There has been great optimism about the scope of micro-enterprises to deliver innovative care (Putting People First, 2007; DH and NAAPS, 2009; DH, 2010). This stems from the suggestion that the informal and often fluid nature of micro-enterprises mean that they can be more creative and flexible than large providers and less bounded by traditional service demarcations (Lockwood, 2013). This chapter considers how far those claims are credible. It focuses on innovation as the second of our two measures of process, which locates it in the black box between inputs and outcomes. The main data source for this chapter is the interviews with people running micro-enterprises, although we do also draw on interview data from people who use services where they drew attention to innovative aspects of care.

Measuring and defining innovation is a complex process and many different definitions of innovation have been put forward by academics and practitioners, as discussed in Chapter Two. As with personalisation, the process of undertaking the research allowed us to develop a better understanding of the types of innovation that were apparent in care and support. After a first phase of coding in which we categorised all aspects of innovative practice together, we proceeded abductively to reanalyse the innovation data using the innovative and policy literature to help refine innovation categories. In the next phase of coding, we separated out what innovations, how innovations and who innovations. The first two of these categories came from existing innovation literature, whereas the third emerged from the claims about micro-enterprises that are made in the policy literature, discussed further below.

Types of innovation

Definitions of innovation often stem from the business literature and are particularly focused around ‘product’ innovation, that is, the production of new types of goods or services (Williams, 2010). Within a healthcare setting, product innovations tend to be associated with a new technology or treatment (Pearson and Rawlins, 2005). Product innovations are also central to generating incremental revenues for many organisations, including in healthcare (Omachonu and Einspruch, 2010). Product innovations therefore refer to what is produced or delivered, and here we refer to it as a what innovation.

An alternative form is ‘process’ innovation, which refers to how a service is delivered and normally includes the introduction of new organisational structures or improved organisational practices (Edquist et al, 2001).