Responsible innovation in health and health system sustainability: Insights from health innovators’ views and practices

2021 ◽  
pp. 095148482110486
Author(s):  
Pascale Lehoux ◽  
Hudson P Silva ◽  
Robson Rocha de Oliveira ◽  
Renata P Sabio ◽  
Kathy Malas
Keyword(s):  
Health System ◽  
System Level ◽  
Responsible Innovation ◽  
Inclusive Design ◽  
Specific System ◽  
Design Processes ◽  
Health Innovations ◽  
Intensity Of Care ◽  
Context Specific ◽  
System Sustainability

Although healthcare managers make increasingly difficult decisions about health innovations, the way they may interact with innovators to foster health system sustainability remains underexplored. Drawing on the Responsible Innovation in Health (RIH) framework, this paper analyses interviews ( n=37) with Canadian and Brazilian innovators to identify: how they operationalize inclusive design processes; what influences the responsiveness of their innovation to system-level challenges; and how they consider the level and intensity of care required by their innovation. Our qualitative findings indicate that innovators seek to: 1) engage stakeholders at an early ideation stage through context-specific methods combining both formal and informal strategies; 2) address specific system-level benefits but often struggle with the positioning of their solution within the health system; and 3) mitigate staff shortages in specialized care, increase general practitioners’ capacity or patients and informal caregivers’ autonomy. These findings provide empirical insights on how healthcare managers can promote and organize collaborative processes that harness innovation towards more sustainable health systems. By adopting a RIH-oriented managerial role, they can set in place more inclusive design processes, articulate key system-level challenges, and help innovators adjust the level and intensity of care required by their innovation.

scholarly journals Nurturing Societal Values in and Through Health Innovations Comment on "What Health System Challenges Should Responsible Innovation in Health Address?"

2019 ◽  
Vol 8 (10) ◽  
pp. 613-615 ◽  
Author(s):  
Payam Abrishami ◽  
Sjoerd Repping
Keyword(s):  
Health System ◽  
System Level ◽  
Responsible Innovation ◽  
Small Step ◽  
Policy Action ◽  
Socially Responsible ◽  
Societal Values ◽  
Health Innovations ◽  
Giant Leap ◽  
Innovation Processes

Aligning innovation processes in healthcare with health system demands is a societal objective, not always achieved. In line with earlier contributions, Lehoux et al outline priorities for research, public communication, and policy action to achieve this objective. We endorse setting these priorities, while also highlighting a ‘commitment gap’ in collectively addressing system-level challenges. To acknowledge that stakeholders engaged in dialogue with one another are addressing the commitment gap is not a small step but a giant leap towards realising a socially responsible innovation agenda. Translating system-level demand signals into innovation opportunities is, therefore, the task-cum-art of all stakeholders, one that often prompts them to innovate how they deal with innovations.

scholarly journals The Co-Constitution of Health Systems and Innovation Comment on "What Health System Challenges Should Responsible Innovation in Health Address? Insights From an International Scoping Review"

2019 ◽  
Vol 8 (11) ◽  
pp. 665-667 ◽  
Author(s):  
Alexander Peine
Keyword(s):  
Health System ◽  
Health Systems ◽  
Scoping Review ◽  
Health Technology ◽  
System Level ◽  
Responsible Innovation ◽  
Future Research ◽  
Technology And Innovation ◽  
Health Innovations ◽  
Potential Risks

Lehoux et al provide a timely and relevant turn on the broad and ongoing discussion around the introduction of health technology and innovation. More specifically, the authors suggest a demand-driven approach to health innovation that starts from identifying challenges and demands at the health system level. In this commentary, I review a number of underlying implications of their study in relation to positions of technology push and techno-optimism, and to the narrow focus on health technology assessment on economic and clinical values. While Lehoux et al’s scoping review provides very relevant insights with the potential to drive further empirical research, it is less clear about its conceptual basis. In particular, the somewhat artificial distinction between health innovations and health systems is worth further scrutiny. I discuss some potential risks of this separation, and propose to more openly address the co-constitution of health, health systems and technology in future research along the lines suggested by Lehoux et al.

scholarly journals Innovation Strategies and Health System Guiding Principles to Address Equity and Sustainability in Responsible Innovation in Health Comment on "What Health System Challenges Should Responsible Innovation in Health Address? Insights From an International Scoping Review"

