Marden Vale Community Health Partnership is a not-for-profit provider delivering community nursing, rehabilitation and long-term condition management under contract to two integrated care boards, employing 940 clinical and support staff across nine locality teams. The author is Head of Service Development. The innovation used as the worked example in Task 2 is the introduction of a remote monitoring service for patients with heart failure. Organisational detail is illustrative and anonymised.
Task 1: Report on the role of innovation within organisations
AC 1.1 Examine the reasons for innovation in organisations
Survival and competitive necessity. The most fundamental reason is that not innovating carries a cost that eventually exceeds the cost of innovating. Kodak held the patent for the first digital camera and declined to commercialise it in order to protect film revenue, and the business it protected disappeared. Examining what this illustrates, the reason for innovation is frequently defensive rather than opportunistic, and organisations most at risk are those currently succeeding.
Responding to changed customer expectations. Netflix moved from postal DVD rental to streaming while its own rental business was profitable, on the judgement that customer behaviour was moving whether or not the company moved with it. Examining this reason, customer expectation is set by the best experience a person has anywhere, not by sector norms, which is why patients now expect a health service to offer the digital access their bank provides.
Cost pressure and efficiency. Examining the dominant reason in a publicly funded setting, Marden Vale’s contract value has fallen in real terms for four consecutive years while referral volume has risen. Innovation here is not about growth but about delivering more within a fixed envelope, and the alternative to innovating is reducing service.
Regulatory and policy drivers. Examining an external reason, national policy direction towards care closer to home has actively required community providers to develop services that did not previously exist. Regulation can compel innovation as well as constrain it.
Technological possibility. Examining this reason, some innovations occur because something newly became feasible. Remote monitoring of heart failure patients was not possible at acceptable cost until connected devices became cheap and reliable, and the opportunity arrived from outside the sector entirely.
Workforce and capacity constraint. Examining a reason particular to health and care, the binding constraint at Marden Vale is registered nurse availability rather than money. Innovation aimed at using scarce clinical time differently is the only realistic response to a shortage the labour market will not resolve.
Risk reduction and resilience. Examining a reason that emerged sharply after 2020, organisations discovered that single points of dependency in supply, delivery and workforce were more fragile than assumed. Innovation aimed at building alternative routes to the same outcome is a resilience investment rather than a growth one, and Marden Vale’s ability to deliver remotely during an infection outbreak existed only because the monitoring service had been built.
Employee engagement and retention. Examining a reason organisations undervalue, staff who see their ideas acted upon report greater commitment, and evidence links how people experience their work and management to retention and discretionary effort (Barends, Rousseau and Janssen, 2023).
AC 1.2 Analyse the types of innovation within organisations
Product innovation. New or improved goods offered to a market. Dyson’s cyclonic vacuum is a conventional illustration. Analysing its relevance here, a service organisation has few products in the ordinary sense, though the patient monitoring kit issued to households is a product decision.
Service innovation. New or changed ways of delivering value to a user. Analysing this type at Marden Vale, the remote monitoring service is a service innovation: nothing physically new was invented, and the way care is delivered changed entirely.
Process innovation. Changes to how work is carried out internally. Toyota’s production system remains the standard illustration, and its significance is that process innovation is frequently invisible to the customer while producing the largest cost effect. Analysing the trade-off, process innovation is also the least likely to be recognised or rewarded internally, because nobody sees it.
Position innovation. Changing the context in which something is offered rather than the thing itself. Lucozade’s repositioning from a drink for the unwell to a sports drink changed nothing about the product. Analysing this type, it is the cheapest form of innovation available and the most often overlooked.
Paradigm or business model innovation. Changing the underlying logic of how an organisation creates and captures value. Analysing an example, Rolls-Royce’s shift from selling engines to charging for engine flying hours changed the commercial model rather than the engineering, and aligned its incentives with the customer’s.
Incremental against radical. Cutting across the categories, innovation may refine what exists or displace it. Analysing the balance, most organisational value comes from accumulated incremental improvement, while the existential risk comes from radical innovation arriving from outside. An organisation good at the first and blind to the second is the common failure pattern.
Architectural innovation. A less familiar category worth analysing because it is where established organisations are most vulnerable. Architectural innovation reconfigures how existing components relate to one another without changing the components themselves. Analysing why incumbents miss it, an organisation’s structure tends to mirror its product architecture, so a change in how the parts connect requires the organisation to reorganise, which it resists. Marden Vale’s monitoring service is architectural in this sense: no new clinical capability was created, and the relationship between patient, data and clinician was rearranged entirely, which is precisely why it required a new pathway rather than an addition to an existing one.
