Innovation and quality management
LITERATURE:
Barlow J (2017). Managing innovation in healthcare. World Scientific, New Jersey, USA.
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Donabedian A (2003). An Introduction to Quality Assurance in Health Care. Oxford. University Press.
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Rollnick S, Edwards A, Barry M. Shared decision making: a model for clinical practice. J Gen Intern Med,
2012;27: pages 1361-67
Emanuel L, Berwick D, Conway J, Combes J, Hatlie M, Leape L, Reason J, Schyve P, Vincent C, Walton, M.
What exactly is patient safety? In: Henriksen K, Battles JB, Keyes MA, Grady ML, editors (2008). Advances
in Patient Safety: New Directions and Alternative Approaches. Rockville: Agency for Healthcare Research
and Quality.
Goffin K, Mitchel R (2017). Innovation Management. Effective strategy and implementation. Third Edition.
Palgrave, London, UK.
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Legido-Quigley H, McKee M, Nolte E, Glinos IA (2008). Assuring the quality of health care in the European
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Sollecito WA, Johnson WJ (2013). McLaughlin and Kaluzny’s Continuous Quality Improvement in Health
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Vincent C, Amalberti R (2016). Safer healthcare: strategies for the real world.
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Wachter RM, Gupta K (2018). Understanding patient safety 3e. McGraw-Hill Education.
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,Tutorial 1: How can we innovate healthcare?
1. What is an innovation? NEEDED BECAUSE AGING POPULATION, RAISING COSTS..
Innovation has many different definitions. Key points in these definitions are:
1. New ideas: a new product, process or service
2. Exploitation: the idea must be implementable and potentially value generating
3. Successful: the innovation is adopted by the target audience
4. New: this is a relative term; ‘new to the world, ‘new to the market’, ‘new to the organization’
According to Barlow (2017):
Innovation can refer to an outcome and it can refer to the process by which these outcomes are
developed Innovation has both a creative dimension and a commercial or practical dimension that
involves the exploitation of the invention. Only when both of these dimensions are managed does
one have an innovation.
Innovation is a double edges sword
On the one side, innovations improve health performances and quality of care. But on the other side,
innovations tend to increase the costs.
a. What is technology?
‘Technology is an application of knowledge to solve problems.’ There are four dimensions:
knowledge, activity, objects and volition.
Hard and soft technology
- Hard technology you can actually touch/products made by humans.
- Soft technology is the knowledge how to use something
Soft technology is defined as systems of thought, practice and action that facilitate the achievement
of explicit aims. So they enable the application of hard technology. How to use the software is the
soft part, the hard part is the software itself they are always combined, you can’t use one without
another.
Introducing a new health technology is often only successful when it is combined with innovative
thinking. You do not only need to think different but also need to act different.
b. How does it differ with technology?
Two components, innovation needs the ‘product’ but also it needs to be implemented. The
technology is just the first component. Innovations needs the two components.
The technology is the thing that has to be implemented, once it is implemented it becomes an
innovation. Innovations has to be something new, but technology does not have to be.
2. What are different types of innovation?
Innovations have been categorised in various ways. One distinction is according to where
the demand for the innovation is originating, is it pushed by the developers or is it pulled by
some kind of expressed demand. In practice this is rarely the case.
Barlow classifies innovation according to:
1. Their scope: the degree of newness as perceived by the adoption (new world, new market, new
organization). In other words, how different from the status quo. It needs to be an innovation for
both parties: the adopter and the external standard.
,2. Their form of application; products, services, processes. Service and processes innovations are
often overlooked but have a bigger impact that most people can imagine.
3. How innovativeness: the amount of change compared to the current form
Henderson and Clark (1990)
Based on the innovativeness four types of innovations can be distinguished:
- Incremental: system unchanged, some components improved
- Modular: system unchanged, components replaced
- Architectural: system changed, components unchanged
- Radical: system changed, components replaced
With regard to these four types, two dimensions of impact can be distinguished:
- Impact of the innovation on the components of a product, service or process (degree of change)
- Impact on the linkages between these components (degree of change in underlying system/core
concept)
Another way to classify innovations is based on their origin
- Supplier led innovation: the knowledge underpinning the innovation is generated internally in the
organization/by own department
- Lead user innovation: innovation is developed through close collaboration between organization
and user. Lead-users are members of the user population and eventually become the norm.
- User-led innovation: user takes prominent role in creating and developing the innovation. Input of
user is very important for development innovation.
Open versus closed innovations
- Open innovation: users take prominent role in creating and developing innovation. Benefits are that
this increases the pool of knowledge, better balance in resources, being able to build a better
business model. Challenges are that it can be hard to use the relevant knowledge and it’s hard to
differentiate from competitors.
