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BMZ2026 IMPLEMENTING INNOVATIONS IN HEALTH CARE (CASES)CASE 1
WHAT IS THE DEFINITION OF INNOVATION ?
Rogers: “An innovation is an idea, practice, or object that is perceived as new by an individual or other unit of adoption.”
It doesn’t matter whether an idea is “objectively” new as measured by the lapse of time since its first use or discovery. The
perceived newness of the idea for the individual determines his or her reaction to it. If an idea seems new to the individual, it is
an innovation.
“Newness” of an innovation may be expressed in terms of:
- Knowledge
- Persuasion
- Decision to adopt
Greenhalgh: he says the definition of Rogers is helpful when considering individual behavior (for example, when a clinical
guideline might be classified as an innovation by a doctor/nurse), but it is less useful at an organizational level (for example,
when the same clinical guideline might be classified as an organizational innovation on a ward). Using this example, the
guideline only becomes an organizational innovation if it precipitates some kind of planned change in the structures and systems
of the organization. People in the organization need to do more than perceive the guideline as new; the must do something →
adopt, new roles, make different decisions, form new relationships, use new technology, develop new systems…
Osbourne (1998) reviewed the organizational studies literature and found over 20 different definitions of innovation, from
which he extracted four core characteristics:
1. Innovation represents newness
2. It is not the same thing as invention (the latter is concerned with the discovery of new ideas or approaches whereas
innovation is concerned with their application)
3. It is both a process and an outcome
4. It involves discontinuous change
Damanpour & Euan (1984): “Innovation is the implementation of an internally generated or a borrowed idea – whether
pertaining to a product, device, system, process, policy, program or service – that was new to the organization at the time of
adoption… Innovation is a practice, distinguished from invention by its readiness for mass consumption and from other practices
by its novelty.
Goes & Park (1997): [A health care innovation is] a medical technology, structure, administrative system, or service that is
relatively new to the overall industry and newly adopted by hospitals in a particular market area. … . [Service innovations are]
innovations that incorporate changes in the technology, design, or delivery of a particular service or bundle of services.
Greenhalgh: “An innovation in health service delivery and organisation is a set of behaviours, routines and ways of working,
along with any associated administrative technologies and systems, which are:
a. perceived as new by a proportion of key stakeholders
b. linked to the provision or support of healthcare
c. discontinuous with previous practice
d. directed at improving health outcomes, administrative efficiency, cost-effectiveness, or the user experience, and
e. implemented by means of planned and coordinated action by individuals, teams or organisations.
Such innovations may or may not be associated with new health technology.
,WHAT ARE THE DIFFERENT TYPES OF INNOVATION ?
Thoma-Lürken, et al. (2015): the following definitions were used as a guideline to sort the innovations:
• A product innovation: the introduction of a good or service that is new or significantly improved with respect to its
characteristics or intended uses. This includes significant improvement in technical specifications, components and
material, incorporated software, user-friendliness, or other functional characteristics.
• A process innovation: the implementation of a new or significantly improved production or delivery method. This
includes significant changes in techniques, equipment and/or software.
• A marketing innovations: the implementation of a new marketing method involving significant changes in product
design or packing, product placement, product promotion, and pricing
• An organization innovation: the implementation of a new organizational method in a firm’s business practices,
workplace organization or external relations.
Defined by the Organization for Economic Cooperation and Development.
Type of Innovation Examples of Different Types of Innovation Described by the Organizations
1. Product innovation
1.1. Supportive Products or services by which technology is used to support the functioning of care-dependent clients or to facilitate the process
technology of care delivery such as:
Domotics in institutional LTC: different types of home automation devices, such as movement sensors, fall sensors, camera
supervision, night-orientation lights, and alarm systems, are used in combination to increase the safety of clients and to enable
more self-determination.
Screen-to-screen care: video consultation between nurse and client as a new service in addition to an existing care contact. For
instance, a video call in the morning to check whether the client feels well or has taken the required medication.
Lifestyle monitoring: sensor system to assess deviant behavioral patterns to supervise community-dwelling older persons.
Electronic drug dispenser: drug dispensers with reminder function.
Tool to apply and remove compression stockings: facilitating the process of applying and removing compression stockings by
means of a tool. Eventually, a patient can manage the process of putting on and removing stockings on their own or the tool is
used to facilitate the work of the care provider.
Washing without water: washcloths impregnated with specific wash/care lotion and 3% dimethicone are used to do full body
wash of bedridden care-dependent patients.