Sustaining against disruptive. Christensen’s distinction holds that sustaining innovation improves products for existing customers, while disruptive innovation initially serves an underserved or overlooked segment with something simpler or cheaper before improving to displace the incumbent. Analysing why incumbents miss it, disruptive offerings first appear unattractive to the customers the incumbent values most, so ignoring them is rational until it is fatal.
Open against closed innovation. Analysing this distinction, closed innovation develops ideas internally while open innovation deliberately draws on external partners, users and academia. Marden Vale’s monitoring service was developed with a university and a technology supplier, which is open innovation and which the organisation could not have delivered alone.
AC 1.3 Evaluate THREE factors that support a culture of innovation in organisations
Factor one: psychological safety. A shared belief that proposing an untested idea, questioning a decision or reporting a failure will not attract a penalty. Evaluating its importance, it is the foundational factor because every other mechanism depends on people speaking. Research consistently links psychological safety to learning behaviour, the reporting of error and innovative performance, with communication behaviour identified as the pathway through which the effect operates (Jin and Peng, 2024; Capezio et al., 2023).
Evaluating it critically, psychological safety is frequently confused with comfort. A safe team is not one that avoids disagreement but one where disagreement is possible, and organisations pursuing harmony often produce the opposite of what they intend. Its principal weakness as a lever is that it cannot be installed by announcement; it is inferred by staff from how the first bad news is received.
Factor two: tolerance of intelligent failure and the resources to fail cheaply. Evaluating this factor, innovation is a process of testing uncertain propositions, most of which will be wrong, and an organisation that punishes wrong answers will receive only safe ones. What matters is the distinction between failure that produces learning at low cost and failure that is avoidable and repeated.
Evaluating its application in health and care, this factor is genuinely constrained. Marden Vale cannot experiment freely where patient safety is engaged, and an unqualified commitment to tolerating failure would be irresponsible. The workable version separates the domains: rapid, low-cost testing of pathway and process changes, and rigorous governed evaluation before anything touches clinical decision-making.
Factor three: leadership behaviour and resource allocation. Evaluating what actually signals priority, staff judge whether innovation matters by what is funded, what is protected and what senior leaders spend time on, not by what is stated. Mullins (2022) observes that organisational behaviour follows resource allocation rather than declared intention. At Marden Vale the decisive signal was protected development time in the locality team rotas, which cost real clinical capacity and was noticed precisely because it did.
Evaluating this factor critically, leadership sponsorship is necessary and insufficient. It creates permission and cannot create ideas, and a programme dependent on one enthusiastic director fails when that person moves.
Task 2: Report on the process of managing innovation in an organisation
This report uses one example of innovation throughout: the development and implementation of a remote monitoring service for patients with heart failure.
Section A: The methods and process used to manage innovation in an organisation
AC 2.1 Evaluate THREE methods used to drive innovation in an organisation
Method one: design thinking. A structured approach working through empathising with users, defining the problem, ideating, prototyping and testing, with the defining feature that the problem is investigated before solutions are generated.
Evaluating its use at Marden Vale, the empathise stage changed the project fundamentally. The service was conceived as a way of reducing home visits. Time spent with patients established that what they feared most was deterioration going unnoticed between visits, which is a different problem, and the solution built for that problem was better and more readily adopted. Evaluating its limitations, design thinking is time-consuming at the front end, which organisations under delivery pressure resist, and its iterative character sits awkwardly with governance processes requiring a defined specification before approval.
Method two: lean startup and minimum viable testing. Building the smallest thing capable of testing the riskiest assumption, then measuring and deciding whether to persevere or pivot. Evaluating its application, Marden Vale’s riskiest assumption was that patients aged over seventy would use the equipment daily. Rather than procuring a full system, twelve patients were given devices for six weeks. Adherence was 81 per cent, which validated the assumption at a cost of under £4,000 against a full implementation cost of £310,000.
Evaluating its limitations in this setting, the language of failing fast translates poorly into clinical services, and minimum viable does not exempt a test from information governance or clinical safety approval. The method needed adapting rather than adopting.
Method three: open innovation and external collaboration. Deliberately sourcing ideas and capability from outside the organisation. Evaluating this method here, Marden Vale had no capability in device integration or data platforms and could not have built the service alone. Partnering with a university and a supplier brought capability, credibility for funding applications and access to evaluation expertise.
