My 4 Questions That Predict Technology Adoption Success in the NHS

Four questions that predict technology adoption success in the NHS: insights from funding healthcare innovation pilots

Sep 04, 2025

Welcome to the sixth installment of Chai With Aditya. This week’s post is bit late - I’ll be back on schedule next week. I will be changing up the cadence for a couple of months as I have a few big projects in the works which will be teased through the posts, and so I’ll be posting once a week.

I was working at NHS England and was reviewing applications from Trusts and ICBs for funding pilots for the cardiovascular disease Rapid Uptake Products Programme. I started to notice a pattern - the applications with the most promising sustainable returns and scalability were ones without flashy applications, a clearly articulated go-to-market strategy and generally speaking the return on invested cash was easy to follow. Reflecting on this, I realised that scaling success had little to do with technical sophistication, but four specific organisational factors which hinges on organisational readiness. To help predict if a project or a technology would scale in the NHS, I have developed four questions which can help to predict which projects can scale and which will remain expensive proof of concepts.

To many these questions won’t be groundbreaking, yet time and again, companies which don’t meet these and want to scale the NHS have received funding. While many others which do meet them aren’t funded. There might be more going there, but it’s still a noticeable issue.

Question 1: Operational integration - Does the innovation fit existing clinical workflows?

Technical brilliance means little if they disrupt the existing workflows. I remember coming across a grant application which could use case finding algorithms built into the EPR to identify patients who could benefit from cardiovascular prevention. On its face, the idea is clinical and technically sound. The issue was the nurse was required to check an additional dashboard and make at least 3 extra phone calls per shift – a shift with so many patients that eating lunch is sometimes considered time poorly spent. Instead, the staff had identified a workaround to this approach and instead opted for a different method of identifying patients.

What the application didn’t appreciate or perhaps glossed over, was a detailed understanding of the clinical workflow, and the existing pressures on clinical staff.

Therefore the killer question to explore if the innovation fits an existing clinical workflow is: Can you show me exactly how this fits into a typical clinical workflow without adding steps, screens, or decisions that didn't exist before?

Question 2: Change management capability - Does the trust have the infrastructure to implement this?

Organisational readiness trumps technical readiness all day, every day. The applications which succeeded came with a realistic understanding of project management requirements, governance and how they would build capacity. The which ones which didn’t were ones with unrealistic expectations, or a perceived lack of engagement to undertake the kind of systemic change we were after. I learned to look for evidence of implementation realistic implementation capability, not just clinical or management enthusiasm.

From my own implementation understanding, there is little thought in Trusts to make such capacity available given the current fiscal pressures. However the reality is if you want something done properly, you need the resourcing to deliver it as is. Running projects on a shoestring budget while expecting Atlantis to be recreated is foolhardy.

Therefore the killer question to explore change management capacity is who in your organisation has protected time to manage this implementation, and what is their track record with previous technology adoptions?

Question 3: Evidence Generation and Scalability - Can you demonstrate impact beyond the pilot?

Pilots which can’t prove value don’t survive. From the pilots I submitted to the equivalent of the Investment Committee, the best funded projects had defined measurable outcomes. They were able to demonstrate value beyond clinical outcomes – operational impact too, such as improved patient flow, measurable efficiency gains, and improve staff productivity.

But what most VCs and startups miss is the transferability problem in the NHS. Most pilot data comes from digital exemplar Trusts - those with established data infrastructure, dedicated project management resources, and the analytical capability to generate evidence. However, these Trusts represent a minority of the NHS.

When a startup shows me impressive results from a digital exemplar site, I now ask a harder question: how will you replicate these outcomes at a typical district general hospital with legacy IT systems, overstretched management, and no dedicated data analytics team? The Trust that generated your evidence probably has resources that most potential adopters lack.

This creates a credibility gap that often kills scaling. Senior Managers and Clinicians at your standard resource constrained Trust often will look at the evidence and see it comes from a digital exemplar and think “this isn’t our reality” and so dismiss adoption. They’re not wrong, as more times than not, there’s no additional staffing for innovation – if anything its how can you cut staff. The innovation environment doesn’t exist as in digital exemplar Trusts it does.

