synthesis

of art and science is lived by the nurse in the nursing act

Art & science |
| The
acute
care
funding

JOSEPHINE G PATERSON

DRAGONS DEN: PROMOTING

HEALTHCARE RESEARCH
AND INNOVATION
Deborah Mazhindu and Siobhan Gregory describe how
a television series livened up the debate about funding
for new ways of working
Correspondence
d.mazhindu@bucks.ac.uk
Deborah Mazhindu is reader
in clinical nursing practice
and innovation, in the
faculty of society and health,
Buckinghamshire New
University, Uxbridge
Siobhan Gregory is director of
quality and clinical excellence,
Hounslow and Richmond
Community Healthcare NHS
Trust, London
Date of submission
April 2 2015
Date of acceptance
April 29 2015
Peer review
This article has been subject
to double-blind review and
has been checked using
antiplagiarismsoftware
Author guidelines
journals.rcni.com/r/
nm-author-guidelines

Abstract
The changing health and social care landscape,
and, in particular, the financial challenges affecting
the NHS, can present difficulties for staff looking
for funding to support innovation and new ways of
working. One method of competitive tendering that
is becoming more accepted as a way of allocating
funds, encouraging staff engagement and developing
innovation for research is a format based the BBC
television series, Dragons Den. This article describes
how Hounslow and Richmond Community Healthcare
NHS Trust, London, has developed a Dragons Den
initiative of annual competitive research funding
allocation to ensure that some of the most dynamic
practice in the trust is captured.
Keywords
Innovation, funding, finances, Dragons Den

Introduction
Dragons Den is a BBC television series in which
entrepreneur contestants have three minutes to pitch
their business ideas to a panel of five multi-millionaires,
known as the dragons. If suitably impressed,
the dragons invest their own money into the proposed
scheme.The contestants often have potentially
profitable business ideas but lack funding and
direction, so the dragons provide financial backing
and mentorship, both of which are often crucial to the
success of proposals, to the lucky participants.

28 July 2015 | Volume 22 | Number 4

The format has been copied in various arenas;

for example, the United Bank of Africa (UBA)
introduced a similar TV programme to promote
entrepreneurship and innovation in Africa (UBA
2015), while in the UK a number of universities
and healthcare organisations have used it to award
research funding for innovation and to pump
prime research and development (Oxford Brookes
University 2013, University of Strathclyde Glasgow
2014, British Gastrological Society 2015, Durham
University Business School 2015). The Dragons
Den platform is ideal for encouraging staff to pitch
their research and innovation ideas to try to secure
funding equitably and justifiably.

Raising support
Hounslow and Richmond Community Healthcare
NHS Trust (HRCH) developed the Dragons Den
initiative to ensure that some of the most dynamic
practice, which often goes on in some of the
smaller healthcare teams, is captured. In 2012,
the trusts director of quality and clinical excellence
(QCE) secured funds of up to 30,000 from trust
charitable funds to be used to develop and host
a Dragons Den-type scenario to encourage research
and innovation.
The first priority was to secure executive support
for the project from members of the HRCH senior
management team, who would be needed to provide
ongoing mentorship for successful applicants.
A collaborating university academic was also invited
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Alamy

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Art & science | acute

care
funding
to be one of the dragons to provide mentorship,
support and academic assistance. The next step
was to hold a forum at which the concept could be
explained in detail to the trusts clinical leaders and
their views sought.
To ensure that each business case was judged
and marked fairly and equitably, successful
graduates of the HRCH in-house management
development programme were asked to volunteer
to support development of the application
process and to design the marking criteria for the
pitches (Table 1).
A short-listing team, which included
clinicians, senior managers and non-executive

directors, acted independently from the dragons and

put forward five project initiation finalist bids to each
of two dragon panel sessions, in October 2013 and
October 2014. In addition, staff volunteers who had
completed the in-house management development
programme were identified to act as support
buddies during the application process to enable
front line clinicians to write and produce robust
business plans and research proposals for their ideas.
The five dragons comprised two executive directors,
one non-executive director and a member of the public
as well as the academic member of the university.
The Dragons Den was advertised widely over
the summer months of 2013 and 2014 with clear

Table 1 Example of Dragons Den marking grid

Applicant names:
Dear Dragon,
Please use this grid to mark your initial thoughts on the bids before the den. The score will be from 1-5:
5 = excellent, 4 = very good, 3 = some evidence, satisfactory, 2 = lack of evidence, below standard, 1 = poor.
Please think about key questions you might wish to ask.
There are two grids. One is based on the process and bid submission. The second to aid our discussions is based
on the 6Cs (in line with the DH NHS Constitution 2012) and the potential quality impact for patients.
Pre-bid presentation
Bid section

Score

Comments

Score

Comments

Purpose/strategic fit
Service aims
Model for service delivery
Costs/income
Benefits realisation quantitative
Benefits realisation qualitative
Knowledge
Post-bid presentation
Bid section
Care does the bid meet the trusts vision and service aims? Will it
improve patients experiences?
Compassion does the bid indicate that it would improve staff
ability to care with compassion?
Communication do you understand the bid? Would it make
sense for patients?
Courage how able is the service to take risks to succeed?
Commitment will the service actually implement the change and
secure publishing?
Competence is the service able to implement the change?
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and concise guidance, timeframes and contacts,

as well as example templates for writing the bids
(Table 2). Staff were asked to submit research or
innovation ideas as collaborative research proposals
with special consideration for three main areas of
importance to the trust: improving patient care,
enhancing patient experience, and preventing
admissions to hospital.

