The drive for innovation

Across health systems there is a drive to roll out innovative models of care that will deliver better value for money and improve the quality of care. Innovation in service delivery has been defined as ‘a novel set of behaviours, routines, and ways of working that are discontinuous from previous practice, directed at improving health outcomes, administrative efficiency, cost effectiveness or users’ experience and that are implemented by planned and coordinated actions’.1 Undertaking this type of innovation at scale is increasingly viewed as crucial to the long-term sustainability of health systems.

In the USA, the Affordable Care Act has provided a legislative framework that promotes innovation in service delivery. Accountable care organisations (ACOs) have emerged from this as innovative payment and delivery models that aim to improve the coordination and quality of care, enhance population health while containing the growth in healthcare costs.2 In England,3 ,4 the Health and Social Care Act has made innovation in the provision of health services a statutory duty and a major initiative to drive innovation at scale is underway.5 Fifty ‘Vanguard’ sites are now starting to act as test beds for multicomponent innovations in service delivery (see table 1), supported by a £200 million transformation fund from National Health Service England.

The danger of innovation without evaluation

The sheer scale of this initiative serves as a timely reminder that innovation without adequate evaluation can lead to misattribution of effects and worse, the wider adoption of technologies, practices and ways of working without proven benefits over existing alternatives. Health systems, and the NHS in particular, can ill afford compromised decision-making in relation to continuation or wider spread on such a scale. Previous large-scale policy initiatives such as the drive to rapidly implement telehealth technologies despite known uncertainties relating …