people-and-communities.pdf. Accessed 13\u003csup\u003eth\u003c/sup\u003e October 2024.\u003c/li\u003e\n \u003cli\u003eCambridgeshire and Peterborough County Council. Census 2021 first outputs: Cambridgeshire and Peterborough population and household estimates. 2022.https://cambridgeshireinsight.org.uk/wp-content/uploads/2022/07/Census-2021-first-results-report-040722.pdf. Accessed 17\u003csup\u003eth\u003c/sup\u003e November 2024.\u003c/li\u003e\n \u003cli\u003eCambridge Council Research Group. Local Population Estimates and Forecasts. https://cambridgeshireinsight.org.uk/population/population-forecasts/ Accessed online 20\u003csup\u003eth\u003c/sup\u003e November 2024\u003c/li\u003e\n \u003cli\u003eNHS England Strategic Data Collection Service https://datacollection.sdcs.digital.nhs.uk/ Accessed 23rd August 2024.\u003c/li\u003e\n \u003cli\u003eNHS England 2023. Population and Person Insight (PaPI) Dashboard. https://apps.model.nhs.uk/report/PaPi Accessed 23rd August 2024.\u003c/li\u003e\n \u003cli\u003eOffice for Health Improvement and Disparities 2023. Mortality Profile: March 2023 https://fingertips.phe.org.uk/profile/mortality-profile Accessed 8th February 2024.\u003c/li\u003e\n \u003cli\u003eThe Health Foundation Adopting Innovation Programme 2020. https://www.health.org.uk/sites/default/files/2021-01/Adopting%20Innovation%20Call%20for%20applications%20-%20UPDATED%2012.01.21.pdf . Accessed 14 November 2020.\u003c/li\u003e\n \u003cli\u003eRomanelli RJ, Dawney J, Adams A, Moriarty S, Wong HS, Ling T. Strengthening Local Innovation- Implementation Ecosystems: Learning from Four Innovation Hubs Across England. A Final Report. RAND Europe 2024, 5\u003csup\u003eth\u003c/sup\u003e July. Embargoed.\u003c/li\u003e\n \u003cli\u003ePawson R, and Tilley N. Realistic Evaluation. 1997. London: Sage publications.\u003c/li\u003e\n \u003cli\u003ePawson R, Greenhalgh T, Harvey G, Walshe K. Realist review - a new method of systematic review designed for complex policy interventions. Journal of Health Services Research \u0026amp; Policy. 2005;10(1_suppl):21-34. doi:10.1258/1355819054308530.\u003c/li\u003e\n \u003cli\u003ePawson R, Manzano-Santaella A. A realist diagnostic workshop. Evaluation. 2012 Apr;18(2):176\u0026ndash;91.\u003c/li\u003e\n \u003cli\u003ePawson R, and Tilley, N. Realistic Evaluation. 2004. London: British Cabinet Office.\u003c/li\u003e\n \u003cli\u003eWeintraub P, McKee M. Leadership for Innovation in Healthcare: An Exploration. Int J Health Policy Manag. 2019; doi: 10.15171/ijhpm.2018.122.\u003c/li\u003e\n \u003cli\u003eWest MA, Borrill CS, Dawson JF, Brodbec F, Shapiro DA, Haward B. Leadership clarity and team innovation in health care. Leadersh Q. 2003; doi: 10.1016/s1048-9843(03)00044-4\u003c/li\u003e\n \u003cli\u003eOverton C, Tarrant C, Creese J, et al. Role of coproduction in the sustainability of innovations in applied health and social care research: a scoping review BMJ Open Quality 2024. doi: 10.1136/bmjoq-2024-002796\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Footnotes","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e Industry e.g. SMEs, wider innovation organisations, local government, charities and voluntary sector organisations\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Our timelines for reporting were impacted by changes in personnel within the CPAIH Leadership team and a transition of the CPAIH into the Cambridgeshire and Peterborough Integrated Care Board.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Participants held senior leadership innovation roles in the NHS, Innovation Networks, wider system and community settings. Three participants identified as male and six as female.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Table","content":"\u003cp\u003eTable 1 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":false,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"complex innovation, innovation implementation, innovation ecosystem, innovation adoption, innovation hubs, catalyst partnerships, realist evaluation, system wide innovation, citizen co-design","lastPublishedDoi":"10.21203/rs.3.rs-5504858/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5504858/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Innovation is critical to transforming how health services can be delivered more effectively, efficiently, and with better outcomes. In 2021, the Health Foundation launched the Adopting Innovation Programme to help stakeholders within the NHS become better adopters of innovation. The Cambridge and Peterborough Adopting Innovation Hub (CPAIH) was one of four ‘innovation hubs’ funded to act as centres of expertise and provide innovation support for organisations and their local health systems. This study describes the findings from the local evaluation of the CPAIH.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A realist evaluation with a multi-method study design was conducted via three primary data sources: documentary review, thematic analysis of formative evaluation reports and data sets, and interviews with stakeholders. Using thematic analysis and realist logic of enquiry context-mechanism-outcome configurations (CMOCs) were identified.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The evaluation identified 6 emergent CMOCs to inform a programme theory of what works and outlined CPAIH’s principles on embedding innovation in the regional healthcare system. The themes identified from the results included: the need to establish infrastructure and mechanisms, implement system innovation governance processes, exercise strategic leadership, foster effective communication, facilitate citizen co-production, and sustainably build an innovation pipeline to streamline and standardise decision-making.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e The evaluation demonstrated that by creating a robust, collaborative, and adaptable ecosystem, the CPAIH has laid the groundwork for sustained innovation in healthcare in the East of England evidenced through its absorption into the Integrated Care System to address health inequalities faster. Through a combination of dedicated roles, shared resources, citizen involvement, and systematic decision-making processes, traditional barriers to innovation were overcome whilst creating a culture that values continuous improvement and responsiveness to patient needs. The CPAIH’s approach could serve as a model for future innovation systems.\u003c/p\u003e","manuscriptTitle":"Adopting Innovation across an NHS Ecosystem in the East of England- a realist evaluation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-12 04:50:07","doi":"10.21203/rs.3.rs-5504858/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1542a308-ab0a-481d-a881-9b68a2eaa015","owner":[],"postedDate":"March 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-03-12T04:50:07+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-12 04:50:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5504858","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5504858","identity":"rs-5504858","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}