Samenvatting
Summary Papers Block A, B & C Innovation in Healthcare Organizations
Een uitgebreide samenvatting van alle benodigde tentamenteksten van het vak Innovation in Healthcare Organizations (Key Debates uitgezonderd).
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Table of contents[1] Barlow, J. (2017)...........................................................................................................................................2
[2] Hwang, J. & Christensen, C.M. (2008).........................................................................................................7
[3] Porter, M.E. And Lee, T.H. (2013)..............................................................................................................10
[4] Wammes, J., Jeurissen, P, and Westert, G. (2015)......................................................................................13
[10] Greenhalgh, T. et al. (2017).......................................................................................................................31
[11] Grol, R., Bosch, M., Wensing, M. (2013)...................................................................................................34
[12] Nolte, E. (2018)..........................................................................................................................................36
[13] Boonstra, A., Van Offenbeek, M. (2021)....................................................................................................38
,[1] BARLOW, J. (2017)
C HAPTER 2: T ECHNOLOGY AND INNOVATION MANAGEMENT : THE NUTS AND BOLTS
There are several reasons as to why innovation processes in healthcare may differ from other
sectors, namely:
- Healthcare is a very complex system, i.e. there are many organisations involved, with many
professional and financial silos, and entrenched cultures
- Healthcare is constantly evolving due to changes in the underlying science, the development of
new technologies, and policymakers tinkering with its funding and institutional arrangements
- Healthcare is heavily regulated, i.e. trying out new procedures does not necessarily go down well
with healthcare managers, politicians, or patients
- Healthcare usually is highly politicised, i.e. the most rational option to improve services may be
to close a hospital or its department, resulting in angry voters and anxious politicians.
Technology tends to be closely associated with innovation but is not the same. It has been
argued that technology has four dimensions, i.e. knowledge, activity, objects, and volition. In
this paper, a distinction is made between ‘hard’ and ‘soft’ technology; the former relates to
tangible artifacts, e.g. computers or mobile phones, whereas the latter relates to how those
artefacts work, i.e. the ‘systems of thought’. There are several knowledge types:
- Explicit knowledge: readily articulated, codified, and accessed
- Tacit knowledge: the opposite of explicit knowledge, not adequately articulated by verbal means
- Codified knowledge: tacit knowledge converted to explicit knowledge
- Embodied knowledge: routines, habits, tasks, and information understandable without conscious
thought
- Situated knowledge: affected by history, language, and values of the person knowing it
Hard and soft technologies are not two ends of a continuum, rather they are bound together to
a greater or lesser extent. Human agencies influence the actions and understanding of
technology. Hence, it is suggested that technology forms part of a ‘socio-technical system’,
where people, organisations, institutions, and technologies interact. Then again, healthcare
technology cannot be defined solely in terms of physical artifacts. Its power lies in the soft
knowledge associated with technology, i.e. skills and techniques involved, and use. The
knowledge is adaptable to specific conditions, and subject to evolution because of the
reflexive nature of healthcare professions. Hence, the implementation and impact of
healthcare technology and innovation can be both challenging and unpredictable.
Because technology is socially constructed, forming part of a wider socio-technical
system, it is important to recognise that there is no inevitability about a technological
trajectory, i.e. there is no guarantee a technology will be adopted or used for a specific
outcome. How a technology is configured, is closely shaped by its starting point and
subsequent historical evolution.
,The term ‘innovation’ may refer to an outcome, or to the processes by which they are
developed. Outcomes may be physical objects, new services, or business models. Viewing it
as a process is associated with research on implementation. Relatively little work is done on
public sector innovation, and the development and application of new ideas in a non-
commercial setting. This notion is important as much of the healthcare provided lies in the
not-for-profit or public sector.
Innovation has both a creative as well as a commercial or practical dimension
involving the exploitation of the invention. Categorising innovations is important because the
influence of technology can differ depending on whether it changes individual or an entire
system of components. Distinctions in innovation categories can be made between:
- Push innovation: previously without demand, developers create it, e.g. e-books
- Pull innovation: reducing production costs, or addressing safety and quality issues in an existing
product
The following three manners are sufficient to classify innovations:
- Scope: degree of novelty. The definition of newness can be subtle. A classification of
innovations to the degree to which they are new to a market or new to a company can be made,
but also to the extent to which innovation activities required the acquisition of new capabilities.
In Figure 2.2 below, the classification can be seen.
- Form or application: a product, process, or service.
- Innovativeness: the change in components compared to the current norm, i.e. an incremental or a
radical innovation. In Figure 2.3 below, the types of innovation including the characteristics are
shown.
Radical innovations consist of terms as ‘discontinuous’, ‘radical’, and ‘disruptive’
innovations. A discontinuous innovation leads to disruption to the status quo, with a radical
innovation essentially synonymous, describing a significant degree of change. A disruptive
innovation is interchangeably used with radical innovation.
, There are numerous models in which innovations can be characterised by its various
functional attributes or degree of novelty, or by the processes by which it came about.
Another model is the role end-users play in the innovation development process and the level
of openness there is in sharing knowledge about the innovation. In Figure 2.5 below,
differences in types of innovations and their characteristics are shown.
A supplier-led innovation is a push model where knowledge underpinning an
innovation is either generated internally or acquired externally. Lead users are members of a
user population experiencing needs
eventually becoming the norm, and who
anticipate significant benefits from
obtaining a solution to their needs. The
difference between lead users and user-
led models lies in who controls the
development and sales process, which
remains with the innovating company in
the lead user case.
Another model used is the model of open
innovation, rejecting the assumption that
innovation only stems from an
organisation’s internal R&D capacity.
Instead, companies seek innovative ideas
from outside, taking them on to develop
and bringing them to the market, or
selling them on for another party to exploit them. The emphasis is on combining external and
internal ideas to advance the development of new technologies. Open innovations have been
criticised for being a vague, prescriptive concept, with a lack of robust academic research on
its benefits too.
In innovation research, the performance ‘S-curve’ depicts the potential evolution of an
innovation. It is the result of increasing, then declining, R&D productivity within a given
innovation architecture. Significant effort is needed during the early stages, whereas in the
later stages, performance can improve with marginal effort. Innovations that move along the
S-curve are incremental, and those that shift to a new curve are radical innovations. The S-
curve model helps in assessing where a technology is in its likely lifecycle and provides an
indication of industry maturity.
The process of innovation commonly is divided into three stages, i.e. the Schumpeterian
trilogy:
1. Invention: ideas are turned into workable inventions, typically characterised by experimentation.
2. Commercialisation: the latent value of a technology is unlocked to generate value.
3. Adoption and diffusion: the process by which innovations are taken-up and spread through a
population; frequently exhibiting an S-curve.
The trilogy has been criticised as it is seen as too linear. Linear models hide the true
complexity of the innovation process; hence, they are seen as normative and deterministic. In
healthcare services, the innovation process tends to be iterative, problem-oriented and
collaborative. Moreover, the process is complex as innovations may emerge as an output of
processes within national and regional systems of innovation, sustained by an infrastructure of
supporting institutions.
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