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Why is critical research on health innovation useful?

Critical researchWhat health innovations are we talking about?

Although innovation in health care is often equated with technology, it is in fact a change that may refer to products and/or processes (OECD, 2005). An innovation may be radical (e.g., the discovery of x-rays) or incremental (e.g., the refinement of computed tomography scanners). It may emerge from the private or the public sector, or from an alliance between the two. It may have been designed by experts such as engineers and scientists, or by non-technical end-users (e.g., physicians, patients, disabled persons).

 

 

  • An innovation may be commercialized by a for-profit or a not-for-profit company, or it can become part of the public domain and freely accessible (e.g., open source software systems). In practice, innovations often combine many of the features mentioned above and their success depends upon the expertise and know-how of a large group of individuals from both the private and public sectors.

  • Some technologies are used in the workplace or community and affect health by preventing either disease/injury or exposure to deleterious products or practices. In fact, keeping a population healthy requires considering not only technologies that are used in clinical settings, but also those used in the community and those that affect health more broadly (see Table 1).

  • Hand washingA technology is rarely just a stand-alone “high-tech” device that generates measurable costs and benefits; it is one component of larger health care and social systems. And several ‘mundane’ technologies (e.g., blood glucose monitors, home care tests, needles) contribute profoundly to the effectiveness of health care. The emergence of Severe Acute Respiratory Syndrome (SARS) in Toronto (Canada) vividly illustrated how effective detection and control of contagious cases relied on the appropriate use of simple tools such as ear thermometers, hand washing and facial masks (and failed when such tools were inconsistently applied in practice) (Poland et al. 2005).

 

 Category  Examples
 Screening tests

Cytological tests, blood tests, prenatal testing, genetic testing

 Diagnostic tests and imaging devices

X-rays, ultrasound, magnetic resonance imaging, computed tomography scanner

 Monitoring systems

Blood glucose monitors, electrocardiograms, fetal monitoring

 Implants

Cochlear implants, left ventricular assist devices, pacemakers

 Surgery and therapeutic devices

Hip replacement, tonsillectomy, laparoscopic cholecystectomy, radiation therapy

 Palliative technologies

Dialysis, ventilators, parenteral nutrition

 Drugs

Caplets, patches, injections, inhalers

 Health promotion technologies

Vaccines, helmets, condoms, smoking cessation strategies, playgrounds, sports facilities

 Occupational health technologies

Protective equipment and clothing, work safety measures, ergonomic furniture and tools, preventive measures for pregnant women

 Technical aids

Wheelchairs, hearing aids, prostheses

 Information technologies

Telemedicine, electronic patient records, health cards, expert systems

 

Table 1. Categories of health technology Source: Lehoux, 2006.

 

Is health innovation bliss, or anguish?

  • For many observers, health technology is bliss —something that must be strategically embraced, not irrationally resisted:

    Technology has streamlined the administration of the hospital and the doctor’s office, enabling more efficient and cost-effective processing and storage of patient medical and billing records. Telemedicine has advanced to the point where remote specialist consultation can take place through videoconferencing and the immediate transmission of X-ray and other images. Technology has brought noninvasive diagnostic and surgical tools to the physician’s practice. And breakthroughs in medicine through computer-assisted research have reduced the half-life of medical knowledge to five or fewer years … (Ellis 2000: xiii-xiv).

  • From such an optimistic perspective, technology evokes time and modernity; the latest is supposed to be better. This understanding is uncritical and therefore misleading: it cannot help us make the best use of our available resources, meet the needs of our population and improve the design of innovations.

  • BalanceCritical research is key for improving what we know about the impact of innovations on health care delivery and people’s lives and for using them in the most appropriate way. That implies clarifying the contexts in which innovation proves clinically and socially valuable or not. The use of certain innovations triggers social changes and raises ethical concerns (i.e., prenatal screening tests, surveillance devices, etc.). Innovation also modifies the expectations of patients and the general public with respect to health and health care. A critical perspective is therefore vital to ensure that negative or unintended effects (both clinical and social) are identified before innovations are widely disseminated.

  • Social scientific research is suited to explore complex questions: Why do clinicians trust and use certain innovations instead of others? Why do patients expect, demand, or reject specific interventions? And how does technology really affect the health and well-being of the population? Social scientists have shown that providers and patients do not use, perceive, or value medical technology in any consistent way; clinical outcomes therefore vary. It is now recognized that non-medical variables influence effectiveness (e.g., emotions, knowledge, values, beliefs, cultural practices, social interactions, organizational structures and processes, financial incentives, and regulatory frameworks). Hence, because health innovations are both bliss and anguish, we need critical research to improve our use of them and their design.

 

Return to the dossier on:
Medical innovations

 

Author : Pascale Lehoux, Ph.D.

 

REFERENCES

  • Ellis, D. 2000. Technology and the future of health care: Preparing for the next 30 years. San Francisco: Jossey Bass.

  • Lehoux, P. (2006). The problem of health technology. Policy implications for modern health care systems. New York : Routledge.

  • Organization for Economic Cooperation and Development (OECD). 2005. Oslo Manual: Guidelines for Collecting and Interpreting Innovation Data. 3d ed, Paris: OECD Publishing.

  • Poland, B., Lehoux, P., Holmes, D. & Andrews, G. (2005). “How place matters : Unpacking technology and power relations in health and social care.” Health and Social Care in the Community 13(2) : 170-180.

 

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