Achieving equilibrium is a tricky thing when attempting to introduce digital innovation to large organisations. There are many different paces to manage; so many different interests to consider; and so many pot holes to fall down. Just when I think we’ve got one thing in balance I look over my shoulder and something else needs adjusting.

If I were to hold a virtual spirit level to our mHealthHabitat programme I’d rarely see a balanced horizontal line. Here are a four learning points from our first six months:

Tactics versus strategy

We began our mHealthHabitat programme by doing stuff – finding pockets of interest and enthusiasm, supporting bright ideas, learning through experience, making mistakes and doing it differently next time. Doing is very important – it is grounded, it engages people and it generates evidence about what works and what doesn’t. But it is not enough. You also have to create a receptive context as well as alignment with organisational strategy if your innovation is to be sustainable. A beautiful strategy but no doing is another trap.  Doing and strategising need to be kept in constant equilibrium with one informing the other and back again. Keeping both in your line of vision are critical but it’s easy to lose sight of one or the other.

Internal versus external

Innovation often emerges when diverse perspectives enable us to see a problem differently and find an unexpected solution. Digital innovation requires not only different perspectives but very different skills sets, language and styles of communication. An internal NHS orientation focuses on building awareness and enthusiasm within organisational channels, and engaging with clinicians and managers in ways which are meaningful to them. An external orientation with developer and designer communities has its own norms and expectations – often much less formal. Industry want one thing and academics another. Not only do you need to build awareness and relationships with very different people, but you need to find ways to bring them together. Our Show and Tell events are one way in which we are doing this but we are learning that you need to do this in many different ways.

Agile versus organisational process

Digital innovation is often orientated around agile methods – start small | play | prototype | iterate – be nimble and light so you can fail fast and move on. This is rarely how NHS Trusts work for all sorts of complex reasons that I won’t expand on here. The benefit of a large organisation is that you have tons of functional expertise at your disposal – from information technology through to contracting and governance. The downside is that each of those functions has their own pressures and priorities. Your priority might not be theirs but you cannot progress without their support. Keeping pace and avoiding getting lost in process is a constant balance and requires relationships with all sorts of different people to get things done.

Citizen versus clinician

I’ve saved the most important balance until last. Digital innovation is not an end in itself – it’s an enabler to support people to improve their health, their wellbeing and their lives. It has to solve the right problems and that can only be done by involving the right people from the outset and at the centre of the entire process – citizens. Digital tools must be acceptable and appealing if they are going to be used. Creating an app with worthy aims but rubbish functionality or design will fail. We are finding that the priorities and preferences of people accessing a service and people providing that service can be very different and these need to be negotiated. Always start with what’s important to the person and build in the clinical second.

So four of our learning points so far are:

• Keep tactics and strategy in balance
• Keep your internal focus and your external focus aligned and over time bring them together
• Smooth organisational bureaucracy to create space for innovation
• Recognise that preferences of citizens and clinicians are often not the same and always start with the former.

We are only six months in to our programme so our learning points are all at the front end of digital innovation – we haven’t even got to issues of deployment and spread yet. Do these chime with you or do you have different learning points? I’d love to hear about other challenges people have experienced introducing digital innovation to large organisations.