- In case of a closed innovation the ideas, inventions, investigations and development required to
place a product in the market, are generated within the company.
,Disruptive innovations
‘A disruptive innovation allows a whole new population of consumers to afford or to own and have
the skill to use a product or service, whereas historically the ability to access was limited to people
who have a lot of money or a lot of skill.’. Disruptive and radical innovations are distinct categories,
driven by different forces and with different outcomes. Now the concept of disruptive innovation is
beginning to overlap with that of frugal innovation, especially in healthcare, causing further
confusion.
Disruptive innovation defined
Original concept argues that products have particular trajectories in the way their performance
improves as innovating companies introduce new and improved versions. Two problems: first, these
incremental improvements often drive consumer prices up rather than down; second, eventually the
pace of technological progress usually exceeds the needs of most customers, as companies try to sell
ever-better versions of the product to the most demanding segment of the market for higher profit
margins.
A disruptive innovation brings to the market a more affordable product or service that is simpler to
use. Therefore it can be taken up by those who are not currently in the market because they demand
less. To qualify as a disruptive innovation, the new product or service must enlarge the overall existing
market by attracting new customers.
Radical innovations create new-to-the-world products and are also disruptive to producers and
consumers, but in a different way from disruptive innovations. Radical innovations introduce new
value propositions that fundamentally disturb prevailing markets, undermining the competences of
incumbent companies. They are rarely driven by demand.
Disruptive innovation and healthcare
We know we need innovation but while there is already plenty of technological innovation in health
systems, part of the problem is that this leads to innovation induced demand and cost inflation.
Therefore health care needs disruptive innovations to avoid an impending resourcing crisis. Countries
with advanced health systems need to radically rethink the way they deliver healthcare. Disruptive
innovation is about disrupting the axiom that technological innovation is synonymous with increasing
costs(Barlow)
Discontinuous innovation: leads to some kind of disruption to the status quo (synonym
radical); significant degree of change
Continuous innovation: improves but preserves the current way of doing things
Disruptive innovation:
o Brings the market a more affordable product (or service) that is simpler to use
o It may be taken up by those customers who are not currently in the market because
they demand less
o Enlarge the overall existing market by attracting new customers
o Disruptive way of working
o Example: uber, same service, but simpler and therefore cheaper.
3. What are the challenges in HC?
Challenges in healthcare
- To provide the best possible care (chronic diseases, strong demand for high quality)
- To many people to take care of (ageing population, pressure on labor force)
, - Make care as affordable as possible (rising costs, unequal accessibility)
To cope with these challenges, we need to make our health system sustainable by redesigning.
Trends in redesigning are:
- Focus on wellness and prevention instead of sickness and treatment
- Making individuals more responsible for their own
- Less hospital care, more community care/voluntary sectors/private sectors
- Solutions like E-health
Innovation can play a part in redesigning by improving the performance, outcome and efficiency in
healthcare! Unfortunately also innovation in HC has at challenges:
1. Costs: innovation often needs large financial investment
2. Waste: not all new science and technology is implemented in everyday mainstream healthcare plus
there is a large time between development and implementation
3. Adoption: innovations are not always adopted correctly (many different stakeholders) and not
everybody has equal access
4. Innovation has the tendency to increase overall healthcare costs since it allows us to provide more
health care.
Challenges for the different industries within HC
The healthcare sector is supported by four major industrial sectors that struggle with their own
challenges:
- Pharmaceutical and biotechnology: slowdown in development of new drugs, increasingly complex
science, regulatory and economic context has become more demanding.
- Medical devices: important markets like cardiovascular market have slowed down, more influence
of government, approval processes have grown longer, more need cost-effectives.
- Information technology: fails to get recognition, fragmented industry, new players are emerging and
the management of big data.
- Built environment: changes in organization of healthcare also has an impact on the buildings, rules
and regulations and integration the newest technology in buildings.
Adoption of an innovation in HC
How an innovation in HC is introduced and the path it takes is influenced by the characteristics of the
given healthcare system:
- Cultural: norms of practice, agreed standards of evidence and code of conduct
- Physical: infrastructure of hospitals and other facilities
- Institutional: configuration of the organisation, financial system and regulations
In some cases, the introduction of an innovation may require some changes in the above
characteristics. Think about additional staff training,
4. How does health care innovations differs from other sector with regard to the innovation
process?
Why innovation processes in healthcare might be different from other sectors
- Complex: there are many organizations involved, with many professionals and financial silos and
entrenched cultures.
- Always evolving: healthcare is always evolving because of constant change due to science and
development of new technologies
- Regulated: ‘taking a risk’ by trying out something new does normally not go down well with
