Innovation and inertia in wounds.

Abstract

It is increasingly accepted that wounds and wound-healing problems are a significant problem and cost to health care systems worldwide. If this is the current situation, then why are we not looking at innovation as a way to tackle this huge and complex problem? At a time when we can transplant many organs and cure many cancers, we still cannot guarantee that a patient with a wound problem will see a clinician with the knowledge and expertise to ensure appropriate and consistent standards of care are provided to all patients globally. This situation is caused by multiple factors. The lack of awareness, provision of services, and evidence to support the benefit of many interventions is a component of this situation, but is that all that is required to change the current situation? Innovation is conventionally seen as something that focuses on technological advances in a subject area, but this is only part of the way forward as there is certainly much more to be completed to ensure that assessment, diagnosis, and therapeutic interventions are developed and proven to be effective in both the prevention and treatment of wound problems. It should be accepted that these innovations should include dressings, devices, drugs, surgical approaches, and biologically based therapies if we are to provide clinicians with a complete armamentarium of therapies. In addition, the development of service, system, and process innovation is as important or even more important than technology advances because how many of us who see patients regularly see opportunities for reducing waste, harm, and variation in practice? The new therapies may be unavailable simply because of the health care system preventing their use. Phillips et al (1) demonstrated that, in Wales, 78 000 patients saw their family doctor with a wound in 1 year. This led to the consumption of £328million or 6% of the NHS budget in that year. Of the costs calculated, less than £10 million were a result of the cost of dressings, but how much effort is put into evaluating, or worse still reducing the cost of, dressings compared with the effective use of resources for the 700 000 home visits, the 68 000 outpatient visits, and the almost 15 000 hospital admissions? Surely an important and neglected aspect of dealing with this problem is the way in which care, particularly for patients with wounds, is currently provided. Another important and neglected challenge is the focus on social innovation to encourage healthy lifestyles in citizens of all countries, such that many diseases are prevented or self-managed. We have seen changes in society around smoking, alcohol consumption, and—more recently—sugar consumption, so why not extend this to patients with or at risk of developing wounds? This, coupled with novel methods of care delivery, could have a huge impact on the provision of care and the health of a nation. An example of this is the Lindsey Leg Clubs, a social enterprise model, for care delivery co-ordinated by the patients and their relatives to encourage self-management of chronic leg wounds. If the premise is that change is needed, then it should also be accepted that this systems approach to problem wounds is essential. If so, why has little been done in this area? Inertia is one explanation, but perhaps focusing on a broader agenda might yield even greater benefits than simply evaluating a new wound product and its ability to heal a wound. In addition, the integration of newer technological approaches (eg, electronic documentation and telemedicine) can change practice and enhance the delivery of care. This truly requires a system-wide adaption and partnership ensuring optimal delivery of care for patients with wounds. It is a challenge but one that is worth tackling if we are to see improvements in care.