The projects which scale have figured out how to generate evidence using the limited measurement capabilities that most NHS trusts actually possess. They focused on metrics that could be captured with existing systems and didn't require dedicated analysts to interpret.

The killer question: Can you demonstrate measurable operational impact in a trust that doesn't have digital exemplar resources and infrastructure?

Question 4: Financial Sustainability - Will this continue after pilot funding ends?

The graveyard of healthcare innovation is filled with successful pilots that couldn't find sustainable funding. The reality of many pilots and startups is the issue of funding and financial viability beyond the pilot phase. Projects or startups that scaled understood their sustainability strategy in detail, including where ongoing funding would come from within existing NHS trust budgets.

I remember speaking to one project lead about how they planned to make their innovation sustainable. The response back was the one I wanted – the funding stream had already been identified and staff had been given protected time to deliver this. The cost savings had been identified and some of which would be reinvested back to develop sustainability. Finance already had buy in, and didn’t rely on “innovation budget” which some startups had said to me…Trusts don’t have such budgets.

The ones that failed had what I call a "proof of concept" mentality - believing that demonstrating clinical benefit would automatically lead to continued funding. This is a dangerous assumption in cash-strapped organisations where every pound spent on innovation is a pound not spent on immediate operational pressures.

The successful projects had answered three specific financial sustainability questions: What does this cost to run annually after pilot funding ends? Which existing budget line can absorb this cost? And what measurable savings or efficiency gains justify that ongoing expenditure to a finance director under budget pressure?

The killer question: What's your pragmatic annual running cost after pilot funding ends, and which specific budget line in a typical NHS trust will fund this - and why will they choose this over other competing priorities?"

This approach gives concrete NHS financial context while maintaining your authentic voice and experience-based authority.

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Strategic Implications for Health-Tech Companies

From my experience speaking to startups and assessing grants, many times the wrong problem is being solved. The focus on building better technology seems to cloud solving adoption challenges. The companies which succeed in the NHS are ones which understand how to use system inertia to their benefit.

Rather than fighting existing workflows and system inertia, they design solutions that make current processes easier rather than different. Instead, they adapt their technology to how the NHS already works. True transformers understand that their real competition isn't other algorithms - it's the spreadsheet, the phone call, or the informal workaround that clinical and operational teams are already using.

The most successful health-tech companies I've worked and spoken with also recognise that NHS adoption decisions aren't always made by early adopters or innovation enthusiasts. They're made by pragmatic operational managers who need to justify every expenditure to finance directors under constant budget pressure. These companies spend as much time understanding the complex NHS procurement cycles and budget structures as they do perfect their algorithms.

Practical Application

For health-tech companies entering or scaling in the NHS: these four questions reveal whether a Trust is genuinely ready to adopt your solution or just interested in an interesting pilot. More importantly, they help you identify the organisational gaps that need addressing before your technology can succeed. This is important when the all important contract renewal is coming up and its found that the technology hasn’t been used because the clinical teams have developed workarounds.

For NHS leaders evaluating new solutions: these questions help separate technologies with realistic implementation prospects from those destined to remain expensive proof-of-concepts.

For investors in health-tech: understanding these adoption dynamics explains why some NHS-focused companies scale while others remain stuck in never-ending (free) pilots, despite having superior technology.

Conclusion

The NHS innovation landscape is filled with technically brilliant solutions that never scaled beyond their initial pilot. Having managed funding for pathway improvements and tracked their outcomes, I'm convinced that adoption success has less to do with algorithm sophistication and more to do with organisational readiness for sustainable change.

The solutions that stick are those that solve real operational problems in ways that make clinical teams' lives measurably better, without requiring organisational infrastructure that most NHS trusts simply don't have.

These adoption dynamics are exactly what I find most interesting to work on with organisations trying to navigate healthcare technology implementation challenges.

What's the most important non-technical factor you've learned to assess when evaluating whether a healthcare innovation will actually stick beyond the pilot phase?

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