What do we mean by innovation in healthcare?
25 October 2018
By Bernard Crump
My definition of innovation in healthcare is doing things differently and doing different things that create a step change in performance.
That implies a number of things. Firstly, in my book, it is not an innovation unless you have implemented the change and it has led to an improvement in health outcomes or another aspect of performance in the system.
Secondly, it doesn’t necessarily mean you have to be the original inventor. It is perfectly legitimate to take an idea that has been successful in another industry or another setting and then adapt it to a new setting and it has led to doing things differently – that would still be classed as innovation.
So we are not only talking about a new drug or medical device, it could be a service innovation in healthcare, a new way of organising care or a new use of IT or a new app.
However, protecting the intellectual property in new medical devices or drugs is easier because individuals or companies can apply for patent protection of their ownership of that specific innovation.
Whereas a service innovation or a new IT system are more difficult to patent and less defensible as being unique. That does mean the mechanisms to support innovation often differ depending on whether it is the innovation of a product or a medication to a service innovation or a different way of organising delivery of care.
So what do we mean by innovation in healthcare? It is not a single activity, it is best regarded as a spectrum. It may start with ideation, invention, having the idea. A good example of innovation in healthcare came when a group of clinicians working some years ago in Birmingham recognised there was the potential for finding an alternative way of managing arthritis of the hip.
Instead of replacing the whole of the head of the femur, they looked at resurfacing it. They carried out both prototyping of developing what materials might be suitable and then conducted clinical trials.
They published the results and it seemed to be promising, but for it to go any further they needed partners who could bring investment and expertise in taking this to a national or international market.
They partnered with a large medical devices company, which put the weight of its R&D and marketing departments behind the process.
It became very widely adopted, but there was controversy along the way about the extent to which the NHS organisation that hosted where the innovation arose should also be a beneficiary of its commercial success.
That is a question which still causes difficulties today. That and other similar cases led to the NHS realising it needed to take more seriously this aspect of its work.
Examples of innovation in healthcare
This is especially true because the UK’s NHS has been one of the most inventive healthcare settings in the world.
Many of the major developments in healthcare originated in the UK, but historically the country has been bad at two things. Spreading the use of the innovations quickly so that patients everywhere benefit in a consistent way; and forming the right links with industry for those innovations to be commercialised and developed in a way that benefits the UK economy.
There are many examples of innovation in healthcare in the UK. Penicillin was a UK discovery; the first hip replacements in the world were done in the UK; the concepts that underpin MRI scanning were first uncovered in the UK. And yet the commercial exploitation of MRI scanning principally took place in Germany, Japan and the USA.
The UK Government woke up to the importance of innovation to the UK economy in 2011 with a publication called Innovation, Health and Wealth by the Department of Health.
It started to recognise the potential benefits for the economy of being better at exploiting these innovations from healthcare by connecting them with the right partners so they could have an impact on UK Plc.
The UK has a theoretical advantage compared to many healthcare systems in the world because a national healthcare system is potentially a really good test bed for new ideas and for new ways in spreading innovative practice, but the UK has never really capitalised on those advantages until recently.
In the past you weren’t promoted to CEO of a hospital because you had a reputation for supporting innovation in healthcare. That is changing and it is recognised that innovation is now an important part of how the NHS develops its healthcare leaders, and that they understand how to create a culture in their organisation that supports innovation in healthcare.
What is service innovation in healthcare?
Service innovation in healthcare focuses more on how care delivery is organised, rather than on the specific equipment or devices that are used.
A lot of service innovation is about looking at other industries, at how they have taken waste out of their system and applying those principles to healthcare.
The innovation in healthcare around ‘lean’ is a great example of the adoption and adaptation of good ideas from elsewhere and applying them to healthcare.
It can cause anxiety. Instinctively clinicians can be sceptical that a way of working that was designed for a production line to produce error-free and perfectly formed products, can also be relevant to the care of individual human beings with their own particular needs.
There are, however, aspects of healthcare that are pretty routine, such as organising a battery of tests for a patient, and here the process and the logistics can draw on operational research from other industries.
When we look at ways of delivering healthcare and use some of the tools from other industries to reduce waste, we find it can be very effective as a way to free up time to do personalised care, by handling the routine in a more efficient and effective way.
And if we can become better at predicting what we need and when we need it, we don’t need to carry so much stock. That frees up resources, and valuable space for other things. Plus, many medicines and consumables have a shelf life so we can cut down on wastage.
This type of innovation in healthcare is not second class innovation at all. It may not focus on angel investors, venture capitalists or IP protection, but some of these changes in service innovation can be really significant.
WBS is currently evaluating a partnership between a number of UK healthcare organisations with the Virginia Mason Medical Center in Seattle, which partnered with Toyota some years ago to learn about lean processes and began to apply them systemically in its healthcare system.
It has been implemented very successfully to improve quality, safety and productivity of care. Virginia Mason now offers support to other organisations to learn these lessons, with the NHS engaged in a trial to see if that knowledge is transferable to a UK setting.
Bernard Crump is Professor of Practice in Healthcare and Leadership and a former CEO of Shropshire and Staffordshire Strategic Health Authority and ex-CEO of the NHS Institute for Innovation and Improvement.
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