Evaluating the costs, open innovation introduces dependency, slows decision-making across organisational boundaries, and raises questions about who owns what is created. The partnership agreement took four months to conclude, which is a real cost against the capability gained.
A note on method selection. Evaluating the three against each other on cost, design thinking is the most expensive in management time, open innovation the most expensive in elapsed time, and minimum viable testing by far the cheapest in both. Evaluating them on risk reduction, the ordering reverses: the minimum viable test reduced financial exposure most, but only because design thinking had already established that the assumption being tested was the right one.
Comparative evaluation. The three are complementary rather than alternative and were used in sequence: design thinking to establish the right problem, open innovation to access capability, and minimum viable testing to reduce risk before committing capital. Used alone, design thinking generates insight without delivery, lean methods optimise a solution that may address the wrong problem, and open innovation acquires capability with no clarity about its purpose.
AC 2.2 Examine the process for innovation in an organisation
Search. Scanning internally and externally for signals: patient feedback, staff observation, sector developments, technology and policy direction. Examining the practical mechanism at Marden Vale, the idea originated with a district nurse who noticed she was repeatedly readmitting the same patients.
Select. Filtering ideas against strategic fit, feasibility, resource requirement and expected benefit. Examining why this stage is decisive, an organisation with limited capacity can pursue few ideas, and selection determines whether those few are the right ones. Marden Vale assesses proposals against a published set of criteria, which matters mainly because it makes rejection explicable.
Develop and test. Prototyping, piloting and iterating, including the minimum viable test described above. Examining this stage, it is where most ideas should stop, and an organisation whose pilots all proceed to implementation is not testing anything.
Implement. Scaling from pilot into routine service: training, pathway redesign, equipment logistics, information governance and integration with existing systems. Examining the common failure, a successful pilot run by enthusiasts frequently fails at scale because the wider workforce did not choose it. Marden Vale’s rollout deliberately used pilot participants to train subsequent teams for this reason.
Capture value and embed. Realising the intended benefit and making the new way the normal way, by revising procedures, objectives and reporting so the old approach is no longer supported. Examining the risk, an innovation not embedded decays back to previous practice within months.
Governance and approval. Examining a stage that a generic innovation process omits and a regulated service cannot, clinical safety assessment, information governance approval and data protection impact assessment run alongside development rather than after it. Examining the practical lesson, treating these as a gate at the end rather than a parallel activity is what delayed the earlier falls project, and the monitoring service ran them concurrently from the design stage.
Learn. Reviewing both outcome and process, and feeding it into the next cycle. Examining a stage almost universally skipped, Marden Vale learned more from a failed falls-prevention pilot than from this successful one, and only because someone insisted on a documented review.
Examining the process as a whole, it is iterative rather than linear. Development frequently returns to selection when testing reveals the problem was misunderstood, and Maylor and Turner (2022) note that treating such processes as sequential is the commonest cause of poor front-end decisions.
Section B: The role of stakeholders in the innovation process
AC 2.3 Discuss the role of the manager in leading innovation in an organisation
Creating the conditions. Discussing the manager’s primary contribution, it is establishing an environment where ideas surface. This means responding well to the first suggestion, since how that is received determines whether a second arrives. Buchanan and Huczynski (2023) note that innovative behaviour responds to what is perceived as safe rather than to what is formally encouraged.
Protecting the work. Discussing a practical role, innovation activity is always the first casualty of operational pressure. The manager’s function is to hold the protected time, defend the pilot budget and absorb pressure from above rather than transmitting it downward.
Framing the problem rather than supplying the answer. Discussing where managers commonly go wrong, presenting a solution rather than a problem forecloses better options. The Head of Service Development’s contribution to the monitoring project was to convert a proposal for more visits into a question about unnoticed deterioration.
Making the case and securing resources. Discussing the boundary-spanning role, the manager translates an operational idea into a business case a board and an integrated care board will fund.
Deciding when to stop. Discussing an underrated role, the manager must be willing to close a project that is not working. This is difficult because sponsorship becomes personal, and Northouse (2025) identifies the willingness to act on unwelcome evidence as central to credible leadership.
Modelling the behaviour. Discussing the strongest signal available, a manager who acknowledges their own misjudgement about the project publicly makes it safe for others to report problems.
Building capability. Discussing a long-term role, most managers reach their position without preparation for leading innovation (Chartered Management Institute, 2023), which makes developing the next layer part of the job rather than an addition to it.
