This page will help you to understand questions such as:
- What are the key stages of innovation adoption in the NHS, and what happens at each stage?
- What evidence is needed to move from pilot to adoption, and from adoption to scale-up?
- Who are the key decision-makers involved at each stage of the adoption process?
- What factors influence whether an innovation successfully scales across NHS settings?
- How can I plan my implementation approach to support long-term adoption and scale-up?
What are the adoption stages of innovations in the NHS?
In discussing adoption of innovations, it is assumed that these have already obtained relevant regulatory requirements and address a specific market need. Most successful innovations move through what we can simplify as three broad stages: pilot, adoption, and scale‑up, each with different objectives, evidence requirements, and decision‑makers. Note that there are various more granular stages that can be found as part of innovation adoption theories.
Stage 1: Pilot
Typically, a time-limited trial in one or more NHS settings, designed to test feasibility, acceptability and early impact. Pilots are often used to:
- Validate that the innovation addresses a real operational or clinical problem
- Test usability, safety and workflow fit
- Generate early real-world evidence
To move beyond pilot status, innovators should:
- Agree success criteria and next steps at the start of the pilot.
- Collect evidence that matters to decision‑makers (for example, cost pressures, capacity, safety, workforce impact), ideally supported by independent evaluation to add credibility, reduce perceptions of bias, and provides NHS decision-makers with greater confidence that the innovation’s benefits are real, robust, and transferable beyond the initial pilot.
- Identify a named senior sponsor accountable for adoption decisions, alongside local champions.
- Align outcomes to local and national NHS priorities.
Ultimately, to move beyond pilot status, the innovation need to showcase its benefits and value proposition through real-world evidence. A pilot should not be treated as a standalone test, but as the first step towards a clear adoption decision. Innovators should agree at the outset what the pilot is intended to prove, what evidence will be collected, who will review the findings, and what decision will be made at the end. This helps avoid situations where a pilot is viewed positively but does not progress because the evidence, ownership, or route to funding has not been defined.
Stage 2: Adoption
Adoption occurs when an NHS organisation makes a decision to continue using an innovation beyond the pilot, typically with allocated funding and ownership. At this stage, the focus shifts to:
- Demonstrating consistent value and outcomes
- Embedding the innovation into routine pathways and workflows
- Clarifying governance, accountability, and ongoing support
Adoption decisions are typically influenced by clinical leaders, operational managers and commissioners working together.
To move beyond adoption to scale-up, innovators should:
- Demonstrate that benefits are replicable across services and/or settings. This could be done through multi-site health economic modelling and analysis.
- Show interoperability with existing digital and clinical systems
- Plan for training, support, and operational handover
- Adapt implementation (if necessary) while maintaining core effectiveness
- Identify long-term sources of funding e.g. long-term procurement/reimbursement approaches or short-term grant funding
Successful scaling often depends as much on implementation capability as on the innovation itself. Ensure that you understand how to prepare an innovation for adoption.
Stage 3: Scale-up
Scale-up means expanding adoption across multiple sites, services, or systems. For example, across a trust, Integrated Care Board (ICB), or nationally. Scaling requires:
- Strong and transferable evidence of impact
- Adaptability across different organisational contexts
- Sustainable funding and procurement routes
Many innovations fail at this stage due to variation in local readiness, workforce culture, operational differences, senior leadership, staff buy-in, workforce capacity, and so on. Ensure that you understand how to prepare an innovation for scale-up.
Overall, understanding the stages of innovation adoption in the NHS is essential for moving beyond initial testing to widespread implementation. Each stage: pilot, adoption, and scale-up, has distinct objectives, evidence requirements, and decision-makers, with increasing emphasis on demonstrating real-world impact, consistency, and sustainability. Successfully progressing through these stages requires strong evidence, alignment with NHS priorities, and careful planning for implementation and expansion.