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A common-sense, practical innovation that improves patient care

An interview with Dr. Sam Hare

Thursday, June 2, 2016

  • Dr. Sam Hare is a consultant chest radiologist at Barnet Hospital, part of the Royal Free London NHS Foundation Trust. He is also a lead radiologist for the London Cancer lung pathway board

  • Sam currently runs the innovative ambulatory lung biopsy service at the Royal Free which has been acknowledged as providing earlier lung cancer diagnosis for a wide range of patients

  • The novel service was awarded the inaugural NHS Innovation Challenge Prize for Cancer Care in 2016 in addition to the 2016 BMJ Award for Cancer Care Team of the Year (sponsored by Macmillan Cancer)

Hi Sam. Congratulations to you and the team at Barnet Hospital on your recent achievement.

Respiratory Futures is keen to share the story behind great innovations, such as your new approach to performing lung-biopsies. We recognise that some of the best ideas simply use an existing idea differently whilst others originate from the forefront of pioneering digital technologies.

‘Innovation’ is quite a broad term. As one of today’s recognised healthcare innovators, where do most of the best ideas for improving patient care come from?

Medical treatments have made extraordinary advances over the years. The packaging and delivery of these treatments is, however, often inefficient and frequently lacks true patient focus.

In terms of innovation, the best ideas are usually not re-inventions of the wheel – rather a willingness to employ common-sense, practical techniques already being performed elsewhere. In my opinion, borrowing a good idea and improving upon its implementation is what constitutes effective innovation.

Tell us a little more about what drove you to develop ‘the Barnet model’ specifically?

My year of chest radiology training in Canada allowed me to appreciate gold-standard lung cancer diagnosis through new eyes: a simple, innovative method of performing lung biopsies that does not require hospital beds but at the same time enables sampling of the smallest lung cancers with improved patient experience.

We owe it to our patients to think differently and look at new ways of achieving earlier diagnosis. That’s always been the goal.

When an absolute ‘no-brainer’ solution to a longstanding NHS conundrum stares you in the face - you just drive without even having to question it.

Did you have a single turning point, a creative epiphany when the solution presented itself, or was the process more incremental?

Honestly, we just started doing it. Having seen it work so seamlessly in Canada I knew it was the way to go. From then on it was an incremental build up. However, I realised that we could make a much wider impact through publication of our work. Hence we diligently collected concurrent outcomes data.

The publication of the ambulatory lung biopsy study in Thorax was the real turning point in terms of being able to spread our message to a national audience: this works in the NHS and there is indeed a better way of doing lung biopsies.

How closely were your patients involved, and were you able to use their feedback to further refine your lung biopsy approach? Is it still evolving?

Very much involved. Their feedback and experience has allowed us to refine the protocols and keep improving.

In particular, I would like to highlight those patients who had already had lung biopsies previously under the conventional method, some of them ending up hospitalised for days with a post biopsy pneumothorax. This group were extremely powerful advocates for our streamlined technique.

Heimlich valve
Heimlich valve

“Why can’t all patients just have access to this small drain?” – this very simple question was asked by one of our patients a few years ago. This inspirational lady with early lung cancer was also the sole carer at home for her disabled husband. Our innovation allowed her to go home and continue caring for him despite a collapsed lung after biopsy. Some months earlier she had ended up hospitalised for 3 difficult days, connected to a bulky painful drain, after suffering the same complication at another NHS Trust. This had also meant major difficulties trying to organise care for her husband while she was in hospital.

There is no bigger motivation to driving innovation than improving patient experience and outcomes.

How important is it for successful innovators to be good team players?

It’s crucial. Teamwork is central to a successful NHS, with all members pulling together to deliver the best care for patients. Teamwork is also vital to improve training of colleagues to deal with new challenges that innovation can inevitably bring.

It’s critical to distinguish between ideas that are ‘fashionable’ rather than true improvements.

Fundamentally, effective innovation is a social process. That’s the medium through which change can be successfully implemented. Being a team player therefore enables engagement with colleagues in the wider NHS. This is essential for national adoption of such innovations to be achieved.

In a climate of digital innovation, what do you think we can we learn from previous generations of healthcare innovators?

Innovation is often more about practical service delivery, where the needs of the patient are the focal point. It’s critical to distinguish between ideas that are ‘fashionable’ rather than true improvements. Our innovation has no digital component – much like the great innovations from the past.

It’s important to remember therefore that innovation comes in many guises – what we can learn is how important it is that we recognise a good one when it comes along.

In what, if any, way does healthcare innovation (or do healthcare innovators) differ from other entrepreneurship?

The major difference is our goal. Entrepreneurship is often driven by economic gains and profit margins. In contrast, healthcare innovation is often driven by a determination to improve patient outcomes and experiences – and usually needs to be aligned with resource savings: this is inherently much more difficult to achieve.

Whatever the context, what are key qualities or characteristics shared by most successful innovators?

Determination, vision and resolve. One has to have the focus to arrive at the destination, even in the face of sceptics who prefer ‘tried and trusted'. Successful innovators embrace and relish change – even when knowing that change in the NHS can be slow and difficult to achieve.

How important is it to strike a balance between determined-tenacity and being flexible and open minded when you’re developing a new healthcare solution? What qualities do you need to succeed?

It’s essential to be open-minded for sure, especially if what is being piloted isn’t going to plan. Yet, this must go hand-in-hand with single-mindedness when it’s clear that the solution is for the greater benefit of patients. In that sense it’s important always to visualise the destination – this approach helps overcome obstacles that may arise on the journey.

What would you say has been the greatest hurdle along the way? For example, has this been around investment or simply about finding the time necessary to reach your goal?

Attitudes and mindset. The evidence for good practice and innovation is frequently already out there, especially internationally. Yet we often get bogged down in small details rather than appreciating the bigger picture. That is often why we just do what we have always done without asking if there actually may be a better way.

Heimlich valve
Sam and colleagues at the 2016 BMJ Awards

Lung cancer outcomes remain poor in the UK principally due to late diagnosis. That’s our big picture – and has been for years. We therefore owe it to our patients to think differently and look at new ways of achieving earlier diagnosis. That’s always been the goal.

Finally, what’s next?

We now have a platform upon which to keep building. This must be about more than just the population served by the Royal Free London NHS Trust. This has to be about all NHS patients without geographical boundaries. The awards and accolades we have received will mean so much more if we can drive wider NHS adoption of the Barnet ambulatory lung biopsy model.

Our focus now lies in leading a national rollout of the technique so that all NHS patients may benefit, and to that end we aim to setup a national lung biopsy registry.

Thank you Sam, good luck and we look forward to hearing how the rollout goes.


Read the Thorax publication of the Ambulatory percutaneous lung biopsy with early discharge and Heimlich valve management of iatrogenic pneumothorax: more for less

Find out more about the team's success at the BMJ Awards 2016 and NHS Innovation Challenge Prize for Cancer