1.2. Activity stimulation Interventions to increase the level of physical activity of older people such as:
Exercise gardens: gardens located close to institutional LTC organizations that are equipped with various devices to stimulate
activity, such as stationary bicycles, balance games, and other exercise equipment.
Game console interventions: interventions, for example using a balance board, which are connected to a game console by means
of which clients can play virtual games (exergames).
Virtual cycling: a stationary bicycle connected to a video screen. When the person steps on the stationary bicycle, a video of a
bicycle tour is projected on the screen. This enables the user to cycle a virtual round.
Walking groups: services provided for clients of institutional LTC organizations enabling them to join a guided walking tour.
Introduction of movement teachers (in institutional LTC): specified movement teachers introduced as a new function in
institutional LTC organizations. They can organize group activities or individual interventions for specific clients to stimulate
physical activity.
1.3. Therapeutic Interventions with a therapeutic goal such as:
interventions Interventions with the seal robot Paro: the seal robot is used in the care for psychogeriatric patients aiming to reduce behavioral
problems, and facilitate daily care tasks and family visits.
1.4. Improvements in Interventions to increase the quality of care of certain target groups such as:
quality of care for certain Introduction of dementia case management: a service for patients with dementia and their informal caregivers. The function of a
target groups case manager includes tasks such as support in the diagnostic phase, coordination of care and an advisory function for patients
and informal caregivers.
1.5. Residence Introduction of new residence forms or new care services such as:
forms/care services Specific residence forms: residence forms specifically adapted to the needs of certain target groups, for example patients with
Parkinson's disease or dementia.
1.6. Web services Online services/interventions targeted at clients of LTC organizations or older people in general, such as:
Virtual communities: online communities that can serve as a market place for services provided by LTC organizations or by
volunteers. In addition, these communities provide the opportunity to video call and chat with other users.
1.7. Self-care/self- Interventions to stimulate the self-management ability of care-dependent older people, such as:
management stimulation Introduction of a function called a self-care coach: self-care coaches can be called in, for example by a GP, to support community-
dwelling home care clients to optimize their self-care.
1.8. Organization of daily Interventions related to the daily activities of clients of LTC organizations or other community-dwelling older people, such as:
activities Daily activity coaches: a new function called “daily activity coaches” being introduced in institutional care. These coaches support
older clients in the planning and execution of daily activities.
,Type of Innovation Examples of Different Types of Innovation Described by the Organizations
1.9. Other product Other new products and services.
innovations
2. Organizational innovation
2.1. Business practices Innovations in the field of business practices defined as “the implementation of new methods for organizing routines and
procedures for the conduct of work.” 16 Examples are:
E-learning environments: digital portals enabling employees of LTC organizations to access information about learning and
development opportunities within the organization. In addition, these environments provide the opportunity to register for and
follow e-learning modules provided by their organization.
Self-care/self-management training: courses for nursing staff to increase the self-care abilities of clients. During these courses, the
importance of the self-reliance of older people is highlighted and the nursing staff members learn how to facilitate their clients in
the process of becoming more independent.
Centers of expertise: centers that aim to gather, develop and spread knowledge about care for a specific target group (such as
psychogeriatric patients or patients in geriatric rehabilitation) within their own organization and outside the organization.
2.2. Workplace Innovations with regard to workplace organization defined as “the implementation of new methods for distributing
organization responsibilities and decision making among employees for the division of work within and between firm activities (and
organizational units), as well as new concepts for the structuring of activities, such as the integration of different business
activities” 16 Examples are:
Self-managing teams: small teams of 5 to 15 nursing staff members in home care. These teams have the shared responsibility for
organizing home care delivery for a certain group of clients and there is no formal leadership role.
Scheduling methods: new methods to generate the work schedules for the nursing staff in LTC organizations by which a basic
schedule is made centrally for all teams. In addition, the teams gain more control over their schedules, having the opportunity to
adapt the basic schedules based on their own preferences in cooperation with the other team members.
2.3. External relations Innovations with regard to external relations defined as “ the implementation of new ways of organizing relations with other
firms or public institutions, such as the establishment of new types of collaborations with research organizations or customers,
new methods of integration with suppliers, and the outsourcing or subcontracting for the first time of business activities in
production, procuring, distribution, recruiting, and ancillary services.” 16
An example is:
Outsourcing of services: organizing the basic medical and paramedic care services in institutional LTC organizations with external
GPs and external physiotherapists and occupational therapists.