Applications and bids

Applicants were advised to start with an analysis
of their practice using strengths, weaknesses,
opportunities and threats (SWOT) (Bplans 2015a)
analysis before writing a business case. SWOT analysis
helps to develop strong strategiesby making sure
all a businesss strengths and weaknesses are
considered, as well as the opportunities and threats it
faces in the marketplace. In addition, applicants were
advised to undertake a political, economic, and social
trends analysis (Bplans 2015b) to help generate
marketing and product ideas.
As part of the bidding process, the finalist
applicants were asked to identify a director buddy
from the panel of dragons from whom they would
like to receive ongoing support and who would act
as a champion and mentor for the project should
they be successful. There was also an expectation
that the winner would publish his or her project
with support from the university dragon.
Year 1 applicants: examples of finalist bids
There were eight applications for the first
Dragons Den from various disciplines, including
district nursing, physiotherapy, dietetics and
occupational therapy. In the second year, there
were 15 applications, again from various disciplines
including nursing.
In the first round, in 2013, the following five bids
were selected for the Dragons Den:
Wheelchair services: the bid focused on identifying
specialist equipment that would enable patients to
continue 24-hour therapy and reduce their pain by
providing night aids.
Diabetes service: this bid outlined how a new
initiative in diet could help practitioners to
provide care at home and in the community for
patients struggling to maintain a healthy weight.
Diabetes care: the bid described a communitydelivered service to identify the pre-diabetic stage
of the condition and to offer treatment to prevent
onset of diabetes.
Community neurological rehabilitation service:
the bid aimed to provide specialist IT equipment
to help patients with cognitive impairment
balance and so prevent hospital admissions.
NURSING MANAGEMENT

Table 2 Example of a Dragons Den bid template

DRAGONS DEN
Business case
Title:
Business case details
Provider lead
Date
Author
Version
Purpose/strategic fit
Sociocultural factors to consider
Governmental and educational research
Infrastructure changes that affect work patterns
Existing technological factors that you could work with or learn from
Further technological factors
Risks for consideration
Service development
Service aims
Impact on existing services/other service providers
Model for service delivery
Description of service
Likely activity projections and how they will be measured
Impact on existing activity
Clinical impact
Costs/Income
Breakdown of costs analysis, including costs, project planning and
productivity impact.
Workforce implications impact on staff resources and actions to be taken to
ensure delivery
How will this be sustainable?
Benefits realisation
Quantitative benefits
Description of how each of the benefits will be realised and how they will be
measured and tracked:
Qualitative benefits
Description of how each of the benefits will be realised and how they will be
measured and tracked:
Knowledge generation and transfer
References
District nursing: this bid outlined the benefits of
community leg-ulcer clinics to provide holistic
care in an informal environment.
Following rigorous debate, the successful bid was
the wheelchair service, which was chosen because it
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Art & science | acute

care
funding
appeared to have the greatest effect on supporting
patient experience and reducing pain, and the
potential to prevent admissions.
Year 2 applicants: examples of finalist bids
The following projects bid for funding in the
second den, in 2014:
Paediatric audiology: this was a bid for purchasing
new equipment to improve the life of a child
with impaired hearing. The technology is called
the HEARLab.
District nursing team: this bid was to provide
a service to prevent the recurrence of leg ulcers
and detect early deterioration of lower-leg health.
The school hearing screening programme with
a paediatric audiologist: this bid was for the
start-up costs of school screening software,
which enables school screening to be fully
managed using a laptop and the integration of
multiple-site data.
School nursing team: this team bid to develop
School Nurse in Your Pocket, an interactive app
that young people, parents and carers can use to
access information or support on health matters
relating to adolescence.
Neurorehabilitation team physiotherapists: this bid
was for the production of a professional-balance
DVD devised by chartered physiotherapists and
aimed at patients with balance and stability
impairments due to neurological conditions.
The successful bid in 2014 was the school nursing
team that wanted funding to develop the interactive
app. The bid appeared to have the most potential
for improving the care given to young people,
enhancing patient experience and preventing
hospital admissions.
The dragons were impressed by the commitment
and compassion expressed by all staff and saw
how those who were inexperienced in writing bids
and proposals had developed business skills and
financial acumen as part of the process.

