DRAGONS DEN: PROMOTING HEALTHCARE RESEARCH AND INNOVATION

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1 Art & science The acute funding synthesis care of art and science is lived by the nurse in the nursing act JOSEPHINE G PATERSON DRAGONS DEN: PROMOTING HEALTHCARE RESEARCH AND INNOVATION Deborah Mazhindu and Siobhan Gregory describe how a television series livened up the debate about funding for new ways of working Correspondence d.mazhindu@bucks.ac.uk Deborah Mazhindu is reader in clinical nursing practice and innovation, in the faculty of society and health, Buckinghamshire New University, Uxbridge Siobhan Gregory is director of quality and clinical excellence, Hounslow and Richmond Community Healthcare NHS Trust, London Date of submission April Date of acceptance April Peer review This article has been subject to double-blind review and has been checked using antiplagiarism software Author guidelines journals.rcni.com/r/ nm-author-guidelines Abstract The changing health and social care landscape, and, in particular, the financial challenges affecting the NHS, can present difficulties for staff looking for funding to support innovation and new ways of working. One method of competitive tendering that is becoming more accepted as a way of allocating funds, encouraging staff engagement and developing innovation for research is a format based the BBC television series, Dragons Den. This article describes how Hounslow and Richmond Community Healthcare NHS Trust, London, has developed a Dragons Den initiative of annual competitive research funding allocation to ensure that some of the most dynamic practice in the trust is captured. Keywords Innovation, funding, finances, Dragons Den Introduction Dragons Den is a BBC television series in which entrepreneur contestants have three minutes to pitch their business ideas to a panel of five multi-millionaires, known as the dragons. If suitably impressed, the dragons invest their own money into the proposed scheme. The contestants often have potentially profitable business ideas but lack funding and direction, so the dragons provide financial backing and mentorship, both of which are often crucial to the success of proposals, to the lucky participants. The format has been copied in various arenas; for example, the United Bank of Africa (UBA) introduced a similar TV programme to promote entrepreneurship and innovation in Africa (UBA 2015), while in the UK a number of universities and healthcare organisations have used it to award research funding for innovation and to pump prime research and development (Oxford Brookes University 2013, University of Strathclyde Glasgow 2014, British Gastrological Society 2015, Durham University Business School 2015). The Dragons Den platform is ideal for encouraging staff to pitch their research and innovation ideas to try to secure funding equitably and justifiably. Raising support Hounslow and Richmond Community Healthcare NHS Trust (HRCH) developed the Dragons Den initiative to ensure that some of the most dynamic practice, which often goes on in some of the smaller healthcare teams, is captured. In 2012, the trust s director of quality and clinical excellence (QCE) secured funds of up to 30,000 from trust charitable funds to be used to develop and host a Dragons Den-type scenario to encourage research and innovation. The first priority was to secure executive support for the project from members of the HRCH senior management team, who would be needed to provide ongoing mentorship for successful applicants. A collaborating university academic was also invited 28 July 2015 Volume 22 Number 4 NURSING MANAGEMENT

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3 Art & science acute funding care to be one of the dragons to provide mentorship, support and academic assistance. The next step was to hold a forum at which the concept could be explained in detail to the trust s clinical leaders and their views sought. To ensure that each business case was judged and marked fairly and equitably, successful graduates of the HRCH in-house management development programme were asked to volunteer to support development of the application process and to design the marking criteria for the pitches (Table 1). A short-listing team, which included clinicians, senior managers and non-executive directors, acted independently from the dragons and put forward five project initiation finalist bids to each of two dragon panel sessions, in October 2013 and October In addition, staff volunteers who had completed the in-house management development programme were identified to act as support buddies during the application process to enable front line clinicians to write and produce robust business plans and research proposals for their ideas. The five dragons comprised two executive directors, one non-executive director and a member of the public as well as the academic member of the university. The Dragons Den was advertised widely over the summer months of 2013 and 2014 with clear Table 1 Example of Dragons Den marking grid Applicant names: Dear Dragon, Please use this grid to mark your initial thoughts on the bids before the den. The score will be from 1-5: 5 = excellent, 4 = very good, 3 = some evidence, satisfactory, 2 = lack of evidence, below standard, 1 = poor. Please think about key questions you might wish to ask. There are two grids. One is based on the process and bid submission. The second to aid our discussions is based on the 6Cs (in line with the DH NHS Constitution 2012) and the potential quality impact for patients. Pre-bid presentation Bid section Score Comments Purpose/strategic fit Service aims Model for service delivery Costs/income Benefits realisation quantitative Benefits realisation qualitative Knowledge Post-bid presentation Bid section Score Comments Care does the bid meet the trust s vision and service aims? Will it improve patients experiences? Compassion does the bid indicate that it would improve staff ability to care with compassion? Communication do you understand the bid? Would it make sense for patients? Courage how able is the service to take risks to succeed? Commitment will the service actually implement the change and secure publishing? Competence is the service able to implement the change? 30 July 2015 Volume 22 Number 4 NURSING MANAGEMENT

