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News & Press: Digital Health Observatory

The Long Road to Digital Innovation in Healthcare

11 March 2018  
Posted by: Matthew Grek
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By Joan Cornet Prat

I had the opportunity to participate in Mobile World Congress 2018 in Barcelona, to Digital Health and Wellness Summit organized by ECHAlliance as a partner of 4YFN. It's a business event where start-ups, investors, corporations and public institutions can discover, create and launch new ventures together. An impressive event:

  • 19,000 attendees
  • 650 Start-ups
  • 700 Investors
  • 275 speakers.

Walking around and listening to several start-ups and the big and global players, you realise the world is changing fast. Innovation is at the forefront and peaking in several industries,.Healthcare is playing catch-up.

Innovation in healthcare is a funny thing

On the one hand you have a world where scarcely a day goes by where an innovation isn't announced, whether it's the use of big data and machine learning to examine medical scans and imaging, or the rise of telemedicine; or the increasing use of robotics in surgical or care home scenarios. Why then, is there an innovation fever in healthcare? One simple answer, there is a huge market which in the coming years will explode.

On the other, you have an industry that still struggles with Baumol’s cost disease (*) and has not benefitted from technology to the extent that other industries have. Indeed, the volume of innovation presents its own challenges, as integrating them into the standard ways of working can be challenging, especially in an environment where time is such a precious commodity. (1)

Significant disruptive changes

Roughly every fifty years, healthcare experiences significant disruptive changes leading to a revolution in clinical care. In the 1870s, the germ theory of disease, antiseptic techniques, and advances in anaesthesia, made life-saving surgeries possible and drove significant and lasting advances in public health.

In the early twentieth century, a few dozen visionary clinicians laid the foundation for modern clinical care by designing the initial physical layout and operational structure of the modern hospital, creating the basic four-year medical school curriculum, establishing postgraduate educational requirements, installing strict licensure requirements for physicians, and launching the first modern nursing practices.

With the discovery of penicillin in 1928, the use of medication as treatment for disease was dramatically accelerated. In the 1940s, the adoption of the randomised controlled trial as the gold standard for evidence ushered in the era of 'evidence-based medicine', defining healthcare as we know it today.

What is healthcare innovation? 
 
'Innovation' as a service delivery and organisation refers to a novel set of behaviours, routines and ways of working, which are directed at:

  • improving health outcomes
  • administrative efficiency
  • cost-effectiveness
  • or; user experience.

which are implemented by means of planned and coordinated action.

From this definition we must consider that innovation needs diffusion of implementation. The organisation adapts the diffusion to the innovation and the innovation is adapted to the organisation.

Different innovations are adopted by individuals and spread to other individuals, at different rates. In healthcare we face a double direction of innovation. One is coming from inside the health organisation, the other is coming from outside. Both the inside and outside approaches are targeting the same objectives, but they need different processes to succeed. 

Innovation gets more complex when we are dealing with digital health transformation. It is a very recent technology, in a way still in its infancy, and few health professionals and few patients know the scope and potential impact of digital transformation using Big Data, Analytics, remote monitoring, digital devices, wearables and virtual healthcare services. (2)

 

 

 

A road to adopt and implement Innovations successfully (3)


Healthcare organisations can enhance innovation if they have:

  • A culture that promotes the free exchange of ideas.

  • An emphasis on internal cross-functional collaboration.

  • An openness to external expertise.

A practical approach to launching innovation programs should include:

  • Routine, cross-department meeting opportunities that promote collaboration between technical and clinical teams.

  • Online employee idea submission and voting mechanisms to make participation easy.

  • Toolkits and/or guidelines that employees can use to properly evaluate ideas.

  • Funding support for vetted projects.

  • Dedicated staff and technology resources.

  • Ongoing, organisation wide touch points to inform, involve and inspire staff.


Leaders must bear several points in mind when evaluating return on investment:

  • Establish specific measurements when developing pilot plans so that progress can be quickly and regularly assessed.

  • Adopt a "fast failure" and "rapid expansion" mindset: If something is failing, abandon it promptly. If another project is succeeding, rapidly adopt and expand to other areas.

  • Educate employees on selecting value-added innovations to continue to improve the project as it evolves.

 


Ten factors that can facilitate adopting a specific innovation

  1. To know the advantages of this innovation in terms of either effectiveness or cost-effectiveness.
  2. If they are based on the organisation values, norms and needs
  3. Simple to use. Innovations that are perceived by key players as simple to use will be easier adopted.
  4. The benefits of on innovation is visible soon to adopters.
  5. Flexibility preserving the hard core of the innovation but allowing a “soft periphery” to adapt to different realities.
  6. The risk balance considers the power base of the organization.
  7. A clear description of the professional changing tasks because of the implemented innovation.
  8. Easy access to the necessary knowledge and capacitation/training to use the innovation
  9. Technology seen as a process where all pieces are linked.
  10. Opportunities to have lab-experiences before real implementation of new technology

Ten barriers to effective innovation in healthcare

  1. Medical efficacy review: To be successful, a new healthcare innovation must improve upon the current standard of medical care without causing harm to the patient and ideally lower costs simultaneously
  2. Product distribution: Unlike consumer products, healthcare products are distributed through a more complex supply chain that involves multiple parties, including medical device manufacturers and distributors.
  3. Manufacturer access: Gaining access to quality manufacturers is a major hurdle for many healthcare inventors because of concerns manufacturers have about “intellectual property contamination” issues.

