Innovation Governance in Adult Social Care: From Ideas to Safe, Auditable Change
Innovation in adult social care is only valuable if it is safe, consistent and evidenced. Without clear governance, “innovation” can look like uncontrolled variation — particularly where it changes routines, staffing approaches, restrictive practice decisions or risk thresholds. This article sits within Innovation, Added Value & System-Wide Impact and connects to broader assurance principles under Social Value.
Good innovation governance does not need to be bureaucratic. It needs to be visible, proportionate and auditable: who decided, on what basis, what risks were considered, what evidence was reviewed, what was trialled, and how learning was captured and embedded.
Why innovation governance matters operationally
Innovation often changes “how things are done” day to day. That can affect:
- Consistency of support across shifts and staff groups
- Risk management and escalation thresholds
- Safeguarding and incident response
- The likelihood of restrictive practices being used (or avoided)
Where these impacts are not governed, the provider is exposed: staff confidence becomes variable, families may experience inconsistency, and commissioners may see innovation as unmanaged risk rather than improvement.
A practical governance model commissioners recognise
A workable model typically includes:
- Initiation: define the problem and intended benefit, grounded in operational reality
- Risk review: identify foreseeable risks and mitigations, including safeguarding and restrictive practice implications
- Approval: agree who signs off and what evidence is required
- Trial: define scope, duration and measures
- Assurance: check delivery through observation, audits and data review
- Embed or stop: decide based on evidence, not enthusiasm
The aim is not to “prove success” but to demonstrate controlled change, learning and accountability.
Operational example 1: Governing a new approach to incident debriefing
Context: A provider introduced a revised incident debrief approach to strengthen learning and reduce repeat triggers. Prior debriefs were inconsistent and often focused on compliance rather than reflection.
Support approach: The provider created a structured debrief tool that required analysis of antecedents, function, staff responses and restrictive practice decision-making, with clear responsibilities for completion and oversight.
Day-to-day delivery detail: After each incident, the shift lead completed the tool within 24 hours; a manager reviewed it within 72 hours; and learning actions were assigned to named staff with deadlines. Themes were discussed in weekly team meetings and monthly governance calls.
How effectiveness was evidenced: Audit showed improved completion rates, clearer learning actions and fewer repeated incidents linked to the same triggers. Supervision notes demonstrated learning being reinforced with staff who were present during incidents.
Operational example 2: Risk-controlled rollout of a digital prompt system
Context: A service trialled a simple digital prompt system to improve consistency with health-related tasks (hydration prompts, wellbeing check-ins, medication-related observations).
Support approach: The provider treated it as a clinical risk-adjacent change: the system was introduced alongside clear boundaries (it supported practice but did not replace professional judgement or existing medication processes).
Day-to-day delivery detail: Managers ran weekly checks to ensure prompts were followed appropriately, incidents of missed tasks were logged and reviewed, and staff feedback was captured to identify where prompts created alert fatigue or confusion.
How effectiveness was evidenced: Compliance improved on targeted tasks, staff reported clearer routine structure, and data showed fewer missed entries. Governance records demonstrated oversight and refinement rather than uncontrolled rollout.
Operational example 3: Governance of restrictive practice reduction initiatives
Context: A provider aimed to reduce low-level restrictions that had become embedded over time (e.g., limiting access to certain items “just in case”, unnecessary supervision rules, blanket decisions driven by past incidents rather than current risk).
Support approach: The provider implemented a restriction review framework that required justification, least restrictive analysis, risk mitigation planning and time-limited review dates.
Day-to-day delivery detail: Staff raised restrictions for review at monthly meetings; managers ensured capacity assessments and best-interest processes were followed where relevant; and decisions were recorded with clear evidence, including what alternative strategies were trialled.
How effectiveness was evidenced: Restrictions reduced without increased safeguarding incidents; staff confidence improved; and audits showed consistent decision-making aligned with least restrictive practice principles.
Commissioner expectation
Commissioners expect innovation to be governed and evidenced, with clear decision-making records, risk controls and assurance mechanisms. They also expect honesty about what has not worked and what learning has been captured, rather than overclaiming success.
Regulator expectation
The CQC expects safe, effective and well-led services. Inspectors will look for consistent delivery, learning from incidents and evidence that leadership understands and controls risk. Innovation that changes practice should leave an auditable trail of oversight, review and improvement.
Building an audit trail without creating admin burden
A strong audit trail can be created through simple, repeatable tools:
- A one-page innovation proposal and risk summary
- A named approver and review date
- A short trial plan with measures (quality, incidents, staff competence, outcomes)
- Monthly audit sampling and observation notes
- Governance minutes capturing decisions and learning
Where these basics are in place, innovation becomes defensible: it can be explained clearly to commissioners, and it stands up during inspection because it shows controlled leadership rather than uncontrolled change.