2019 ◽  
Vol 8 (9) ◽  
pp. 570-572 ◽  
Author(s):  
Sandra C. Buttigieg
Keyword(s):  
Health System ◽  
Health Systems ◽  
Scoping Review ◽  
Global Scale ◽  
System Level ◽  
Responsible Innovation ◽  
Policy Makers ◽  
Innovation Strategies ◽  
Sustainability Challenges ◽  
The Right

The insights from an international scoping review provided by Lehoux et al challenge health policy-makers, entrepreneurs/innovators and users of healthcare, worldwide, to be aware of equity and sustainability challenges at system-level when appraising responsible innovation in health (RIH) – purposefully designed to better support health systems.The authors manage to extract no less than 1391 health system challenges with those mostly cited pertaining to service delivery, human resources, leadership and governance. Countries were classified according to the Human Development Index (HDI), while the authors decided not to classify according to the types of health systems justifying this on the basis that the articles reviewed studied a specific setting within a broader national or regional health system. The article presents highly powerful and discerning viewpoints, indeed providing numerous standpoints, yet in a comprehensive manner, thereby putting structure to a somewhat highly complex and multidimensional subject. This commentary brings forth several considerations that are perceived on reading this article. First, although innovation strategies are important for the dynamicity of health systems, one should discuss whether or not RIH can adequately address equity and sustainability on a global scale. Secondly, RIH across countries should also be debated in the context of the principles garnered by the type of health system, thereby identifying whether or not the prevailing political goals support equity and sustainability, and whether or not policy-makers are adequately supported to translate system-level demand signals into innovation development opportunities. As key messages, the commentary reiterates the emphasis made by the authors of the need for international policy-oriented fora as learning vehicles on RIH that also address system-level challenges, albeit the need to acknowledge cultural differences. In addition, the public has not only the right for transparency on how equity and sustainability challenges are addressed in innovation decisions, but also the responsibilities to contribute to overcome these challenges.

scholarly journals What Health System Challenges Should Responsible Innovation in Health Address? Insights From an International Scoping Review

2018 ◽  
Vol 8 (2) ◽  
pp. 63-75 ◽  
Author(s):  
Pascale Lehoux ◽  
Federico Roncarolo ◽  
Hudson Pacifico Silva ◽  
Antoine Boivin ◽  
Jean-Louis Denis ◽  
...  
Keyword(s):  
Service Delivery ◽  
Human Resources ◽  
Health System ◽  
Health Systems ◽  
Scoping Review ◽  
Rural Areas ◽  
Distribution Systems ◽  
Qualitative Content Analysis ◽  
System Level ◽  
Responsible Innovation

Background: While responsible innovation in health (RIH) suggests that health innovations could be purposefully designed to better support health systems, little is known about the system-level challenges that it should address. The goal of this paper is thus to document what is known about health systems’ demand for innovations. Methods: We searched 8 databases to perform a scoping review of the scientific literature on health system challenges published between January 2000 and April 2016. The challenges reported in the articles were classified using the dynamic health system framework. The countries where the studies had been conducted were grouped using the human development index (HDI). Frequency distributions and qualitative content analysis were performed. Results: Up to 1391 challenges were extracted from 254 articles examining health systems in 99 countries. Across countries, the most frequently reported challenges pertained to: service delivery (25%), human resources (23%), and leadership and governance (21%). Our analyses indicate that innovations tend to increase challenges associated to human resources by affecting the nature and scope of their tasks, skills and responsibilities, to exacerbate service delivery issues when they are meant to be used by highly skilled providers and call for accountable governance of their dissemination, use and reimbursement. In countries with a low and medium HDI, problems arising with infrastructure, logistics and equipment were described in connection with challenges affecting procurement, supply and distribution systems. In countries with a medium and high HDI, challenges included a growing demand for drugs and new technology and the management of rising costs. Across all HDI groups, the need for flexible information technologies (IT) solutions to reach rural areas was underscored. Conclusion: Highlighting challenges that are common across countries, this study suggests that RIH should aim to reduce the cost of innovation production processes and attend not only to the requirements of the immediate clinical context of use, but also to the vulnerabilities of the broader system wherein innovations are deployed. Policy-makers should translate system-level demand signals into innovation development opportunities since it is imperative to foster innovations that contribute to the success and sustainability of health systems.

