College aantekeningen
Innovation in Healthcare Organizations Lecture Notes
Alle collegeaantekeningen van het vak Innovation in Healthcare Organizations, inclusief gastcolleges (van o.a. UMCG/HartNet).
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INNOVATION IN HEALTHCARE ORGANIZATIONSWEEK 1, LECTURE 1: INTRODUCTION
COURSE GOALS
We’re a first world country when it comes down to healthcare organization. Why do we need
innovation?
Health is important to people
o Reduce costs | healthcare costs are hard to contain
o Improve quality of care
o Rising customer expectations | patients are more informed and demanding
nowadays
What makes costs rise?
Ageing society
Medical knowledge developments
Technological developments
Well-informed healthcare decisions
Peter Bennemeer: if health is important to people, are rising costs a problem? “No.”
It partly depends on your own role and on your own personal values. It affects solidarity,
are we willing to pay taxes and pool risks through insurance?
Improve cost-effectiveness/rationing/value-based healthcare.
Managerial innovations seem to be needed to achieve the “Triple Aim” in healthcare
organizations.
Part of the solutions may lie in decreasing overhead costs by smarter HC organizing.
Example: WIJ organization. However, managing has its limits.
New technologies can be exploited for constructing more effective and efficient ways of
organizing (Barlow, 2017; p. 21).
Exploiting a new hard technology implies changing the soft technology, e.g., roles of HC
organizations, professionals, patients, informal carers, insurers, government and the way their
roles are co-integrated.
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,Example: HMC Bronovo
Why this course?
HC systems require maintenance and improvement, yet also innovation of all levels
HC managers need to cope with societal health debates and seek to deploy innovative
opportunities in acceptable ways
Managerial challenges in HC require a strategic vision and coordinated efforts both
within organizations and across players in the field
Course focus: the strategic choices, adoption and implementation of managerial innovations in
healthcare.
DEFINING INNOVATION
What is an innovation? What is the difference between improving and innovating?
Improving: working on the existing
Innovating: radical breakthrough. Translating an idea or invention into value creation in a way
that is new to the adopting entity. Value creation is not always done objectively.
There are three ways to classify an innovation
1. By its scope | is it new to the market or organization?
2. By its form or application: product, service, process
3. By its innovativeness | novel component / re-combination / or a whole system
Managerial innovation applied to healthcare: new approaches to devise strategy and structure
of tasks and units, modify HC’s management processes and administrative systems, motivate
and rewards HC workers, and enable HC organizational adaptation and change (Damanpour &
Aravind, 2012)
To be able to achieve this, you need healthcare professionals.
The focus in this course will be on process innovation and service innovation.
Example: Deloitte Center for Health Solutions
Any combination of activities or technologies that break existing performance tradeoffs
in the attainment of …
Providing “more for less” – more value, better outcomes, greater convenience, access and
simplicity; all for less cost, complexity, and time required by the patient and the
provider, in a way that expands wat is currently possible.
WEEK 1, LECTURE 2: KEY DEBATES IN HEALTHCARE: INTRODUCTION, PART I AND II
The introduction of the book is about:
Debates, tensions, conflict and controversy over healthcare issues and direction of
change, including innovation.
Conflicting views on the aims, organization and processes of healthcare.
Different world views affect views on healthcare issues: how it should be provided,
covered and adapted.
Debates are related to stakeholders, where does power reside, who makes decisions,
who contributes and who benefits (slide 2).
An example of an actual debate in healthcare are the protests against the COVID-19 measures.
These debates are fierce, and when you think about debates about the covid-pandemic, you can
think of:
2
,Who is responsible for prevention measures and what should be done?
Sweden versus China, Italy, Spain
Individuals Local government led Central government
Does the advancement of public health and economic growth result in different or
similar policies? What is the price of health?
How should limited IC capacity be allocated among patients with coronavirus?
Should there be solidarity among generations and how should that be organized?
Should people be forced to be vaccinated or to use a coronavirus app?
How should vaccines be allocated among and within countries? (Slide 4).
THREE PARTS
The book, Key Debates in healthcare, is divided in three parts
I Politics of provision
who should provide healthcare: state (1), private (3) or voluntary sector (4)
II Setting priorities, pressures on health budget
requires tough choices
III Patients and health professionals (slide 6)
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, PART I
Today, we’ll focus on the first part, the politics of provision
Innovation is driven by the questions of who is responsible for health, and who should provide
care. Should the state play a major role in direction and provision of healthcare or should we
rely on the private sector and voluntary sector? (Slide 7)
WHAT IS HEALTH AND ILLNESS?
In different eras, people had different opinions on what was health and prosperity. In the
Victorian age it was favorable to be very thin (wasp) and pale, while in the 1950’s it was
smoking. Health and illness are not objective things, and views on them shift in time.
Illness is subjective, about how we feel and, in our society, it is seen as dysfunctional. Sickness
is a role and allows a person to withdraw temporarily from labor and seek help to improve
health.
HOW SHOULD WE DEFINE HEALTH?
The view of health started with: the ‘absence of disease’ (disease oriented), which is a ‘negative’
definition. Absence of disease is a passive state.
After WWII, the WHO came up with the definition that set the standard very high: ‘A state of
complete physical, mental and social well-being’ (WHO, 1948).
is that even possible? And when you adopt this definition, what does it mean for policy makers
and society?
It basically means that the most part of society is unhealthy. Many people feel that they aren’t
well, and this means that there is an increased demand of care on all kinds of levels (social,
psychological, etc.).
This also means that the government obtains a large role in providing care.
In 2011, a BMJ paper “how should we define health” proposed the following definition: ‘The
ability to adapt and to self-manage’
Three definitions from different point of views from different times.
Whereas the first definition shifts to a negative view of health, which assumes that there is a norm
for all bodies and relies on diagnosis, more recent definitions shift toward a positive view on health,
which look at health from a holistic viewpoint as something we possess.
Holistic approach looks at someone’s overall wellness and not at illness or sickness.
An example of a positive view on health are the blue zones. Blue zones are areas where people
generally live longer and healthier. Blue zone hotspots include Okinawa, Loma Linda, and
Sardinia. These blue zones tend to have the following characteristics:
Family
No smoking
Plant-based diet
Moderate physical activity
Social engagement
Health has a social, cultural, economic, and a historical context.
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