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How to TRANSL8© innovation

Brigadier Professor Tim Hodgetts CBE PhD MMEd MBA

Medical Director, Defence Medical Services

Early innovation adoption has been a key component of the clinical advances within recent combat operations. The internal organisational conditions to support this in Defence have been captured and described within the concept of ADOPTER©.

In parallel, history identifies that advances in military medicine during war are frequently translated into wider civilian healthcare benefits in peace. But what are the conditions that support the translation of innovation from one health sector to another, and how can an awareness of these factors potentially accelerate the translation process? These conditions for translation are described within the concept of TRANSL8©.

  Transformational leadership. This requires leadership to drive a combination of culture, clinical practice and governance change. It can be effectively, but not necessarily exclusively, applied by experienced military clinical staff embedded within host NHS Trusts and/or 3rd sector healthcare delivery organisations (such as the charity air ambulance network). The central leadership characteristics are to inspire others to change and to provide the decisiveness and determination for success.


Relevance of the innovation. This represents the wider need. War has been the catalyst to develop medical diagnostics, treatments and preventive interventions that have immediate crossover application to the same illnesses or injury patterns seen in civilian healthcare. The innovation may, however, be environmental specific and while remaining relevant for transfer to military allies and/or NGOs and/or the international healthcare community it has little direct transferability to NHS. An example of high relevance for translation has been the personal protection and clinical treatment guidelines for managing Ebola virus in West Africa in 2014-2015.

  Adaptability of the innovation. This represents the adjustment required. Some innovations will require no adjustment and can be directly transferred: the use of the 'AT MIST' message developed within UK military and now widely applied by civilian ambulance services is one example (see box). The use of limb tourniquets has undergone a resurgence in contemporary combat casualty care: an adaptation for civilian use has been to produce a high visibility orange version.                                    







Time of injury





Mechanism of injury




Injuries found or suspected








Treatment given



'AT MIST': a military message widely adopted by the civilian community

  Networks for innovation. An extensive network of military clinical experience exists in the NHS within the Regular and Reservist communities. Specific concentrations of civilian-military integration exist in those NHS Trusts that are partnered with the Defence Medical Services to host the Regular personnel. This network represents an inkblot phenomenon (see figure) for innovation translation. Over time, the inkblots may coalesce to demonstrate a genuine nationally exploited benefit. While military personnel embedded in the NHS are the natural source from which translation can begin, this is not exclusive. Innovation can occur in any location when there is knowledge of the benefit and military clinicians are actively engaged in publicising the potential benefits (for example, through conference presentations, journal articles and textbooks). Strategic innovation influence networks also exist through integration of senior military clinical staff within Royal College committees, university academic departments and NHS decision bodies.




Simplicity and Sustainability. This represents the practicality. Simple innovations have been readily transferred: these have been based around control of external bleeding and include the topical haemostatic agents. Concepts that demand step change in process and/or infrastructure and substantially challenge the status quo have been adopted less comprehensively, such as 'right turn resuscitation' (the concept of taking the most seriously injured directly from the helicopter or ambulance to the operating theatre, bypassing the Emergency Department). 'Haemostatic resuscitation' (in particular, the administration of blood products in pre-hospital care), is not a simple process to adopt logistically or from a regulation perspective, but the perceived value of this intervention has led to substantial effort to overcome the practical challenges. 

Life-changing outcome for the patient. This constitutes the value. If there is no perceived substantial benefit to the patient, then there is no real value in translating the innovation. Conversely, new concepts, technology advances and organisational changes that have saved lives in the military operational setting can save lives in the civilian setting-the transformational approach to managing the coagulopathy of severe injury is one example, as are the advances in prosthetics for traumatic amputees who can exploit the new technology to lead increasingly active lives.

  8 essential steps for implementation. The 8 essential steps for implementing an innovation are captured within Kotter's model for change. However, this model misses a key 9th step that precedes all others: this is to fully understand the problem before implementing a solution. This understanding is derived from a critical analysis of both external factors (STEEPLE: Social, Technological, Economic, Environmental, Political, Legal, Ethical) and internal factors (InTREPID COIL: Innovation, Training, Research, Personnel, Infrastructure, Doctrine, Clinical, Organisational, Information systems, Logistics).

© Copyright 2015 DMS & NISW

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