Multi-level Barriers for Utilization of Youth Friendly Reproductive Health Services (YFRHS) among Youths

2020 ◽  
Vol 8 ◽  
pp. 95-108
Author(s):  
Shanti Prasad Khanal
Keyword(s):  
Reproductive Health ◽  
Health Services ◽  
Health System ◽  
System Level ◽  
Mixed Method Research ◽  
Reproductive Health Services ◽  
Group Discussions ◽  
Personal Level ◽  
Multi Level ◽  
Youth Friendly

 The present study aims to examine the multi-level barriers to utilize by the youth-friendly reproductive health services (YFRHS) among the school-going youths of the Surkhet valley of Nepal. This study is based on the sequential explanatory research design under mixed-method research. The quantitative data were collected using the self- administered questionnaire from the 249 youths, aged between the 15-24 years, those selected by using random sampling. The qualitative data were collected using the Focus Group Discussions (FGDs) from the 12 participants who were selected purposively. The study confirmed that school-going youths do not have appropriate utilization of YFHS due to multi-layered barriers. However, the utilization of the service was higher among females, those the older age group, studying in the upper classes, the upper castes, and married youths. The key findings and themes are recognized as multi-layered barriers including personal-level, health system-level, community-level, and policy-level on the entire socio-ecological field. Among them, the existing health system is the foremost barrier. Multi-level interventions are, therefore, required to increase the YFRHS utilization and improve concerns for school-going-youths.  

India as a Pioneer of Innovation

2018 ◽  
Keyword(s):  
Public Health ◽  
Health System ◽  
Informal Economy ◽  
Urban Poor ◽  
Public Health System ◽  
Low Cost ◽  
Social Enterprises ◽  
Specific Context ◽  
Innovation Project ◽  
Context Specific

What does innovation mean to and in India? What are the predominant areas of innovation for India, and under what situations do they succeed or fail? This book addresses these all-important questions arising within diverse Indian contexts: informal economy, low-cost settings, large business groups, entertainment and copyright-based industries, an evolving pharma sector, a poorly organized and appallingly underfunded public health system, social enterprises for the urban poor, and innovations for the millions. It explores the issues that promote and those that hinder the country’s rise as an innovation leader. The book’s balanced perspective on India’s promises and failings makes it a valuable addition for those who believe that India’s future banks heavily on its ability to leapfrog using innovation, as well as those sceptical of the Indian state’s belief in the potential of private enterprise and innovation. It also provides critical insights on innovation in general, the most important of which being the highly context-specific, context-driven character of the innovation project.

scholarly journals Quality in crisis: a systematic review of the quality of health systems in humanitarian settings

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Keely Jordan ◽  
Todd P. Lewis ◽  
Bayard Roberts
Keyword(s):  
Systematic Review ◽  
Health System ◽  
Health Systems ◽  
Point Of Care ◽  
System Level ◽  
System Quality ◽  
High Quality ◽  
Humanitarian Settings ◽  
Quality Health

Abstract Background There is a growing concern that the quality of health systems in humanitarian crises and the care they provide has received little attention. To help better understand current practice and research on health system quality, this paper aimed to examine the evidence on the quality of health systems in humanitarian settings. Methods This systematic review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The context of interest was populations affected by humanitarian crisis in low- and middle- income countries (LMICs). We included studies where the intervention of interest, health services for populations affected by crisis, was provided by the formal health system. Our outcome of interest was the quality of the health system. We included primary research studies, from a combination of information sources, published in English between January 2000 and January 2019 using quantitative and qualitative methods. We used the High Quality Health Systems Framework to analyze the included studies by quality domain and sub-domain. Results We identified 2285 articles through our search, of which 163 were eligible for full-text review, and 55 articles were eligible for inclusion in our systematic review. Poor diagnosis, inadequate patient referrals, and inappropriate treatment of illness were commonly cited barriers to quality care. There was a strong focus placed on the foundations of a health system with emphasis on the workforce and tools, but a limited focus on the health impacts of health systems. The review also suggests some barriers to high quality health systems that are specific to humanitarian settings such as language barriers for refugees in their host country, discontinued care for migrant populations with chronic conditions, and fears around provider safety. Conclusion The review highlights a large gap in the measurement of quality both at the point of care and at the health system level. There is a need for further work particularly on health system measurement strategies, accountability mechanisms, and patient-centered approaches in humanitarian settings.

