Innovation in health and social care is not just about technology

Why leadership, governance and system readiness matter more than technology when scaling innovation across complex health and social care systems

When innovation is discussed in health and social care, the conversation usually begins, and too often ends, with technology. Artificial intelligence. Digital platforms. Dashboards. Automation. “Scaling solutions.“

Technology matters. But treating innovation primarily as a technology challenge is one of the most persistent and costly misconceptions in the sector.

Innovation rarely fails because the tools are inadequate. It fails when systems, people, incentives and governance are not aligned to absorb change. For organisations operating in regulated, high-risk environments, this distinction is critical.

In this blog, Dr Richard Dune explores why innovation in health and social care so often falters, not because of the technology itself, but because systems, people, incentives, and governance are not aligned to absorb and sustain change in regulated, high-risk environments.

The technology bias in how innovation is understood

The tendency to equate innovation with technology is not new. More than two decades ago, an analysis by the National Endowment for Science, Technology and the Arts (NESTA) highlighted a fundamental bias in how innovation performance was measured.

Traditional indicators focused heavily on patents, scientific research and formal R&D. Yet the majority of the UK economy, including financial services, retail, consultancy and the public sector, generated little of this activity. Innovation in these sectors occurred through new ways of organising work, improving services and meeting human needs, not through laboratory breakthroughs. Health and social care sit firmly in this category.

Despite this, innovation discourse in the sector remains dominated by procurement: new systems, new platforms, new tools. The implicit assumption is powerful: install the right technology and improvement will follow. Experience consistently shows otherwise.

Why good ideas struggle in real-world systems

Across the NHS and social care, there is no shortage of pilots, prototypes and “what works” evidence. What remains scarce is successful, sustained scaling.

A forthcoming Harvard Business Review article by Hill, Tedards and Wild offers a compelling explanation. Innovations rarely fail because the idea is weak. They fail because cross-boundary collaboration breaks down. No single team or organisation holds all the capabilities required to scale change. Innovation increasingly depends on partnerships across professions, departments, organisations and sectors.

This is where complexity emerges.

• Innovation teams are incentivised to experiment
• IT teams are incentivised to prioritise stability
• Clinicians are accountable for professional judgement and patient safety
• Regulators emphasise assurance and compliance
• Boards seek value, control and predictability.

Each of these positions is rational in isolation. Together, they create friction. Without leadership that can translate between these worlds, innovation stalls, or worse, appears to be implemented while workarounds quietly undermine it.

Health and social care already know this, even if it’s rarely named

This dynamic is not theoretical. The sector has lived it. Take the widespread adoption of Clinical Decision Support Systems in the NHS over a decade ago. In many cases, the technology performed as designed. The failure was organisational.

• Clinicians feared erosion of professional autonomy
• IT leaders prioritised system reliability over usability
• Managers perceived surveillance as safety.

Without leaders capable of bridging technical ambition and professional values, teams developed informal workarounds. On paper, systems were live. In practice, behaviour barely changed. This pattern continues to repeat across digital transformation programmes today.

Technology can enable change. Leadership and system design determine whether it sticks.

Innovation is a leadership and governance challenge

One of the most important insights from contemporary innovation research is that scaling change requires a particular type of leadership: leadership that can operate across boundaries, build trust and integrate competing priorities.

Effective innovation leaders:

• Curate the right partners, rather than assuming stakeholder engagement will happen naturally
• Translate across clinical, technical, managerial and regulatory languages
• Integrate innovation into everyday workflows, rather than running parallel programmes. 

This work relies on a blend of emotional intelligence (humility, empathy, conflict management) and contextual intelligence (understanding incentives, pressures and constraints).

In health and social care, these are not “soft skills“. They are core governance capabilities. Without them:

• Innovation becomes performative
• Risk accumulates unseen
• Staff absorb complexity through informal workarounds
• Benefits are delayed or never realised.

This explains why organisations can appear digitally advanced while remaining operationally fragile.

The innovation gap: Capability, not creativity

The Health Foundation has been explicit on this point. Its 2023 analysis argued that innovation in the NHS is being squeezed out, not because ideas are lacking, but because capacity, skills and headroom are missing.

Implementing complex change requires:

• Project and improvement capability
• Data literacy
• Time to reflect and learn
• Space to adapt workflows. 

Without these conditions, even proven solutions struggle to deliver impact. There is often a long lag, sometimes years, between installing technology and realising benefits. Productivity gains do not come from the tool itself, but from how people are supported to use it differently.

Lord Carter’s review of NHS productivity highlighted this clearly. Many trusts had invested in technologies such as e-rostering and electronic patient records, yet were using only a fraction of their functionality. The issue was not technology adoption. It was organisational maturity.

Innovation, in this sense, is not about speed of deployment. It is about the speed of benefit realisation.

Innovation upstream, not just downstream

There is a familiar parable about people rescuing children from a river. Each day, they improve their nets and processes. Eventually, someone asks a different question: why are the children falling in upstream in the first place?

Health and social care innovation often focuses downstream:

• Managing demand
• Improving throughput
• Optimising discharge. 

Upstream innovation asks harder questions:

• Why do crises recur predictably?
• Where does friction accumulate?
• Which processes were designed for a different era?

This kind of innovation is rarely technological. It involves re-examining pathways, incentives, information flows and relationships. It also requires courage, because upstream innovation challenges assumptions, redistributes power and exposes inefficiencies that technology alone cannot fix.

Innovation as a mindset, not a moment

Another persistent myth is that innovation arrives in moments of brilliance. In reality, innovation is a process:

• Noticing friction
• Asking better questions
• Testing small changes
• Learning from failure
• Iterating over time. 

In health and social care, innovation is fundamentally socio-technical, shaped by institutions, professions, power and context, not just tools. Sometimes innovation involves advanced technology. Sometimes it is as simple as redesigning a form, changing how meetings are run or removing an unnecessary approval step.

The most effective innovators do not chase novelty. They focus on fit: fit with people, practice and purpose.

What this means for health and social care leaders

If innovation is not just about technology, leaders must change the questions they ask. Instead of:

• What platform should we buy?
• How fast can we roll this out?

We should be asking:

• What problem are we really trying to solve?
• Which behaviours need to change for this to work?
• Where are incentives misaligned?
• Who is translating between clinical, technical and regulatory worlds?
• How will learning be captured and acted on?

These are governance questions, not IT questions. And they determine whether innovation delivers impact, or quietly fails.

A different definition of innovation

Innovation in health and social care should be defined less by novelty and more by impact. It is about:

• Reducing friction for staff
• Improving safety and equity for patients
• Freeing time for professional judgement
• Aligning systems with how care is actually delivered.

Technology can help. But innovation only happens when people are supported to think differently, work differently and learn continuously.

The next decade will bring faster data, more AI and greater complexity. Handled well, these tools can strengthen systems. Handled poorly, they will amplify existing fractures. Because innovation is not defined by the tools we deploy. It is defined by our willingness to rethink how things are done.

References

• Carter, Lord (2021) – Review into unwarranted variation in NHS ambulance trusts
• Ferlie, E., Montgomery, K. and Reff Pedersen, A. (eds.) (2016) – The Oxford Handbook of Healthcare Innovation
• Harvard Division of Continuing Education (2024) – What is innovation? Why is innovation important in business? 
• Health Foundation (2023) – Innovation is being squeezed out of the NHS
• Hill, L.A., Tedards, E. and Wild, J. (2026) – Why great innovations fail to scale.

Innovation in health and social care is not just about technology – LearnPac Systems UK –