  4. Lack of access to healthcare providers purchasing data: Even large, well-connected medical manufacturing companies may find it difficult to access purchasing and product needs data and input from healthcare providers. 

  5. Regulatory oversight: While it’s necessary to enforce strict guidelines on healthcare product manufacture and distribution to prevent incompetent or unscrupulous suppliers from harming patients, the EU regulatory environment slows the innovation process considerably.

  6. Intellectual property complexity: Intellectual property rights have always been a confusing aspect of the inventing process for most individual inventors. It can be virtually impossible to navigate without professional help.

  7. Healthcare culture: The fact that most of healthcare professionals are increasingly time-pressed, and so learning and adopting new systems, new methods of care or new devices often take a backseat to day-to-day patient care.

  8. High-stress environment: Healthcare workers have high-stress jobs and often work long hours. They are dedicated to delivering great patient care, but the nature of the job can make it difficult for innovative thinking to flourish, since creativity naturally diminishes when an individual is in steady “fight or flight mode”.

  9. Complex value analysis model: In the healthcare sector, it is difficult for a product developer or individual inventor to generate data on how the product affects not only direct treatment but also the downstream healthcare supply chain, which means that determining the true value of an innovation idea is difficult.

  10. Misconceptions about what constitutes innovation: Within healthcare, those traditionally tasked with product development (engineers and technical experts) are generally not the same people who are living with or treating a particular healthcare challenge. Inparticular, not involving patients, who, after all, are the beneficiaries of most of the innovations. 

Innovation, adoption and implementation processes 

https://www.milbank.org/wp-content/files/documents/featured-articles/html/Milbank_Quarterly_Vol-82_No-4_2004.htm

Greenhalgh et al.’s diffusion of innovation model.

Technology alone cannot lead transformation. We need leadership!

The digital transformation of healthcare is underway and inevitable. As digital continues to move forward, healthcare organizations must remember that technology alone cannot and will not lead the transformation. Technology is merely the enabler. The true driver will be innovation — innovation managed and championed by senior leaders who have the ability to create a vision and inspire the hearts and minds of their teams to do things differently to drive overall healthcare improvement.

The Korn Ferry Four Dimensions of Leadership (KF4D). (3)

 
Innovation, adoption and implementation processes are dependent of good leadership at all levels. This includes organization's boards, CEOs, CIOs, CCIOs, clinical heads, managers and administrative personnel.

Without a real and consistent alignment to an innovation strategy, we can expect only “exotic innovations” that do not impact to the clinical outcomes.

A long road lies ahead…


References

(*) Baumol's cost disease (or the Baumol effect) is the rise of salaries in jobs that have experienced no increase of labour productivity, in response to rising salaries in other jobs that have experienced the labour productivity growth. This pattern seemingly goes against the theory in classical economics in which real wage growth is closely tied to labour productivity changes. The phenomenon was described by William J. Baumol and William G. Bowen in the 1960s ( from Wikipedia)

Top 25 Greatest Medical Innovations in History:  

https://onlinenursepractitionerprograms.com/2010/top-25-greatest-medical-innovations-in-history/

Timeline: A history of area medical innovations: http://www.philly.com/philly/health/special_reports/Timeline_A_history_of_medical_innovations.html

The emerging market in health care innovation: 

https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/the-emerging-market-in-health-care-innovation

Leaders for a digital transformation: 

www.kornferry.com/institute/leaders-for-a-digital-transformation

Bibliography

(1) Noseworthy J., Madara J., Cosgrove D., et al. Physician burnout is a public health crisis: a message to our fellow healthcare CEOs. Health Affairs Blog, Available at:

http://healthaffairs.org/blog/2017/03/28/physician-burnout-is-a-public-health-crisis-a-message-to-our-fellow-health-care-ceos/

(2) Bhavnani S.P., Parakh K., Atreja A., et al. (2017) 2017 roadmap for innovation—ACC health policy statement on healthcare transformation in the era of digital health, big data, and precision health. J Am Coll Cardiol 70:2696–2718

(3) Greenhalgh, T., Robert, G., Bate, P., Macfarlane, F. and Kyriakidou, O. (eds) (2005) Innovations, in Diffusion of Innovations in Health Service Organisations: A Systematic Literature Review, Blackwell Publishing Ltd, Oxford, UK. doi: 10.1002/9780470987407.ch5

(4)  Explaining high and low performers in complex intervention trials: a new model based on diffusion of innovations theory. Heather McMullenEmail author, Chris Griffiths, Werner Leber and Trisha Greenhalgh

https://doi.org/10.1186/s13063-015-0755-5 ©  McMullen et al. 2015

https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-015-0755-5 

(5) Leaders for a digital transformation: 

www.kornferry.com/institute/leaders-for-a-digital-transformation