Summary
Innovation And Quality Management
Case 1 – Innovation in healthcare ....................................................................................................... 2
Case 2 – Managing innovation in healthcare ...................................................................................... 5
Case 3 – Quality management in healthcare ...................................................................................... 7
Case 4 – Patient involvement in quality improvement ..................................................................... 10
Case 5 – Patient safety management ................................................................................................ 13
Case 6 – Chronic care management .................................................................................................. 16
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,Case 1 – Innovation in healthcare
➢ Why do we need innovation in healthcare
➢ Challenges of innovation
➢ Challenges of innovation in healthcare
➢ Types of innovations
Current challenges in healthcare:
- Aging of the population
- Growing incidence of chronic disease
- Pressure on the labour force
- Rising healthcare costs
- Strong demand for high quality of care
- Unequal accessibility of care
Summarized, the main challenges faced in healthcare are (Barlow - resources, costs, and demand):
- Providing the best possible care
- Providing care to as many people as possible
- Providing care as affordable as possible
To cope with these challenges, healthcare should be redesigned to make it sustainable for the future.
Trends in redesigning: shift from sickness and treatment to wellness and prevention, and the shift
from hospital to community care. Innovation plays a big role in redesigning the healthcare system:
- Improving the performance (quality) of the healthcare system
- Improving health outcomes for individuals
- Increasing efficiency of health care
Technology (Barlow) = concerned with the application of knowledge to solve problems. Distinction
between hard technology (tangible artefacts) and soft technology (the knowledge on how the
artefacts work, influences the adaptation). The aspect of soft technology important in healthcare.
Innovation (Barlow, the Schumpeterian trilogy) a simplified view, more in case 2:
1. Invention: creation or first occurrence of a new product / process.
2. Commercialization: creating economic value, making product / process into use
3. Adoption: the diffusion of the product/process to users
Adoption and implementation are difficult processes, especially in healthcare
Types of innovation
Barlow:
- Scope: the degree ow newness (new to the world, market, organisation, of individual. Also
measured by the extent to which a company has to acquire new skills/competences to use it)
- Form of application (product, service, or process)
- Innovativeness: how much change compared to current norm
o Incremental innovation: improvements and / or additional components to existing
design (HC: improved MRI-scanner) (like continuous innovation)
Problems: often drives up the costs and exceeds the needs of the users
o Modular innovation: employs new components in an existing product/process and
uses a different design concept (HC: 3D printed heart valve)
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, o Architectural innovation: components remain unchanged but the configuration of
the system changes (HC: providing specialized (hospital) care in a community setting)
o Radical innovation: major technological breakthrough or a new technology, different
linkages and different components (new to the world) (HC: service robot / advanced
types of telemedicine)
Additional:
- Origin: pushed or pulled, or more detailed:
o Supplier-led innovation: knowledge supporting the innovation is generated within
the organisation
o Lead user innovation: collaboration between organisation and lead users (members
of future target population)
o User-led innovation = users take a prominent role in developing the innovation, the
organisation uses their input
▪ Benefits: bigger knowledge pool, less costs and uncertainty then with
internal R&D, building a better business model, better balance in resources
▪ Challenges: difficult to identify the relevant knowledge, difficult to
differentiate from competitors.
In HC: mostly lead user or user-lead in developing medical technologies
- Openness: involvement of the users
o Open innovation = user plays a prominent role
o Closed innovation = organization innovated alone
In supplier led / lead user / and user-led innovations: the level of openness depends. The level of
openness also refers to in what extent the new innovation is based on the wants of the user. Thus
supplier-led innovation can use intellectual property of external sources and in this was it’s open
innovation that is supplier-led.
- Impact:
o Discontinuous innovation: a new-to the world product, made to perform a new
function (similar to a radical innovation)
o Disruptive innovation: a radical innovation that potentially disrupts existing ways by
e.g. bringing the market a more affordable product or service that is easier to use,
this could be taken up by new users for the market who demand less (e.g. easy jet)
HC: shift to apps, shift from inpatient to outpatient care
o Frugal innovation: innovations aiming to reduce costs, partly overlaps with disruptive
innovation
Disruptive innovation may help to reduce healthcare costs:
- Introducing new more efficient models of care, e.g. shifting care to cheaper locations
(secondary → primary)
- Breaking down processes to see if healthcare workers with less skills can execute them (less
costs)
- Ensuring more self-management and responsibility for own health
But innovation has challenges:
- Innovation often needs large financial investments
- Waste, not all science and technology is implemented in everyday mainstream healthcare
- Waste, often there is a big time lag between development and implementation
- Innovation is not always adopted correctly and not everyone has (equal) access.
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, - Innovation had the tendency to increase overall healthcare costs (often costs to the health
system, or payers or governments, rise because new technologies allow a larger overall
`quantity' of care to be provided)
As healthcare is very complex, always evolving, heavily regulated, and highly politicized, innovation is
even more challenging than in various other sectors. Four main sectors in healthcare are defined, all
these face challenges concerning the evolving market, changing balance of power, and pressure on
their business model. Additionally, all four sectors have specific challenges of innovation in
healthcare:
Pharmaceuticals and biotechnology - Slower development of drugs
(‘biopharma’ / drug innovation) - Patent expiration → loss of drug sales
- Increasingly complex science of new drugs (attention
shift to chronic disease)
- More demanding regulatory and economic context
Medical devices - Important sectors for growth have slowed done
- Government and payers have an increasing influence
- Approval processes have grown longer
- Difficulties in determining the cost-effectiveness of
medical devices
Informational technology (IT) - Difficult to show benefits (fails to get recognition)
- Fragmented industry
- Management of big data
- Reimbursement of new technologies is difficult
The built environment (design, - Changes in organization of HC, also influences the
engineering, and construct) buildings
New hospitals are getting smaller, - Rules and regulations
more home care, nursing homes - Buildings need to have integration options for the
are more like homes instead of newest technologies
hospitals.
Additionally, Barlow identified four features of healthcare that influence innovation (and are
different from other sectors):
1. The nature of healthcare technology and innovation: lines between soft and hard
technology are often blurred and often it’s unclear what the innovation really is. Local
adaption can therefor lead to many subversions and interpretations. (unpredictable)
2. A risk-adverse culture and extensive regulation: difficult to obtain robust evidence and
different opinions on what good evidence is. This may slow down the process if payers need
evidence.
3. The economics and politics of healthcare: some views are short-term e.g. political planning
is only four years and this is shorter than time needed for decision making. Plus, benefits may
fall unequally across multiple sectors, this makes it more difficult to measure the impact of
the innovation (now a shift to ‘process studies’ of healthcare innovation adoption that
emphasises the dynamics and complexity of innovation)
4. The environment into which new technologies and other innovations are adopted and
implemented is often extremely complex: especially in developed countries. Multiple
stakeholders are involved and adoption could be constrained by the general resistance to
change due to the rigidity of healthcare systems, professionals etc. Often unclarity on
responsibilities, no long-term view, and no funding for implementation.
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