Technological innovation in surgery: developing system readiness in the NHS

The pace of technological innovation in surgery is accelerating at an impressive rate. From Virtual Reality tools that help surgeons plan and execute complex operations, offering real-time views of a patient’s unique anatomy, to mobile digital technologies enabling “virtual wards” that support safe, early discharge and remote monitoring – these advances are reshaping how healthcare is delivered. 

However, as these technologies continue to emerge, it’s essential that the NHS prioritises those that are not only clinically beneficial but also cost-effective and implementable in real-world settings. 

For surgical technology to truly benefit both patients and healthcare providers, it needs to be fully integrated into the existing healthcare system. Unfortunately, many technological advancements fail to deliver the expected outcomes due to poor integration and a lack of effective system adaptation. So, how can we ensure that these innovations are embedded in ways that lead to improved clinical and organisational results? 

A focus on socio-technical implications 

The answer lies in understanding the socio-technical challenges involved in implementing new technologies into the NHS. By this, we mean that it’s not enough to simply focus on the technology itself or even the human-technology interaction; how it interdependently interacts with the culture, goals, processes, and infrastructure within the healthcare system plays a crucial role in its success. 

At the National Institute for Health and Care Research (NIHR) HealthTech Research Centre (HRC) in Accelerated Surgical Care, Dr Helen Hughes and I are leading the Surgical Care Observatory theme, which focuses on the socio-technical aspects of implementing new surgical technologies and how, by understanding these, we can better prioritise technology that will be able to be mainstreamed effectively in the broader system.  

Our goal is to explore how these technologies can be prioritised, not just based on their clinical and economic potential, but by considering the broader context in which they will be deployed. 

System readiness 

The UK government and NHS are investing significantly in medical technologies, with over £10 billion committed to digital transformation between 2025 and 2029. Despite this, the translation of innovation into practice remains inconsistent and inefficient.  

A key challenge lies in the dominance of the Technology Readiness Level (TRL) scale as the primary methodology for assessing innovation maturity. While valuable for evaluating technical progress - it focuses on technological characteristics e.g. functionality, limitations, and development trajectory - evidence shows that technological maturity alone is insufficient to ensure successful adoption.  

As such, change initiatives that focus solely on the technology, without accounting for the human, organisational, and contextual system into which they are introduced, are significantly more likely to fail. For instance, 88% of technology-driven projects fail to meet their objectives, with just 7% of National Institute for Health and Care Excellence (NICE)-recommended products fully adopted within the NHS. Such failures represent missed opportunities for patient care and inefficiencies in public investment.  

Socio-technical systems (STS) thinking offers a critical lens through which to address this problem. This approach conceptualises organisations as complex systems comprising interdependent social and technical components. Research has shown that barriers to adoption are frequently socio-technical in nature, yet these are often identified in the late stages of development or post-deployment, when mitigation is costly or infeasible.  

Some innovations (such as incremental medical device upgrades) can be integrated into the system with minimal disruption. Others, particularly those that alter care pathways or transitions, workforce roles, or patient engagement models, require substantial redesign of the surrounding system.  

Our STS approach reaches broader than ‘human’ readiness, since the system readiness challenges could relate to aspects like procurement, physical infrastructure, storage and maintenance, in addition to ‘human’ aspects such as training, culture and work design. Crucially, the approach also captures interdependencies between these aspects.  

While these challenges are commonly recognised, they are difficult to resolve because they require an integration of knowledge and insight, and deep collaboration between a range of stakeholder groups. For example, technologies that support the shift from hospital to community care simultaneously necessitate new infrastructure and changes in clinical workflows, inter-professional coordination, and public perceptions of care. Similarly, the transition from analogue to digital involves cultural transformation, data governance reform, and interoperability across legacy systems.  

These are not just technical challenges; they are complex socio-technical transitions requiring integrated methodologies. Procurement and prioritisation decisions must therefore mature in the way they evaluate the surrounding organisational, behavioural, and cultural infrastructure that underpin effective technological adoption. 

Categorising technologies for better implementation 

At the HealthTech Research Centre, we are developing methodologies, networks and tools to help categorise incoming technologies based on their system change requirements. These resources and tools will be used to assess whether a clinical area is ready for a particular technology and to determine what steps need to be taken to ensure smooth implementation.  This way, we can better anticipate potential challenges and create strategies for overcoming them, ensuring that new innovations are successfully embedded into the existing healthcare system. 

To successfully implement new surgical technologies within the NHS, it’s crucial to consider more than just their clinical and economic benefits. Understanding and addressing their socio-technical implications are key to ensuring that innovations are integrated effectively and lead to the desired outcomes. 

At the HRC, we are committed to exploring these challenges in depth and developing practical solutions that can guide the NHS and technology developers themselves in successfully implementing new technologies.  

This project is funded by the National Institute for Health and Care Research (NIHR).