The NHS needs to make space to look outwards

When it comes to innovation, a frequent complaint about the NHS is that it is too inward-looking.[ref]Trust boss urges directors to experience private sector, HSJ, Sep 2025[/ref] It doesn’t do enough to build partnerships with industry and academia that would pull in and test promising ideas and products.[ref] The Innovation Ecosystem Programme – how the UK can lead the way globally in health gains and life sciences powered growth, NHS England, Nov 2024 [/​ref]

There is plenty of evidence highlighting both the risks posed by a failure to engage externally, and the benefits that come from prioritising this engagement. 

The best performing NHS trusts with the most mature approaches to improvement make extensive use of external learning networks.[ref] Jones, L. et al How do hospital boards govern for quality improvement? A mixed methods study of 15 organisations in England, BMJ Quality and Safety, 2017[/ref] They dedicate time to researching how other high performers have achieved success. Their boards are ​‘outward-facing’ in nature[ref]Fulop, NJ., Ramsay AIG, How organisations contribute to improving the quality of healthcare, BMJ, 2019 [/​ref] and curious about what’s happening elsewhere. They are open to ideas and practices that haven’t been developed locally.[ref] Chambers, N et al, Roles and behaviours of diligent and dynamic healthcare boards, Health Services Management Research, 2019. [/​ref]

The same is true of primary care organisations. Research on the adoption of remote and digital innovation in UK general practice found that larger, ​‘well-networked’ practices with established horizon-scanning approaches, looking out for new solutions, generally ​‘find it easier to identify, procure, assimilate, embed and adapt new technologies’. [ref]Greenhalgh, T., et al Remote and digital services in UK general practice 2021–2023: the Remote by Default 2 longitudinal qualitative study synopsis, NIHR, 2025 [/​ref]

Under-performing health care organisations, in contrast, often have ​‘dysfunctional external relationships’[ref]Vaughn, MV etc al, Characteristics of healthcare organisations struggling to improve quality: results from a systematic review of qualitative studies, BMJ Quality & Safety, 2018 [/​ref] and ​‘inadequate focus on learning from others’[ref] Curry, LA. et al, What distinguishes top-performing hospitals in acute myocardial infarction mortality rates? A qualitative study, Annals of Internal Medicine, 2011 [/​ref]. They also tend to be more complacent about their performance, which makes them less likely to benchmark themselves against others or draw on external practices.[ref]Jones, L.  et al, How do hospital boards govern for quality improvement? A mixed methods study of 15 organisations in England, BMJ Quality & Safety, 2017 [/​ref]

Despite this evidence, it’s not surprising that some organisations under pressure turn inwards and neglect external networks and relationships. Health Foundation research on the leadership and management of NHS trusts suggests that embattled leaders in struggling organisations find it hard to make the case for ringfencing time for activities that don’t make a direct and immediate contribution to current operational demands. [ref] Jones, B., Burgess, N. Leading NHS Groups The Health Foundation, 2025 [/​ref] [ref] Jones, B., Horton, T., Home, J. Strengthening NHS management and leadership, The Health Foundation, 2022 [/​ref] [ref] Jones, B. Building an organisational culture of continuous improvement, The Health Foundation, 2022 [/​ref]

This research also shows that some organisations stopped looking outside for innovative practices during the pandemic. They are still some way off where they were in 2019. Others feel that the job of identifying and spreading cutting-edge practices is best left to organisations with a specific innovation remit (such as the fifteen local Health Innovation Networks). 

Emphasising the importance of outward-facing attitudes and behaviours at policy level would certainly help. CQC’s Well Led Framework[ref]CQC’s Well Led Framework[/​ref] highlights the value to provider organisations of having external relationships that support innovation and improvement. However, this message needs to be underlined more consistently by policymakers. 

The NHS could also do more to recruit people with innovation experience from other industries. As it stands, many of those who do apply from outside the NHS lose out to internal NHS candidates. These internal candidates have a combination of skills deemed essential and hard to develop beyond the NHS. 

Conversely, the NHS could make it easier for its existing staff to gain innovation experience from other sectors, for example through short-term secondments and placements. 

We also need to look at how NHS organisations process and assimilate knowledge from the external world to improve their performance. 

Without mature ​‘absorptive capacity’[ref]Harvey, G. et al,  Analysing organisational context: case studies on the contribution of absorptive capacity theory to understanding inter-organisational variation in performance improvement, BMJ Quality & Safety, 2014[/ref] (the ability to identify, acquire, assimilate, transform, and apply external knowledge), organisations will struggle to make the most of valuable knowledge from external networks. This requires effective knowledge management processes and systems. And these need to be targeted towards performance challenges and priorities for innovation and improvement. 

It also requires something less tangible, but equally important, namely ​‘adaptive space’[ref]Arena, MJ., Adaptive Space: Shifting from Structural to Social Design, Management and Business Review, 2021[/ref]. This is space that allows people to come together to explore, exchange and diffuse ideas and begin to catalyse change. 

Healthcare organisations need to become more agile to simultaneously meet current operational demands and grasp opportunities to drive innovation and future transformation.[ref] Horton, T., Mehay, A., Warburton, W., Agility: the missing ingredient for NHS productivity, The Health Foundation, 2021 [/​ref] Nurturing adaptive spaces, developing a learning culture[ref]Hardie, T., Horton, T., Thornton, N., Home, J., Pereira, P., Developing learning health systems in the UK: Priorities for action, The Health Foundation, 2022,[/ref] and building dynamic improvement capabilities,[ref]Furnival, J. et al, A dynamic capabilities view of improvement capability, Journal of Health Organization and Management, 2019[/ref] will enable this agility.

As NHS leaders are increasingly recognising, balancing short and long-term goals[ref]Split-screen thinking is the secret to balancing short- and long-term goals, HSJ, March 2025[/ref] is key to ensuring that the service has the headspace for developing and adopting innovative practices. 

What this all shows is that outward-facing mindsets, behaviours and practices should not be seen as discretionary or optional. They must be core features of NHS provider organisations. It also highlights that looking out is not enough in itself to embed innovation. 

Being outward-facing may enhance an organisation’s reputation. It can make an organisation appear ambitious, future-facing and alive to new thinking. But it must go hand-in-hand with the capability and capacity to do something with the ideas generated. 

Implementation know-how and resources are therefore pivotal to realising the benefits of being less inward-facing. All too often though, these are things that do not get the attention or investment they need in the NHS. This needs to change if the NHS is to successfully spread the innovations that are best placed to improve the quality and productivity of its services.