Building the Structures and Ecosystem Required for Sustainable Health Innovation in Canada.

The purpose of public health and healthcare is to create healthier populations. The purpose of innovation in healthcare is to accelerate the transformation of the work processes and economic models required to improve health. The use of information technology and telecommunications, and especially of health informatics, is critically important to these goals. It is an inspiring and highly productive frontier for engineering, science, and human behavior, and is the most direct path to unleashing transformative and beneficial innovations in healthcare. I believe, however, that it is under-appreciated in terms of its potential. Innovations such as these are often disruptive, and therefore require strong scientific, public, and private health support. In this article, I focus on four tectonic shifts in the nature of innovations in health informatics. I would encourage students, young faculty, and researchers to broaden their understanding of the range of opportunities in this field, and to consider these tectonic shifts as fundamental pillars for the application of informatics to discovery and large-scale transformation.

Medicine is changing rapidly and diagnostic and therapeutic innovations are common. Not all professionals adopt these innovations in the same way. To survey the physicians' opinions on adopting innovations in cardiovascular health care, to classify individuals from an innovative to a conservative behavior, and to individualize opinion leaders among them, in order to build a social network of influence. Between November and December 2008, 765 Argentine cardiologists were surveyed via e-mail in Argentina, to assess the way they adopt and disseminate innovations in cardiovascular health care. The survey was answered by 537 professionals (70.2%). Fifty three percent of respondents were "Early adopters". However, 63 to 79.3% of respondents preferred to wait for a full demonstration of the usefulness of innovation before adopting it. The opinion leaders' distribution adopted a scale-free network pattern, where few leaders had many connections and influence on the whole network. The giant component of the network included 41% of physicians; growth simulation of the network showed that the four most popular leaders influenced over 44% of the giant component. Among surveyed physicians there was an attitude towards rapid acceptance of innovations in health care. However, when analyzing the direct opinion of physicians, most cases preferred usefulness demonstrated before accepting innovations. The social network including respondents and opinion leaders showed a scale-free topology with a big influence of a few over the whole network.

Ten years ago, the Advisory Panel on Healthcare Innovation, chaired by C. David Naylor, gave its prescription to strengthen Canada's healthcare systems. Unfortunately, the report fell victim to politics and shifting government priorities. This commentary argues that key barriers to healthcare improvement in Canada - particularly siloed structures that prevent collaboration, a lack of political will to challenge the status quo and a myopic federalism paradigm - continue to bedevil Canada's health systems, and that the recommendations of the Naylor panel, particularly the proposed healthcare innovation fund and federal healthcare innovation agency, are as relevant today as they were in 2015.

Innovation in Health Care: Time for a Gut Check

It has been 10 years since the Advisory Panel on Healthcare Innovation Report (Advisory Panel on Healthcare Innovation 2015) recommended patient engagement and empowerment as one action to enhance the quality and sustainability of healthcare in Canada. Since that time, patient engagement has become internationally recognized as a key component toward improving healthcare systems. In this article, the author highlights how organizations across Canada have engaged patients in healthcare and health research planning, design and governance activities, and discusses three key areas wherein improvements are needed to leverage the potential of patient engagement: leadership and infrastructure, diversity and representation and power structures/imbalances.

The importance of the Family Health Strategy in the health sector in Brazil, and the debate on technology and technological innovation have led to the development of a theoretical reflection aiming to characterize the Family Health Strategy as a non-material technological innovation of the health field. In order to construct the text, the philosophical and sociological approach was used, as was the conceptualization of technological innovation, found in international documents and in Brazilian legislation and publications regarding technological innovation in health care. These references were used in order to analyze what is prescribed for the Family Health Strategy in the National Primary Healthcare Policy, emphasizing the innovative aspects in relation to biomedicine, which made it possible to support that the Family Health Strategy consists of a non-material technological innovation in health care, of the incremental type. It is concluded that the Family Health Strategy is a non-material technological innovation in health care, due to the principles which it anchors, and is incremental, as it does not completely break with the traditional model in health care.