Reflections
Following the Dragons Den sessions, the panel
considered the effect on the unsuccessful teams
and how the trust might ensure that staff remained
motivated and encouraged to put forward ideas.
It appeared that those who made bids required the
whole budget, which prevented funding more than
one initiative, and the dragons felt frustrated at their
inability to support more than one idea.
The dragons wanted to ensure that each
service received positive feedback, so the director
of QCE visited each of the applicant teams to
provide this and to discuss how the ideas could
32 July 2015 | Volume 22 | Number 4

be fostered. Consequently the unsuccessful

bids have been referred to managers for further
in-house development and one project is now being
developed to support commissioning discussions
around future funding.
The Dragons Den format the trust uses does not
allow projects deemed viable, but which require
more development, to be reconsidered within
the year, which risks losing staff commitment.
Therefore, the project team has proposed the
consideration of continual project-initiation
documents at set intervals during the year to
support ongoing research development. There has
to be a balance between making whole-scale
change with less funding and allowing smaller
change-management projects with less impact and
longer-term financial gain to take place.
There were resource implications, not least
financial, as the amount secured for a winning
proposal needs to be up to 50,000 a year.
The money is agreed from trust funds and is
managed by the non-executive directors. In addition,
if projects are truly innovative, they are referred
to other funding sources, such as the Florence
Nightingale Foundation. A further two applications
were funded through such sources.
There have also been some logistical problems
for the winners trying to complete their desk-based
project work as office space is scarce, and, for the
dragons, time and resource management was
challenging. For example, the roll out and judging of
projects fell to the director of QCE and her assistant,
while paperwork, communication and advertising were
led by the director of QCE with corporate support.
The support for research and enterprise in service
development requires long-term protected investment
and clear role identification and accountability to
avoid overburdening management staff.
Another issue to emerge is the time required for
graduates of the in-house management development
programme to act as support buddies for aspiring
bidders. The executive team for HRCH identified
directors to provide ongoing support on specific
projects, which helped implement the cascade of
learning between successful bidders and the trust.
Successful projects will be published and the writing
and publication process is supported in-house and
by the university dragon.
The trust is committed to continual learning and
development for staff and, where projects and ideas
are aimed at providing high quality services to the
public and improve patient experiences, HRCH is
keen to ensure they are embraced and supported.
Therefore, the team wants to ensure that the
Dragons Den, or something similar, should continue
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to be held annually, and that executive director

buddies should continue to provide mentorship and
act as champions for change.
The trusts management team has also agreed
that commercial involvement, from companies such
as HEARLab, should remain a priority to ascertain
potential service development and commissioning
interest, and that feedback on bids should be shared
widely though trust communications.
Ongoing financial support for future Dragons Dens
of between 30,000 and 50,000 a year has been
identified, and the team now needs to undertake an
ongoing evaluation to determine further support
and guidance for staff around the size and cost of
projects against positive effects such as improvement
in patient care, enhancement of patient experience
and prevention of hospital admissions.

The Dragons Den style competition has provided an

excellent platform for staff to showcase their research
and ideas for locally, nationally and internationally
relevant innovation. There was no shortage of ideas to
help achieve the trusts ambitions for demonstrating
improvements to patient care, enhancing patients
experiences and preventing hospital admissions.
It was difficult to reach a final decision and choose
a winner in each case as all the projects demonstrated
innovative approaches to tackling important health
issues and, in an ideal world, they would all be funded.
The trust is looking forward to the next competition
later this year and hopes many more aspiring staff
innovators will participate to keep research and
innovation at the heart of service delivery.
References
Bplans (2015a) What is a SWAT Analysis? tinyurl.com/oh4a22j (Last accessed:
May 18 2015.)

Conclusion
A climate of efficiency savings can be challenging
for staff looking for funding to support innovation
and new ways of working. There is a tendency to
respond to the changing health and social care
landscape, and, in particular, the financial challenges
affecting the NHS, by limiting spending on research
and innovation. While there is evidence of efficiency
savings in the NHS, it is not always so easy to
determine where the saved money has been spent.
Money for research and innovation in particular is
highly competitive and difficult to secure.

Bplans (2015b) PEST Analysis. tinyurl.com/na8vt54

(Last acessed: May 18 2015).
British Gastrological Society (2015) A total of 3000 to be awarded
in the Endoscopy Dragons Den at DDF2015 apply now! tinyurl.com/qgb88oh
(Last accessed: May 18 2015.)
Durham University Business School (2015) Dragons Den Competition.
tinyurl.com/okryhj2 (Last accessed: May 18 2015.)

Online archive

Oxford Brookes University (2013) Dragons Den 24,000 Awarded.

tinyurl.com/or9j2xt (Last accessed: May 18 2015.)

For related information, visit

our online archive and search
using thekeywords

University of Strathclyde Glasgow (2014) Strathclyde University Dragons Den

Style Event 2014. tinyurl.com/o2kch8r (Last accessed: May 18 2015.)
United Bank of Africa (2015) UBA Introduces DRAGONS DEN, a Reality TV
Show for Entrepreneurs. tinyurl.com/pd6sm97
(Last accessed: May 18 2015.)

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