AC 2.4 Analyse the role of stakeholders in the innovation process
Patients and carers. Analysing their role, patients were sources of the problem definition, participants in testing and ultimately the determinants of adoption. Their role was not consultative but constitutive: the service works only if patients use the equipment daily, so their willingness was the innovation’s central risk rather than a factor to be managed.
Frontline clinical staff. Analysing this group, district nurses generated the idea, identified operational flaws no designer would have seen, and became advocates or obstacles at implementation. Analysing what determined which, staff involved in testing became advocates while those who first encountered the service as an instruction did not.
Commissioners. Analysing their role, the integrated care boards funded the work and defined the outcomes against which it would be judged. They exercised influence over scope well before any contract existed, since a proposal must be shaped to what they will fund.
Clinical governance and information governance functions. Analysing an internal stakeholder group frequently treated as an obstacle, these functions determine whether the innovation may lawfully and safely proceed. Engaging them at the design stage rather than at approval reduced the timeline substantially, whereas the earlier falls project engaged them at the end and lost five months.
Technology and academic partners. Analysing their role, they supplied capability the organisation lacked and evaluation credibility the funding application required, while introducing dependency and negotiation cost.
Executive and board. Analysing their role, they authorised resource and carried the risk. Their sustained attention determined whether the project survived the period when it was consuming money and producing nothing.
Trade union and staff representatives. Analysing a stakeholder group frequently omitted from innovation accounts, the monitoring service changed how district nurses spent their day and altered caseload structure. Representatives were engaged before the pilot rather than at implementation, which converted a potential dispute about workload into a negotiated caseload adjustment. Analysing the general point, any innovation that changes working practice engages representatives whether or not the project plan acknowledges them.
Analysing stakeholder roles collectively. They differ in the kind of influence held. Some can stop the innovation, some can determine whether it works, and some can only comment. Whittington et al. (2023) note that treating these as equivalent wastes effort on those who cannot affect the outcome while under-engaging those who can.
Section C: Methods used to measure the impact of innovation
AC 2.5 Evaluate THREE methods used to measure the impact of innovation
Method one: outcome measurement against a pre-innovation baseline. Comparing defined outcomes before and after implementation. At Marden Vale the measures were unplanned admissions among the monitored cohort, emergency department attendances and length of stay when admitted, captured for twelve months before the pilot.
Evaluating this method, its strength is that it measures what the innovation existed to change and produces evidence commissioners accept. Its weakness is attribution: admissions respond to weather, seasonal illness and pressure elsewhere in the system, so a fall cannot be claimed as a causal effect without care. The comparison group used, patients meeting the same criteria in localities not yet covered, strengthens the inference considerably without making it conclusive.
Method two: return on investment and cost-benefit analysis. Setting the financial benefit against the cost of achieving it. Evaluating its application, Marden Vale calculated avoided admission costs against equipment, staffing and platform costs, producing a return that supported continued funding.
Evaluating this method critically, it carries two problems in a public service. The saving is frequently cashable only for a different organisation, since an avoided admission benefits an acute trust’s costs rather than the community provider’s. And the method captures only monetised effects, so a patient’s improved confidence appears as zero. Presenting return on investment alone systematically undervalues innovation.
A note on what to measure and when. Evaluating the timing problem before considering methods, the outcomes an innovation exists to change are usually the slowest to move, so an organisation measuring only those will have no evidence during the period when the project is most vulnerable to cancellation. Leading indicators such as adherence, staff adoption and time to respond to an alert moved within weeks and were what sustained board confidence while admission data accumulated.
Method three: user and staff experience measurement. Structured feedback from patients and clinicians, covering confidence, usability, perceived quality and willingness to continue. Evaluating this method, it captures what quantitative outcome data cannot and it predicts sustainability, since a service staff find burdensome will decay however good its outcome data. It also surfaces problems early, well before they appear in admissions figures.
Evaluating its weaknesses, response rates are low and skewed towards those with strong views, satisfaction correlates weakly with clinical benefit, and participants in a new service report positively for reasons connected to novelty rather than merit.
Comparative evaluation. Each method has a blind spot the others cover: outcome data is credible and confounded, financial analysis is persuasive to funders and blind to unmonetised benefit, and experience measurement is timely and subjective. Used together they support a defensible claim of contribution. The honest position, and the one Marden Vale adopted in reporting, is to claim contribution rather than causation, because a claim of causation would not survive the first year in which admissions rose for reasons unconnected to the service.
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