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Summary Case 1 We need to innovate!
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Case 1: We need to innovate!Learning goals:
1. What is an innovation?
a. Different types of innovations
b. Practical application task
2. What is technology?
3. What are barriers & facilitators for innovation in healthcare?
4. In what way does innovation in healthcare differ from innovation in other sectors?
5. What are the main reasons to innovate in healthcare?
Barlow chapter one main focus on page 1-9 but read whole chapter
Chapter 3 use box 3.1 as starting point
Literature suggestions
Barlow J (2017). Managing innovation in healthcare. World Scientific, New Jersey, USA.
- Chapter 1: Why do we need to understand healthcare innovation? (p. 1-18)
Not all the science and technology is taken up into every day, mainstream healthcare
practice. There is a disconnection between the research effort and the proportion that
makes it into mainstream practice. Secondly, while innovation – thinking creative about
what healthcare is and how we deliver it – is needed more than ever, innovation can itself
be a problem. New technologies often increase costs because they allow us to ‘do more’
healthcare.
Three innovation challenges for 21st century healthcare
- Resources costs, and demand – the challenges for advanced health systems
Across the developed world, in the high- and middle-income countries with
advanced health systems, healthcare is consuming an ever-increasing share of GDP,
driven by the ageing population and the rising incidence of non-communicable
diseases. Decisions about how much we spend on healthcare over the next decades
will partly be shaped by political choices about how we allocate national resources.
Many countries with long-established health systems are trying to redesign them –
adopting new payment and reimbursement models to incentivise innovation and
improve performance, moving from a paradigm that emphasises sickness and
treatment to one which is more about wellness and prevention, reforming the
organisational architecture by integrating primary, secondary and social care, and
trying to find new ways of involving the private and voluntary sectors. There is much
interest ‘disruptive innovation’, moving towards cheaper, simpler organisational, and
technological solutions which emphasize the importance of individuals taking more
responsibility for their own care and shifting services away from expensive hospitals
to community settings.
- Healthcare technology innovation is big business – but it needs to evolve
, Healthcare is supported by four major industrial sectors: pharmaceuticals and
biotechnology (‘biopharma’), medical devices, information technology (IT) and the
built environment (design, engineering, and construction).
Of these four core industries, biopharma has been the most turbulent. The
innovation model for the pharmaceutical industry has faces a slowdown in the
development of new drugs at the same time that a ‘patent cliff’ – the loss of drug
sales as patent protection expires – has been most acute. Innovation has also
become harder partly due to the increasingly complex science underlying the
discovery process, as the industry shifts its attention towards people with chronic
diseases. At the same time, the regulatory and economic context has become more
demanding as governments and healthcare payers as insurance companies have
exerted downward pressure on prices and tightened regulations around the drug
development process.
Innovations in the healthcare IT sector have been slower to take off for several
reasons:
o Many healthcare investments are designed to improve back-office processes
and are often seen by healthcare providers as something that can be
deferred
o Innovation in healthcare IT fails to get recognition because it is hard to clearly
demonstrate its benefits
o The industry is also fragmented
o New players are emerging
o The IT industry is also poised to play a part in radically changing science and
practice of healthcare in the form of ‘big data’.
- Delivering universal high-quality healthcare in lower-income countries
There is an inverse relationship between availability of health technology and health
need – people in the world’s poorest countries often lack the most fundamental
drugs and devices, let alone the latest advances in science and technology. Tackling
this gap requires the development of appropriate and affordable health technologies
and ensuring their availability to the poorest people in the world – the ‘bottom of
the pyramid’.
Broadening what we mean by innovation to embrace the whole process from initial
idea to implementation and diffusion is essential.
o Technological innovation, to create affordable new drugs, devices,
diagnostics, and vaccines that are more cost-effective than existing
interventions; and
o Social innovation, to ensure the distribution of essential goods and services,
including new technologies
- Chapter 2: Technology and innovation management: the nuts and bolts (p. 19- 44)
o Introduction
, Box 2.1 Summary: Some reasons why innovation processes in healthcare might be
different from other sectors
- Healthcare is a system, and it is very complex – there are many organisations
involved, with many professional and financial silos and entrenched cultures
- Healthcare is always evolving because of constant change in its underlying science
and the development of new technologies, and because policy makers like to tinker
with its funding and institutional arrangements.
- Healthcare is heavily regulated – taking a risk by trying out something new does not
necessarily go down well with healthcare mangers, politicians or patients
- Healthcare is usually highly politicised – for instance we may know that the most
rational option to improve services might be to close a hospital or hospital
department that is no longer needed, but this is almost guaranteed to result in angry
voters and anxious politicians
.
o Section: What is ‘technology’? (includes 8 subsections)
Technology is concerned with the application of knowledge to solve problems. Technology
has four dimensions: knowledge, activity, objects and violation.
Hard and soft technologies
- Hard technology: tangible artefacts such as computers or mobile phones
- Soft technology: the knowledge about how those artefacts work. Defined as systems
of thought, practice, and action that facilitate the achievement of explicit aims. Soft
technology enables the application of hard technology to a problem.
Box 2.2 Concepts: Types of knowledge
- Explicit knowledge: can be readily articulated, codified and accessed
- Tacit knowledge: is the opposite of explicit knowledge; it cannot be adequately
articulated by verbal means
- Codified knowledge: is tacit knowledge converted to explicit knowledge in a usable
form
- Embodied knowledge: is the routines, habits, tasks, and information we understand
without conscious thought
- Situated knowledge: is knowledge affected by the history, language and values of
the person knowing it
In short, we affect the way technology is used and evolves, and thus the factors that enable
or inhibit technological innovation. The consensus is that technologies are not neutral in
how they relate to both human agency and to the institution in a society. Researchers
therefore suggest that technology forms part of a ‘sociotechnical system’ – a system where
people, organisations, institutions and technologies interact – and its role is subject to
processes of ‘social construction’, where understandings of the world and shared
assumptions about reality are jointly constructed by individuals.
Technology determinism
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