4 and concise guidance, timeframes and contacts, as well as example templates for writing the bids (Table 2). Staff were asked to submit research or innovation ideas as collaborative research proposals with special consideration for three main areas of importance to the trust: improving patient care, enhancing patient experience, and preventing admissions to hospital. Applications and bids Applicants were advised to start with an analysis of their practice using strengths, weaknesses, opportunities and threats (SWOT) (Bplans 2015a) analysis before writing a business case. SWOT analysis helps to develop strong strategies by making sure all a business s strengths and weaknesses are considered, as well as the opportunities and threats it faces in the marketplace. In addition, applicants were advised to undertake a political, economic, and social trends analysis (Bplans 2015b) to help generate marketing and product ideas. As part of the bidding process, the finalist applicants were asked to identify a director buddy from the panel of dragons from whom they would like to receive ongoing support and who would act as a champion and mentor for the project should they be successful. There was also an expectation that the winner would publish his or her project with support from the university dragon. Year 1 applicants: examples of finalist bids There were eight applications for the first Dragons Den from various disciplines, including district nursing, physiotherapy, dietetics and occupational therapy. In the second year, there were 15 applications, again from various disciplines including nursing. In the first round, in 2013, the following five bids were selected for the Dragons Den: Wheelchair services: the bid focused on identifying specialist equipment that would enable patients to continue 24-hour therapy and reduce their pain by providing night aids. Diabetes service: this bid outlined how a new initiative in diet could help practitioners to provide care at home and in the community for patients struggling to maintain a healthy weight. Diabetes care: the bid described a communitydelivered service to identify the pre-diabetic stage of the condition and to offer treatment to prevent onset of diabetes. Community neurological rehabilitation service: the bid aimed to provide specialist IT equipment to help patients with cognitive impairment balance and so prevent hospital admissions. Table 2 Example of a Dragons Den bid template DRAGONS DEN Business case Title: Business case details Provider lead Date Author Version Purpose/strategic fit Sociocultural factors to consider Governmental and educational research Infrastructure changes that affect work patterns Existing technological factors that you could work with or learn from Further technological factors Risks for consideration Service development Service aims Impact on existing services/other service providers Model for service delivery Description of service Likely activity projections and how they will be measured Impact on existing activity Clinical impact Costs/Income Breakdown of costs analysis, including costs, project planning and productivity impact. Workforce implications impact on staff resources and actions to be taken to ensure delivery How will this be sustainable? Benefits realisation Quantitative benefits Description of how each of the benefits will be realised and how they will be measured and tracked: Qualitative benefits Description of how each of the benefits will be realised and how they will be measured and tracked: Knowledge generation and transfer References District nursing: this bid outlined the benefits of community leg-ulcer clinics to provide holistic care in an informal environment. Following rigorous debate, the successful bid was the wheelchair service, which was chosen because it NURSING MANAGEMENT July 2015 Volume 22 Number 4 31