The era when Canadians could be confident their health care system is among the best in the world is “drawing to a close,” says Dr. David Naylor, chair of the federal government’s new Advisory Panel on Healthcare Innovation. Naylor, former president of the University of Toronto, and his seven

Hands across Care: Art and social practice in health and elder care contexts

In 2015, the Advisory Panel on Healthcare Innovation (APHI) highlighted shortcomings in Canada's healthcare systems, including weak integration, ineffective workforce planning and deployment, uneven infostructure and misaligned incentives. Progress in the last decade has been modest, underscoring both the challenges faced by provinces/territories in effecting top-down structural reforms and the limited yield from federal attempts to "buy change." APHI anticipated that outcome and argued for a new bottom-up model of collaborative catalysis, evaluation and scaling of effective innovations in healthcare. This model also facilitates the selective commercialization of novel Canadian goods and services and bears consideration given our healthcare crisis and weak innovation indices.

Federal Health Minister Rona Ambrose created the Advisory Panel on Healthcare Innovation, asking them to identify five priority innovation areas that would improve accessibility, quality of care and health spending. Their 2015 report found fragmented systems, a lack of collaboration across jurisdictions to share learnings and best practices and undercapitalized technological advancements, among other barriers to spreading successful innovation. Ten years later, we review the report's main recommendations and examine progress in the key areas identified for action. Progress on many of the recommendations is lacking. The panel's main recommendations - creation of a $1-billion innovation fund to enable sustainable changes in care delivery and a national healthcare innovation agency - have gone largely unanswered. We illustrate the need for an innovation agency that spans all provinces using several examples, including ones where digital health innovation is required, including central intake and triage for specialist referrals. We discuss the conditions needed for successful implementation: An interoperable digital solution, changes to models of care and funding flows, leadership and a patient-centred culture within the health system. We also highlight how local innovation hubs enable the development of new technologies and identify the key local, provincial and national factors for success that should be considered for a new federal agency.

Canada has a history of innovative pilot projects that have failed to spread and scale to achieve transformative change in the organization and delivery of healthcare. Past experience suggests four essential dimensions of sustainability: funding, including incentives to adopt new working methods and longer-term program funding; strong policy guidance and/or legislation and regulation; sustained focus on addressing a particular problem or issue; and accountability for results. Had the Naylor Panel recommendations been implemented a decade ago, Canada's healthcare system would now be on a much stronger footing to confront today's challenges. The Naylor blueprint offers pertinent, practical solutions for issues such as improving access to primary care, improving digital health and contending with artificial intelligence.

Background: Innovation is associated with improvement, however, there is little published about the “ingredients” for successful innovation in healthcare, and the skills required of Health Service Managers (HSMs) who facilitate change in their organisations. \n\nAim: This paper synthesizes the findings of a literature review performed to describe the organizational and contextual factors that enable and sustain innovation in healthcare settings. Implications for the practice of Health Service Management and curriculum development have been extrapolated as innovation has been identified as a solution to escalating health system demands in a rapidly changing environment.\nApproach: A literature review used a systematic approach to source articles from the Scopus and Emerald databases over the period of 1993 to February 2016. Papers were also retrieved from a BMC Health Services Research weekly alert. Snowballing from relevant articles identified additional and significant papers. Grey literature, peer-reviewed papers and reports were similarly reviewed to incorporate contemporary perspectives on this topic across the business, health and University sectors, and to facilitate discussion of the skills and competencies for HSMs practice and education in relation to this topic. \n\nContext: Innovation is crucial to the sustainability and viability of Australia’s world class health system. There is potential for innovation to lead to more cost-effective and efficient ways to address the challenges of limited health budgets and increasingly complex morbidities in an ageing population. \n\nMain findings: Successful innovation according to the literature, is determined by a complex interaction of determinants including organizational culture, support and resourcing for innovation, leadership and a clear and shared vision. An organizational culture supportive of innovation includes strong transdisciplinary communication, engaged and invested staff and recognition of the role of innovation in health improvement and outcomes. A setting that is open to identifying, testing and evaluating initiatives for innovation requires capabilities to establish and maintain the working relationships, team dynamics and to prioritise resourcing to facilitate and sustain new ways of working, services, products or technologies.\nRecent research on the skills required for health service management employability and career success was also examined and identified the importance of skills such as communication, creativity and problem solving. These skills are critical and linked to the role of the HSM in accelerating innovation in their organisations.\n\nConclusions: The key ingredients for successful innovation in health were inferred from the literature. HSMs are well positioned to support innovation as they possess the necessary technical and professional skillsets. The literature suggests that the development of graduate skills in the areas of communication, problem solving, and team work is critical to meet industry needs and for HSMs to enable innovation.\nUniversities educating health service managers strive to ensure that graduates are professionals equipped to lead and manage health services. HSM graduates can foster the organizational and contextual factors that sustain and sanction innovative ideas to flourish and progress to implementation. Current research advocates that strong industry and higher education collaboration is important to further develop the graduate attributes necessary for innovation.

