There’s been a lot of media interest recently in the idea of frugal innovation, defined in this BBC World Service programme as ‘keeping things simple, and looking hard at what people actually need.’ The concept has been inspired by the kinds of innovations to be found in developing countries such as India, where it is sometimes referred to as Jugaad, a Hindi word meaning ‘an improved solution to a problem using scarce resources’. Both ‘affordable’ and ‘flexible’, frugal innovation is different from top-down, centralist approaches to innovation because it is driven by the imagination and will of people operating at ground level – those who really understand the problems and needs specific to certain individuals, cultures and communities, and can implement solutions or develop services which meet those needs by capitalising on and reconfiguring available resources.
Most of the material I have read on this topic suggests that we in ‘the West’ have a lot to learn from countries like China and India, where necessity has forced entrepreneurs to find radical and effective solutions to immediate problems, by whatever means available. David Cameron has a special phrase for this – ‘Delhi ‘drive’’, and in his conference speech he suggested that this ‘drive’ is lacking from British society, a society which (he implies) has historically been ‘spoilt’ by choice and abundance.
My work on the M(ums)Power project, however, leads me to feel that this blanket judgment of ‘the West’ does a disservice to those thousands of frontline staff who drive our public services. They, after all, are the people who – despite often working in less-than-ideal circumstances, frequently under-resourced and time-pressed – develop an intimate understanding of service users; and in doing so, they come up with ingenious ideas for how to improve both their own working practices and the quality of the service that they are able to provide. Our overstretched public services are full of frugal innovators.
For example, just in the past week (and without really trying very hard) I have come across at least three examples of ‘frugal innovation’ within midwifery care – some of which has grown out of robust partnerships between midwives, and some of which can be found in the working practices of individuals. I have heard, for example, about how the job of a midwife sometimes turns into one of ‘detective’, when women who are considered to be vulnerable (for example, they might be affected by domestic violence, homeless, or involved with social services) do not turn up to antenatal appointments. This can send midwives to knock on people’s doors – and if this fails to uncover the woman in question, the midwives will then sometimes send out national alerts. ‘We’ve noticed that women who don’t want to be found usually change their name,’ one midwife told me, ‘but it is much less common for them to change their date of birth – or sometimes they only tweak their date of birth slightly. So we tell midwives across England to be on alert for those details, in order to ensure that– when that woman does surface in a different part of the system - she gets the care that she and her baby need.’ I also met a midwife who had put a personalised nameplate on her desk typed out in Comic Sans MS script and mounted on bright yellow card, because she had found that ‘it’s better than the clinical name tags that the hospital give us. The women feel more relaxed when they see that you’ve got not just ‘another clinician’, but that you’ve got a name and a personality. You’re a human being just like them.’ Another midwife had independently developed and laminated her own information about topics such as morning sickness, which she felt were not adequately covered in other sources of information – ‘just because, you know, it breaks your heart when the women come in saying ‘I’ve got this problem, I’ve got that symptom’ – I just wanted to do something to help them, and I wanted to develop materials that would be easy for me to use and easy for them to understand.’
The M(ums)Power project has, for the past few months, been grappling with precisely these issues: how do we develop really good systems for supporting vulnerable women and increasing accessibility to antenatal care? How can we improve information sharing and make it more tailored to individuals? How can we personalise services and make them seem more ‘friendly’? The solutions, it seems, are already budding away in the heads, hearts and working practices of those people who are working on the front line.
My last M(ums)Power blog post was about the notion of celebration in the NHS, since what emerged from our workshops with women and clinicians was the sense that there is a lot to be celebrated about pregnancy, but ‘the system’ – that complex tangle of protocols and procedures, usually unwieldy and often inefficient - frequently saps a lot of the enjoyment out of the jobs of those who deliver antenatal care. Through working on the M(ums)Power project, however, I have seen clear evidence of the fact that this does not equate to a lack of passion and ideas. Is it any wonder that people are sometimes suspicious of or resistant to ‘improvement agendas’, when these agendas are usually packaged as ‘responses’ to things that aren’t working well – weaknesses in the system, facts and figures which suggest that they aren’t doing their job properly? We need to reframe the reason for change in a much more positive way – to say, ‘we know you’re trying your best, and you’ve got some great ideas – how can we support you to make those ideas even better?’
Making ‘good ideas’ bigger and better – so that they have impact on more lives, and can be embedded in the routine delivery of care – is, however, a difficult and complex process. As we enter the practical implementation stage of the M(ums)Power project, it will require a lot of hard work, resilience and persistence. But the more I work on this project, the more I am persuaded that the rather nebulous raison d’etre behind our project – ‘closing the gap’ between women and clinicians – is not about developing brand new ‘solutions’ with bells and whistles on top. Rather, it is about paying attention and listening to those staff who work hard to meet people’s needs everyday, and to develop processes, tools and feedback loops which empower and enable them to realise their potential as highly effective innovators, and to take joy and satisfaction in doing so.
'Delhi drive' exists in abundance within public services - we just need to find better ways to harness and nurture it.
In my next monthly M(ums)Power blog, I hope to be able to provide some insights and lessons from the interventions that we have started to test this week. Stay tuned!