5 Art & science acute funding care 32 July 2015 Volume 22 Number 4 appeared to have the greatest effect on supporting patient experience and reducing pain, and the potential to prevent admissions. Year 2 applicants: examples of finalist bids The following projects bid for funding in the second den, in 2014: Paediatric audiology: this was a bid for purchasing new equipment to improve the life of a child with impaired hearing. The technology is called the HEARLab. District nursing team: this bid was to provide a service to prevent the recurrence of leg ulcers and detect early deterioration of lower-leg health. The school hearing screening programme with a paediatric audiologist: this bid was for the start-up costs of school screening software, which enables school screening to be fully managed using a laptop and the integration of multiple-site data. School nursing team: this team bid to develop School Nurse in Your Pocket, an interactive app that young people, parents and carers can use to access information or support on health matters relating to adolescence. Neurorehabilitation team physiotherapists: this bid was for the production of a professional-balance DVD devised by chartered physiotherapists and aimed at patients with balance and stability impairments due to neurological conditions. The successful bid in 2014 was the school nursing team that wanted funding to develop the interactive app. The bid appeared to have the most potential for improving the care given to young people, enhancing patient experience and preventing hospital admissions. The dragons were impressed by the commitment and compassion expressed by all staff and saw how those who were inexperienced in writing bids and proposals had developed business skills and financial acumen as part of the process. Reflections Following the Dragons Den sessions, the panel considered the effect on the unsuccessful teams and how the trust might ensure that staff remained motivated and encouraged to put forward ideas. It appeared that those who made bids required the whole budget, which prevented funding more than one initiative, and the dragons felt frustrated at their inability to support more than one idea. The dragons wanted to ensure that each service received positive feedback, so the director of QCE visited each of the applicant teams to provide this and to discuss how the ideas could be fostered. Consequently the unsuccessful bids have been referred to managers for further in-house development and one project is now being developed to support commissioning discussions around future funding. The Dragons Den format the trust uses does not allow projects deemed viable, but which require more development, to be reconsidered within the year, which risks losing staff commitment. Therefore, the project team has proposed the consideration of continual project-initiation documents at set intervals during the year to support ongoing research development. There has to be a balance between making whole-scale change with less funding and allowing smaller change-management projects with less impact and longer-term financial gain to take place. There were resource implications, not least financial, as the amount secured for a winning proposal needs to be up to 50,000 a year. The money is agreed from trust funds and is managed by the non-executive directors. In addition, if projects are truly innovative, they are referred to other funding sources, such as the Florence Nightingale Foundation. A further two applications were funded through such sources. There have also been some logistical problems for the winners trying to complete their desk-based project work as office space is scarce, and, for the dragons, time and resource management was challenging. For example, the roll out and judging of projects fell to the director of QCE and her assistant, while paperwork, communication and advertising were led by the director of QCE with corporate support. The support for research and enterprise in service development requires long-term protected investment and clear role identification and accountability to avoid overburdening management staff. Another issue to emerge is the time required for graduates of the in-house management development programme to act as support buddies for aspiring bidders. The executive team for HRCH identified directors to provide ongoing support on specific projects, which helped implement the cascade of learning between successful bidders and the trust. Successful projects will be published and the writing and publication process is supported in-house and by the university dragon. The trust is committed to continual learning and development for staff and, where projects and ideas are aimed at providing high quality services to the public and improve patient experiences, HRCH is keen to ensure they are embraced and supported. Therefore, the team wants to ensure that the Dragons Den, or something similar, should continue NURSING MANAGEMENT

6 to be held annually, and that executive director buddies should continue to provide mentorship and act as champions for change. The trust s management team has also agreed that commercial involvement, from companies such as HEARLab, should remain a priority to ascertain potential service development and commissioning interest, and that feedback on bids should be shared widely though trust communications. Ongoing financial support for future Dragons Dens of between 30,000 and 50,000 a year has been identified, and the team now needs to undertake an ongoing evaluation to determine further support and guidance for staff around the size and cost of projects against positive effects such as improvement in patient care, enhancement of patient experience and prevention of hospital admissions. Conclusion A climate of efficiency savings can be challenging for staff looking for funding to support innovation and new ways of working. There is a tendency to respond to the changing health and social care landscape, and, in particular, the financial challenges affecting the NHS, by limiting spending on research and innovation. While there is evidence of efficiency savings in the NHS, it is not always so easy to determine where the saved money has been spent. Money for research and innovation in particular is highly competitive and difficult to secure. The Dragons Den style competition has provided an excellent platform for staff to showcase their research and ideas for locally, nationally and internationally relevant innovation. There was no shortage of ideas to help achieve the trusts ambitions for demonstrating improvements to patient care, enhancing patients experiences and preventing hospital admissions. It was difficult to reach a final decision and choose a winner in each case as all the projects demonstrated innovative approaches to tackling important health issues and, in an ideal world, they would all be funded. The trust is looking forward to the next competition later this year and hopes many more aspiring staff innovators will participate to keep research and innovation at the heart of service delivery. References Bplans (2015a) What is a SWAT Analysis? tinyurl.com/oh4a22j (Last accessed: May ) Bplans (2015b) PEST Analysis. tinyurl.com/na8vt54 (Last acessed: May ). British Gastrological Society (2015) A total of 3000 to be awarded in the Endoscopy Dragons Den at DDF2015 apply now! tinyurl.com/qgb88oh (Last accessed: May ) Durham University Business School (2015) Dragons Den Competition. tinyurl.com/okryhj2 (Last accessed: May ) Oxford Brookes University (2013) Dragon s Den 24,000 Awarded. tinyurl.com/or9j2xt (Last accessed: May ) University of Strathclyde Glasgow (2014) Strathclyde University Dragons Den Style Event tinyurl.com/o2kch8r (Last accessed: May ) United Bank of Africa (2015) UBA Introduces DRAGONS DEN, a Reality TV Show for Entrepreneurs. tinyurl.com/pd6sm97 (Last accessed: May ) Online archive For related information, visit our online archive and search using the keywords Conflict of interest None declared Journal articles Revalidation resources RCNi Hub RCNi Portfolio From just 5.50 a month NURSING MANAGEMENT July 2015 Volume 22 Number 4 33