Background: Innovation is associated with improvement, however, there is little published about the “ingredients” for successful innovation in healthcare, and the skills required of Health Service Managers (HSMs) who facilitate change in their organisations. Aim: This paper synthesizes the findings of a literature review performed to describe the organizational and contextual factors that enable and sustain innovation in healthcare settings. Implications for the practice of Health Service Management and curriculum development have been extrapolated as innovation has been identified as a solution to escalating health system demands in a rapidly changing environment.Approach: A literature review used a systematic approach to source articles from the Scopus and Emerald databases over the period of 1993 to February 2016. Papers were also retrieved from a BMC Health Services Research weekly alert. Snowballing from relevant articles identified additional and significant papers. Grey literature, peer-reviewed papers and reports were similarly reviewed to incorporate contemporary perspectives on this topic across the business, health and University sectors, and to facilitate discussion of the skills and competencies for HSMs practice and education in relation to this topic. Context: Innovation is crucial to the sustainability and viability of Australia’s world class health system. There is potential for innovation to lead to more cost-effective and efficient ways to address the challenges of limited health budgets and increasingly complex morbidities in an ageing population. Main findings: Successful innovation according to the literature, is determined by a complex interaction of determinants including organizational culture, support and resourcing for innovation, leadership and a clear and shared vision. An organizational culture supportive of innovation includes strong transdisciplinary communication, engaged and invested staff and recognition of the role of innovation in health improvement and outcomes. A setting that is open to identifying, testing and evaluating initiatives for innovation requires capabilities to establish and maintain the working relationships, team dynamics and to prioritise resourcing to facilitate and sustain new ways of working, services, products or technologies.Recent research on the skills required for health service management employability and career success was also examined and identified the importance of skills such as communication, creativity and problem solving. These skills are critical and linked to the role of the HSM in accelerating innovation in their organisations.Conclusions: The key ingredients for successful innovation in health were inferred from the literature. HSMs are well positioned to support innovation as they possess the necessary technical and professional skillsets. The literature suggests that the development of graduate skills in the areas of communication, problem solving, and team work is critical to meet industry needs and for HSMs to enable innovation.Universities educating health service managers strive to ensure that graduates are professionals equipped to lead and manage health services. HSM graduates can foster the organizational and contextual factors that sustain and sanction innovative ideas to flourish and progress to implementation. Current research advocates that strong industry and higher education collaboration is important to further develop the graduate attributes necessary for innovation.

Background Clinical and non-clinical health leaders both seek to leverage data to drive innovative improvements in models of care and create sustainable and effective health systems. For the last three years, Activity-Based Funding (ABF) has been the main driver for funding public hospitals in New South Wales (NSW), Australia. The data generated by the implementation of ABF has been used for both policy and funding decisions. As quality improved, the data became more relevant to a wide range of stakeholders, and drove improved interactions and conversations between clinicians and administrators. These conversations and opportunities were particularly relevant for patient-level clinical costing. This process uses a large range of data sets to allocate costs, and is presented with patient activity data that are familiar to clinicians. Clinical analytics, which leverages on cost and activity data, are being used to shape the future of local health systems, improve service delivery, and enhance patient outcomes. This shift moves the system from ABF to Activity-Based Management (ABM), through which data can be used not only for funding the annual budgets of Local Health Districts (LHDs) but also to inform local policy decisions. For several years, LHDs have submitted annual patient costing data returns to the Ministry of Health. Until recently, however, they saw few benefits from the effort required to submit these data, since state-wide benchmarking and variance analysis were limited and/or provided with significant time delays. The ABM Portal was created and launched to address this issue. The Portal provides a rich data source that can support local decision-making about clinical care evaluations, reduce unwarranted clinical variations, improve care models, facilitate service planning, and effectively manage services within budget. The ABM Portal was developed with significant input from clinicians and is currently being expanded to incorporate additional data elements. The ABM Portal contains data aggregated to LHDs from patient-level data, enabling users to drill down to the lowest-level information and understand the causes of any identified variances (i.e., in cost or length of stay).

National health innovation systems: Clustering the OECD countries by innovative output in healthcare using a multi indicator approach