Attitudes towards innovation survey: early development of a structured method for assessing staff views

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.

Table 1.

Mean scores for each question by sample group

ATIS section	Questions*	Whole group (n=87) Mean score (SD)	General practice staff (n=36) Mean score (SD)	NHS Trust staff (n=22) Mean score (SD)	Wessex AHSN staff (n=29) Mean score (SD)
Your general views about innovation	I’m open to taking risks and implementing something new, if there is a chance of achieving better care for patients	3.2 (1.0)	3.3 (0.7)	2.8 (1.4)	3.2 (0.8)
	I’m open to taking risks and implementing something new, if there is a chance of improving efficiencies in the way we work	3.2 (1.1)	3.4 (0.9)	3.0 (1.3)	3.2 (0.8)
	I’m confident in my ability to weigh up the pros and cons of implementing something new, before deciding whether to move forward	2.9 (0.9)	3.0 (0.7)	2.5 (1.1)	3.0 (0.8)
	I prefer to support what is known to work for patients rather than try something new†	2.4 (0.8)	2.2 (0.9)	2.5 (0.7)	2.6 (0.7)
	I have the personal capacity to support innovation in my working context	2.6 (1.0)	2.9 (0.8)	1.9 (1.1)	2.8 (1.0)
	I feel capable enough to support innovation activities	2.6 (1.0)	3.0 (0.7)	1.8 (1.1)	2.8 (0.9)
Your perception of your colleagues’ views about innovation	I believe staff in my organisation are open to implementing innovations	2.6 (0.9)	2.7 (0.7)	2.6 (0.8)	2.6 (1.1)
	I believe staff in my organisation generally have the confidence to implement innovations	2.4 (1.0)	2.6 (0.7)	2.1 (1.1)	3.3 (1.1)
	I’m confident in the ability of my colleagues to collectively weigh up the pros and cons of implementing something new, before deciding whether to move forward	2.6 (0.9)	2.9 (0.6)	2.6 (1.2)	2.3 (0.9)
	I believe staff in my organisation generally have the capability to implement innovations	2.7 (1.0)	2.8 (0.8)	2.6 (1.3)	2.6 (0.9)
	I believe staff in my organisation usually have the capacity to support the implementation of innovation	2.2 (1.1)	2.7 (0.7)	1.9 (1.2)	2.8 (1.2)
	I believe staff in my organisation are usually able to adapt innovations to suit local needs	2.6 (0.9)	2.9 (0.5)	2.4 (1.0)	2.5 (0.9)
	I believe staff in my organisation are usually clear on the value of innovations	2.4 (0.9)	2.8 (0.5)	2.0 (1.0)	2.3 (1.1)
	I believe staff in my organisation are usually clear on who needs to use innovations	2.2 (0.8)	2.6 (0.6)	2.0 (0.8)	2.8 (0.8)
	I believe staff in my organisation are usually clear on the types of activities needed to make innovations work for us, and have sustained use	2.4 (0.9)	2.7 (0.6)	2.3 (0.9)	2.5 (1.0)
	I believe staff in my organisation generally assess how innovations are being used (if they’re working and having a positive impact, or not)	2.5 (1.0)	2.7 (0.6)	2.2 (1.1)	2.3 (1.1)
Your perception of your organisation’s position on identifying and utilising innovation	I believe leadership support is available to support innovations	2.9 (0.9)	3.0 (0.7)	2.9 (0.6)	2.8 (1.1)
	I believe the infrastructure (eg, I.T., Information Governance, procurement etc) is mature enough to support innovations	2.5 (1.0)	2.8 (0.6)	2.0 (1.1)	2.4 (1.2)
	I believe my organisation supports individual staff that identify innovations	2.7 (1.0)	3.0 (0.7)	2.3 (1.0)	2.6 (1.0)
	I believe my organisation is constantly on the look-out for innovations	2.7 (1.0)	2.7 (0.9)	2.7 (0.7)	2.7 (1.1)
	I believe my organisation has a clear decision-making structure to choose innovations	2.3 (1.0)	2.4 (0.8)	2.4 (0.9)	2.5 (1.2)
	I believe my organisation usually has the capacity to support innovation	2.5 (0.9)	2.6 (0.8)	2.4 (0.7)	2.4 (1.1)
	I believe my organisation usually has the financial resources to support the adoption of innovation	2.3 (0.9)	2.4 (0.7)	2.0 (0.7)	2.5 (1.0)
	I believe my organisation has a review process to show whether an innovation was successful or not	2.4 (0.8)	2.6 (0.7)	2.4 (0.6)	2.6 (1.0)

*All questions scored: strongly disagree=0, disagree=1, neutral=2, agree=3, strongly agree=4, missing values scored neutral=2. Scoring range per question: 0–4.

†Question is reversed scored: strongly disagree=4, disagree=3, neutral=2, agree=1, strongly agree=0, missing values scored neutral=2. Scoring range per question: 0–4.

ATIS, attitudes towards innovation survey; NHS, National Health Service.

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).

Table 2.

Mean score for ATIS sections

ATIS section	Whole group (n=87) Mean score (SD) and (attitude level)	General practices staff (n=36) Mean score (SD) (attitude level)	NHS Trusts staff (n=22) Mean score (SD) (attitude level)	Wessex AHSN staff (n=29) Mean score (SD) (attitude level)
Personal attitudes towards innovation*	16.9 (4.2) (high)	17.9 (3.3) (high)	14.4 (5.2) (high)	17.6 (3.6) (high)
Perception of team/colleagues’ attitudes towards innovation†	24.7 (7.9) (high)	27.5 (4.6) (high)	22.6 (9.1) (high)	22.7 (9.0) (high)
Perception of my organisation’s attitudes towards innovation‡	20.1 (5.0) (high)	21.4 (4.2) (high)	19.1 (2.9) (high)	19.3 (6.5) (high)

*Section total score range: 0–24 with higher scores indicating more positive attitudes towards innovation. Low attitudes towards innovation=score between 0 and 5; moderate attitudes towards innovation=score between 6 and 11; high attitudes towards innovation=score between 12 and 17; very high attitudes towards innovation=score between 18 and 24.

†Section total score range: 0–40 with higher scores indicating more positive attitudes towards innovation. Low attitudes towards innovation=score between 0 and 9; moderate attitudes towards innovation=score between 10 and 19; high attitudes towards innovation=score between 20 and 29; very high attitudes towards innovation=score between 30 and 40.

‡Section total score range: 0–32 with higher scores indicating more positive attitudes towards innovation. Low attitudes towards innovation=score between 0 and 7. Moderate attitudes towards innovation=score between 8 and 15. High attitudes towards innovation=score between 16 and 23. Very high attitudes towards innovation=score between 24 and 32.

ATIS, attitudes towards innovation survey; NHS, National Health Service.

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).

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.

Figure 1.

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

Not applicable.

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.