This post is part of a series on the Health Affairs blog related to the 4th European Forum on Health Policy and Management: Innovation & Implementation, to be held in Berlin, Germany on January 29 and 30, 2015. For more information or to request your personal invitation contact the Center for Healthcare Management.
The Innovation Conundrum in Healthcare
By Katharina Janus
It is never too early for new technology in health care. In contrast to the innovator’s dilemma in other industries where the adoption can be sluggish because current customers may not be able to use the future’s toolbox, in medicine innovators always can be assured of an audience when announcing the “life-saving impact” of something new.
Coverage and widespread implementation usually are a different story, but creating hype and demand for unusual and unfamiliar medical technology has never been hard. But who then drives the invention, diffusion, application, and evaluation of such innovation?
There are multiple “customers” for medical innovation: the patient who might benefit from advances in technology (if proven effective and covered); the doctor who is excited to play with the technology; the evaluator who finds an abundance of new gadgets to be assessed, tested, and recommended (or not). And finally, payers, including the government, influenced by the health care system’s value system — which in the U.S. favors excellence, whatever it costs, over utilitarianism — will also have a say.
With this populous and fragmented universe of actors, how can we hope to steer medical innovation in the direction where it is most critical? And what can we learn from other industries and other national settings?
Learning to See the Big Picture
In health care, the innovator’s dilemma is less about innovations coming up the pipeline “too early” and more about the risk of defining innovation “too narrowly.” Medical innovation not only engages a wide range of stakeholders, it can also take many forms, for example:
- Strategic innovation: putting international best practices in a national context
- Managerial innovation: how policies affect day-to-day operations in complex formal organizations, taking into account the need to respond to multiple chronic diseases at once as a case in point
- Policy innovation: what laws and regulations tend to “optimize” innovation and create the fertile ground for innovators?
- Technological innovation: what approaches best capture the promises and pitfalls of new drugs, devices, and procedures
Most approaches to assessing, dealing with, and implementing “innovation” refer to technological advances and their effectiveness with respect to improving patient care or saving costs. This is an invaluable perspective — so far as it goes. However, the technologies do not operate within a controlled, sterile operating theater; they depend on and interact with enfolding patterns of professional, institutional, and social continuity and change.
Innovations live and thrive (or do not) in symbiosis with the immediate context of the many various stakeholders involved. “Mapping” and assessing these contexts is complex, but luckily we have the IT and modeling capacity and capability today to draw the big picture. With a better understanding of the relationship between innovations and the context in which they are presented, stakeholders will be better equipped to implement those innovations in health care systems in the future.
Learning From our Neighbors and Joining Forces
Well-crafted incentive systems often facilitate the implementation of innovative provider and stakeholder strategies, including new medical technologies, innovative management systems, and promising policy initiatives. Sometimes, however, innovations of proven effectiveness fail to be implemented or their adoption is delayed — as was the common use of antiseptics that were discovered around the same time as anesthesia but still are not as widely used as they might be, given the high rate of hospital-acquired infections.
The supposed beneficiaries of these innovations may not find them useful, easy to use, consistent with cherished routines, or otherwise appealing. In the case of anesthesia, it made the life of patients and doctors better. Antiseptics “only” improved the rate of infections with a benefit for the patient, while disturbing the doctor’s routine. We badly need a deeper understanding of the advances and setbacks encountered by different innovations in diverse settings. For instance,
- What do innovations imply for the right skill mix of providers and what kind of incentives should be employed to support improved performance and care coordination?
- What kinds of research are best able to capture the procedural and substantive impact of change on the “ground floor?”
- Can big data tell us all we need to know in order accurately to monitor the effects of implementation?
On all these issues we should learn from other societies and sectors. Indeed some studies suggest professional cultures in medicine tend to override national cultures. In other words, nations can share and benefit from each other’s experience despite different governmental frameworks among their health care systems.
Cross-national learning, which informs a range of topics in health policy and management research, is too rarely employed as a source of insight into how innovators can successfully implement their discoveries and make them accessible to a broad and diverse population. Initiatives in various countries aiming at achieving integrated care have shown that — after all — governmental monies and frameworks are important triggers of innovation; however, long-term implementation and sustainability depend on sound and sophisticated strategies, taking the context into account.
To confront these challenges, the 4th European Forum on Health Policy & Management: Innovation & Implementation will bring together a distinguished line-up of industry experts, government decision-makers, and leading academics from several countries. By encouraging free thinking and creative discussions, we hope to process and collect ideas in close collaboration with practitioners.