Implementing innovation in NHS trusts: exploring the dissemination and implementation of NICE workplace health and wellbeing guidance in three organisational case studies

The National Institute for Health and Care Excellence (NICE) provides evidence-based guidance for employers on how to improve the health and wellbeing of their staff. My research project seeks to explore the dissemination and implementation of two pieces of NICE workplace guidance in three NHS Trusts, which varied in size and geographical location, using the Greenhalgh et al diffusion of innovation conceptual framework (2004). A thematic cross-case analysis with 62 face-to-face semi-structured interviews was conducted. A broad range of participants were selected using purposive sampling, including board members, middle managers, administrative staff and clinical staff. My findings suggest that the formal Trust processes for monitoring the NICE workplace guidance were little more than a ‘box-ticking’ exercise. Interviewees suggested that lack of slack resources (spare capacity) and differing organisational priorities may have hindered the implementation of the NICE workplace guidance. In addition, incentives and mandates played a large role in influencing their decision to implement innovations. The findings also highlight limitations in the communication and dissemination of the NICE workplace guidance. Interviewees believed the NICE workplace guidance was poorly formatted and presented, and believed that the workplace guidance needed to be better targeted at key audiences. However, the NICE workplace guidance had a broad target audience, and this may have restricted NICE’s ability to use targeted language, formatting and communications. Interviewees did not believe the guidance added value to their Trust, and used other innovations that were similar to the NICE workplace guidance but better met their needs. My findings clearly demonstrate the importance of relative advantage to the diffusion of an innovation. Future NICE guidance should ensure that resources used to develop and implement a piece of guidance justify the potential added value over and above similar existing innovations