scholarly journals Who could be One Health Activist at the community level?: A case for India

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Sandul Yasobant ◽  
Walter Bruchhausen ◽  
Deepak Saxena ◽  
Farjana Zakir Memon ◽  
Timo Falkenberg
Keyword(s):  
Health System ◽  
Work Experience ◽  
Financial Incentives ◽  
One Health ◽  
Health Workers ◽  
Structured Interview ◽  
Communicable Diseases ◽  
Community Level ◽  
System Level

Abstract Background Community health workers (CHWs) are the mainstay of the public health system, serving for decades in low-resource countries. Their multi-dimensional work in various health care services, including the prevention of communicable diseases and health promotion of non-communicable diseases, makes CHWs, the frontline workers in their respective communities in India. As India is heading towards the development of One Health (OH), this study attempted to provide an insight into potential OH activists (OHA) at the community level. Thus, this case study in one of India’s western cities, Ahmedabad, targeted identifying OHA by exploring the feasibility and the motivation of CHWs in a local setting. Methods This case study explores two major CHWs, i.e., female (Accredited Social Health Activists/ASHA) health workers (FHWs) and male (multipurpose) health workers (MHWs), on their experience and motivation for becoming an OHA. The data were collected between September 2018 and August 2019 through a mixed design, i.e., quantitative data (cross-sectional structured questionnaire) followed by qualitative data (focus group discussion with a semi-structured interview guide). Results The motivation of the CHWs for liaisoning as OHA was found to be low; however, the FHWs have a higher mean motivation score [40 (36–43)] as compared to MHWs [37 (35–40)] out of a maximum score of 92. Although most CHWs have received zoonoses training or contributed to zoonoses prevention campaigns, their awareness level was found to be different among male and female health workers. Comparing the female and male health workers to act as OHA, higher motivational score, multidisciplinary collaborative work experience, and way for incentive generation documented among the female health workers. Conclusion ASHAs were willing to accept the additional new liaison role of OHAs if measures like financial incentives and improved recognition are provided. Although this study documented various systemic factors at the individual, community, and health system level, which might, directly and indirectly, impact the acceptance level to act as OHA, they need to be accounted for in the policy regime.

scholarly journals Building the Evidence for Hospital Mobility

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 867-867
Keyword(s):  
Nursing Home ◽  
Health System ◽  
Functional Decline ◽  
Bed Rest ◽  
Illness Severity ◽  
Adverse Outcomes ◽  
Nursing Home Placement ◽  
System Level ◽  
Home Placement

Abstract Low mobility in the hospital, defined as mobility limited to bed rest or bed to chair transfers, is associated with high rates of functional decline, nursing home placement, and death even after adjusting for illness severity and comorbidity. This lecture will describe the gradual of building of evidence for both the adverse outcomes and potential solutions at both an individual and a health system level to address the challenge of low mobility.

scholarly journals Empirically evaluating the impact of adjudicative tribunals in the health sector: context, challenges and opportunities

2011 ◽  
Vol 7 (2) ◽  
pp. 147-174
Author(s):  
Steven J. Hoffman ◽  
Lorne Sossin
Keyword(s):  
Health System ◽  
Health Sector ◽  
Cost Effective ◽  
System Level ◽  
Challenges And Opportunities ◽  
External Impact ◽  
Health System Governance ◽  
Evaluation Matrix ◽  
The Impact ◽  
Methodological Difficulties

AbstractAdjudicative tribunals are an integral part of health system governance, yet their real-world impact remains largely unknown. Most assessments focus on internal accountability and use anecdotal methodologies; few, studies if any, empirically evaluate their external impact and use these data to test effectiveness, track performance, inform service improvements and ultimately strengthen health systems. Given that such assessments would yield important benefits and have been conducted successfully in similar settings (e.g. specialist courts), their absence is likely attributable to complexity in the health system, methodological difficulties and the legal environment within which tribunals operate. We suggest practical steps for potential evaluators to conduct empirical impact evaluations along with an evaluation matrix template featuring possible target outcomes and corresponding surrogate endpoints, performance indicators and empirical methodologies. Several system-level strategies for supporting such assessments have also been suggested for academics, health system institutions, health planners and research funders. Action is necessary to ensure that policymakers do not continue operating without evidence but can rather pursue data-driven strategies that are more likely to achieve their health system goals in a cost-effective way.

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