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Background
The basis of quality improvement (QI) is about giving healthcare staff the time, permission, skills and resources they need to improve services.1 QI requires both technical and relational skills2 and positive attitudes about innovation for collaborative change.3 However, decades of research evidence indicate healthcare staff behaviours can be a significant barrier to service improvement efforts and the adoption of innovation.4–6 Understanding staff attitudes to innovation would enable the use of appropriate strategies to deliver innovations effectively. Preliminary scoping of the literature did not identify any quantitative surveys, outcome measures or tools to measure staff attitudes towards innovation.
We define an attitude as an evaluative response to how favourably or not an individual is predisposed towards using a particular innovation. This predisposition is established by an individual’s belief about the consequences of using that innovation, which can be considered advantageous or disadvantageous.7 We defined an innovation as an idea, service or product, new to the National Health Service (NHS) or applied in a way that is new to the NHS, which significantly improves the quality of health and care wherever it is applied.8
This short report describes the early development and face validity of an outcome measure designed to assess the general attitudes among healthcare staff towards innovation.
Survey development and pilot
The development of the attitudes towards innovation survey (ATIS) was influenced in two ways, first the authors undertook a rapid review of available literature on the effects of staff engagement to drive change, and second, the experience of Wessex Academic Health Science Network (Wessex AHSN) which has a track record of supporting and evaluating innovation adoption.9 Both revealed the importance of staff engagement to implement innovation and the influence of individual, team and organisational attitudes.
Questions were developed and organised into four sections: ‘about you’, ‘your general views about innovation’, ‘your perception of your colleagues’ views about innovation’ and ‘your perception of your organisation’s position on identifying and using innovation’. The first section asks open questions that are later categorised, the remaining sections use five-point Likert scales (see table 1). ATIS structure and questions were reviewed by an expert panel at Wessex AHSN. A convenience sample of healthcare staff was obtained by contacting individuals involved in service evaluations administered by Wessex AHSN, through professional networks, and by inviting Wessex AHSN staff—many of whom are healthcare professionals. This sample piloted ATIS and completed a feedback survey via Microsoft Forms to assess face validity.
Mean scores for each question by sample group
A provisional scoring system was developed for the ATIS (see table 2), to include calculations of section scores and cut-offs for typologies of different attitude levels (ie, low, moderate, high and very high attitudes towards innovation).
Mean score for ATIS sections
Results
In total, between July 2022 and January 2023, 87 respondents completed ATIS. This included 36 staff across four general practices in Hampshire, 29 Wessex AHSN staff and 22 staff from four NHS trusts. Of the 87 respondents, 56.3% (n=49) were aged under 45; 56.3% (n=49) had worked under 13 years in the health system; 51.7% (n=45) had worked under 4 years in their current organisation; and 74.7% (n=65) had worked under 4 years in their current organisational role (see extended online supplemental table 2).
Supplemental material
Assessing staff attitudes
Using the provisional scoring system, it is possible to develop ‘attitudinal profiles’ of the respondents overall, by staff type and by demographic factors. Table 1 reports mean scores per question. Statistical analyses were not conducted due to sample size; however, the data indicate staff from NHS trusts had the lowest scores on several questions compared with the other staff types. Scores under 2.0 on questions about capacity and capability (personal and organisational) to support innovations show the extent to which they believe colleagues lacked confidence to implement innovations. Likewise, they were concerned about organisational infrastructure maturity, and the financial ability to support innovations identified.
Table 2 reports the mean scores for ATIS sections. In the personal attitudes section, staff from NHS trusts had the lowest mean score compared with other groups. However, the whole sample and all staff types were categorised as having ‘high’ attitudes towards innovation. Interestingly, the previous experience score (see extended online supplemental table 2) was also lowest for NHS trust staff, suggesting that general attitudes towards innovation are possibly influenced by previous experience with using and adopting innovation.
ATIS development feedback
Twenty-seven of 87 respondents completed the online ATIS feedback survey. Evaluative questions focused on the purpose, acceptability and comprehensiveness of ATIS and used Likert scales (see figure 1). Nearly all (95%) staff either ‘strongly agreed’ or ‘agreed’ to all the evaluative questions, when combining these two response options. Free text feedback led to several minor changes to wording and question order.
Feedback on the purpose, acceptability and comprehensiveness of ATIS. ATIS, attitudes towards innovation survey.
Conclusions
ATIS obtained an encouraging level of face validity from several cohorts of healthcare professionals engaged in the identification and adoption of innovation. Attitudinal profiling has the potential to be used in several ways. First, to increase organisational leaders’ awareness of their innovation landscape, how attitudes may vary between staff roles and location, and support conversations about innovation culture. Second, to support transformational change and decision-making through a one-off assessment during an innovation adoption project. Third, to support research activity comparing changes in staff attitudes over time as interventions are deployed.
A psychometric assessment of obtained ATIS data, alongside data from other measures and further respondent feedback, will ensure that internal, convergent and discriminant validity, and inter-rater and test–retest reliability is examined. This assessment will ensure the question scoring system is appropriate and determine what might be a meaningful change in staff attitudes towards innovation.
Ethics statements
Patient consent for publication
Ethics approval
This study was considered a service evaluation and so did not require NHS ethics approval. Best practice for obtaining informed written consent during surveys was undertaken.
Acknowledgments
We would like to thank the healthcare staff who took the time to complete and review the ATIS. Thank you to Dr David Kryl, Director of Insight, Wessex AHSN for reviewing the draft and Charlotte Forder, Associate Director of Communications for proofing the manuscript.
Supplementary materials
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
Contributors AS led on the writing and submitted the manuscript. RB, JC and PD contributed to the manuscript. All authors reviewed and responded to peer review comments and agreed on the submitted manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Authors note ATIS is available under licence from Wessex AHSN. Options for use: (1) ‘Licence’ - free to use, with agreement to share anonymised data collected from your survey with Wessex AHSN, (2) ‘Licence+ Training’ - support to use, (3) ‘Licence+ Co-delivery’ - administration and analytical support from Wessex AHSN, to be agreed on an individual basis. Please contact Wessex AHSN for details on the use of this survey.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.