March 5, 2015 katharina.janus

New on the Health Affairs Blog: How to advance medical innovation by putting international best practices in a national context

This post is part of a series of several posts 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 or follow @HCMatColumbia.

To Advance Medical Innovation, Put International Best Practices In A National Context
by David Roye and Kevin Wang

Innovation is a driving force of any nation’s economy, shaping the delivery of new services and the development of new products. Nowhere is this more true than in the US health care system which represents nearly a fifth of GDP. Medical innovation has catalyzed improvements in the tools and therapies used to deliver health care, the practices of managing its delivery, and even the financing of its delivery.

These innovations evolve primarily through research supported by universities and government institutions including the National Institutes of Health (NIH). Research supported by the NIH allows for development of treatments that target a large number of diseases and conditions. However, identifying new therapies is only a fraction of the work needed to ensure that the right patients receive that treatment at the right time, the right dose, and for the right reasons.

Furthermore, meeting these goals for each individual—with a unique genetic makeup, living in and influenced by a unique environment—and ensuring reliable, high quality care for every encounter is even more difficult. That is why confirming a treatment or test’s efficacy and safety is necessary but not sufficient. The assessment of innovative medical treatments must also account for how much they improve value, outcomes, and the patient experience.

Today, health care innovation is quickly moving to include not only the pharmaceutical and the medical device industries, but also Health IT, predictive analytics, quality improvement and mobile heath technology, fields where management, policy, and technology continue to intersect.

Spreading the use of best practices across clinical practice requires an understanding of not only doctors’ behaviors, but also the fact that individual physicians are parts of larger systems. In this context, stakeholders from national organizations and medical associations might identify a centralized governing body whose role would be to recognize best practices that meet local needs and are supported by high level evidence from peer reviewed literature.

Once these best practices have been identified, national leaders must focus on improving systems and engaging transdisciplinary teams consisting of those same stakeholders. These teams can apply sociological theories, human factors engineering, and economic theory, to incentivize the adoption of best practices and make behavior change easier. Regulation and financial incentives can be used to advance these goals as well.

An entirely new field called implementation science has evolved with a focus on developing expertise in spreading and disseminating best practices. This expertise has already been applied to the treatment of malaria, TB, and HIV/AIDS saving millions of lives. These efforts have succeeded by summarizing and presenting evidence of treatment outcomes, identifying barriers to implementation, and rigorously measuring performance and metrics with regular evaluations to continually refine, encourage and promulgate the adoption of best practices. Success also requires identifying pioneers and early adopters to champion the spread of new technologies, techniques, or therapies before they become mainstream.

Today, foreign surgeons are invited to observe cutting edge techniques and technology in the US institutions, including the Columbia University Department of Orthopaedic Surgery where we practice. As part of this initiative, foreign surgeons are also exposed to the development and implementation of best practice guidelines — a primer in quality, safety, and efficacy. Many executive management training programs also use cross-national learning.

For example, one of us (Roye) started International Healthcare Leadership, a program which identifies China’s best and brightest health care administrators, many of whom are senior ministers, presidents and vice presidents of major Chinese hospitals, to learn about state-of-the-art management methods and strategies by applying them in realistic simulations. These skills can then be adapted to their local contexts and assist in the spread of medical innovation and improved management.

In the future, executive management seminars and visiting fellowships will be key for disseminating best practices to the most appropriate leaders who will be able to implement them within national and local contexts and improve care delivery for millions of people around the world.