Blog: Why do we need social legitimacy before introducing an innovation?

At the Innovation Agency, our purpose is to identify innovations which can improve health and create efficiencies – and help to spread them at pace and scale. 

We are involved with a large number of projects and each of them has its idiosyncrasies! 

We find that implementing an app is very different from introducing new technology and each project is unique in the issues to be overcome. We regularly find that some innovations are introduced based on light evidence and seem to slot into place fairly easily, while some evidence-heavy products seem to be impossible to establish.

Research by Carter et al (2017) suggests that authority (provided through evidence) does not necessarily command social legitimacy (which is provided by the people who are implementing it). We saw this come into play when we* started looking in more detail at why a NICE approved medicine called Nalmefene was not being taken up. Nalmefene, delivered along with psychological support is a way of reducing alcohol intake in those who drink too much.

Social legitimacy helps to smooth the path of many of the essential but time consuming activities such as setting up effective working groups, seeking clarity on how services should be delivered, planning and pathway development and sorting out financial issues.. However in our research we found that there was a fundamental mistrust of Nalmefene as a product, despite robust evidence about its efficacy.

Alcohol and other addictions are very value laden conditions and those who plan addiction services may unknowingly exert a subtle influence based on their own limited understanding. Former Government drugs tzar David Nutt had a strong message for the NHS about this lack of understanding:

“At all levels the NHS and other staff involved in the implementation of NICE Technology Appraisal 325 were found wanting. There were issues of cynicism over the value of reducing drinking because the mindset of abstinence-only outcomes pervades many alcohol services.

“Also, the profound value of investment in alcohol treatment is poorly understood by many in healthcare provision, probably because so many people drink above the recommended limits. Finally, the complexity of service provision when so many different stakeholder groups are involved is intimidating; without committed treatment champions it is unlikely any new interventions will be introduced with dedicated funding.”

We are familiar with many of the complexities in service provision; but we should also be aware that each innovation we try to implement may well come with a large unwritten sub-text which will influence the adoption of the innovation as much, if not more than, any technical issues.

The full report, including learning points and recommendations, can be found here.

*Our collaboration consisted of the Innovation Agency, Oxford AHSN and MGP.

Dr Julia Reynolds

@JulsReynolds