3. Process innovation
3.1. Digitalization of Administrative processes are supported by means of computers and computer programs, for example by means of:
administrative processes EPR: electronic records replacing handwritten patient dossiers. These records tend only to contain care-related information.
Sometimes the EPR is also connected to the registration and invoicing system of the care organization.
Digital planning and registration system: equipping home care staff with a mobile phone enabling them to access the digital
planning and registration system. By means of this system they can access patient-related information, information about the
sequence of patients to be cared for (routing), and to register the time spent on the actual care delivery.
Tablet PC in home care: equipping home care staff with a tablet PC to provide a flexible workplace where they can undertake the
following processes digitally: accessing client-related information, reporting in the EPR, filling in required forms, searching care-
related information such as protocols or specialist literature, and communicating with clients and colleges via email or video
calling.
3.2. Distance care Providing care services (eg, consultation or supervision) at a distance, for example by means of:
Video communication: enabling clients to contact a nurse or vice versa, by means of video calling on a computer or mobile device.
This consultation should replace regular face-to-face consultation.
3.3. Consistent A principle according to which the same nursing staff members are constantly assigned to the same clients, which can be
assignment introduced as follows:
Same staff member, same place, same time: a fixed number of nursing staff per patients assigned to deliver home care needed.
Efforts are made to schedule the home visits of nurses regularly at the same time.
3.4. Rehabilitation Innovations in the organization of rehabilitation care processes, such as:
process Care pathways: clients in geriatric rehabilitation follow a standardized treatment program that can be adapted to the needs of a
specific target group (eg, trauma care, stroke care).
3.5. Other process Other changes in care delivery processes.
innovations
4. Other innovations Interventions with multiple, equally important elements incorporating characteristics of different types of innovation, such as:
EXBELT Program: an intervention to reduce the use of physical restraints in nursing homes. Consisting of 4 elements: policy
change, training for nursing staff, availability of alternative interventions, and the introduction of a specialized nurse as
consultant. 17
Hospitality concepts: interventions to increase the hospitality of institutional LTC organizations. Consisting of different elements,
such as task differentiation between nursing staff and service staff, changes in work processes, and eventually renovations,
hospitality training for staff, and special food- and drink-related activities for clients.
Living and care concepts: newly-built sheltered accommodation in which multiple supportive technology is used, such as inbuilt
ceiling hosts, cameras, video call facilities, etc. In addition, new ways of organizing care processes are introduced, such as nurses
supervising their clients by means of a camera. These concepts also partly include task differentiation between nursing staff and
service staff.
, Technology innovation
A technology is a design for instrumental action that reduces the uncertainty in the cause-effect relationships involved in
achieving a desired outcome.
A technology, by definition, has two elements – the hardware or physical ‘stuff‘of the technology, and the information that goes
with it (often but not always presented as software)
• Hardware aspect → consisting of the tool that embodies the technology as material or physical objects.
• Software aspect → consisting of the information base for the tool.
o Computer hardware or computer software.
Technology cluster consist of one or more distinguishable elements of technology that are perceived as being closely
interrelated. Some change agents promote a “package” of innovations because they find that the innovations are thus adopted
more rapidly. Example: the smartphone, includes hardware manufacturers, operating system developers, app creators,
accessory makers, and service providers, all collaborating.
Grol & Wensing: various types of improvements require various types of change proposals:
Different types of innovations in the healthcare setting:
- Systematic reviews - Scientific literature,
- Evidence-based guidelines guidelines, decision support,
- Care protocols and decision aids
- Integrated care pathways - Clinical pathways
- Disease management systems - Improved care processes
- Best practices - Other innovations
- Prevention programs -
- Quality of care methods
Grol & Wensing: Innovations in patient care and prevention, such as clinical guidelines, care protocols, technologies, devices,
organizational healthcare delivery models, and health system reforms, are rarely automatically adopted “as is”, since they are
frequently inaccessible for users in regular practice and/or it is unclear exactly what performance is expected.
A process of implementation should therefore start with a very specific description of the behavior and processes desired and
the changes to be pursued.
These changes should be concrete, and both ambitious and feasible within the setting of the implementation. For example,
indicating “the reduction of the volume of unnecessary laboratory tests by 15% over a 12-month period” is better than “increase
the rational use of laboratory tests.”.
In the process of defining a proposal of recommendation,
features of the innovation that are important for its ultimate
adoption by the target group should be considered. See below.
However, many innovations need to be modified to meet local
needs and opportunities → thus translating them into a product
adapted to the specific setting.
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