It included approximately 20 Canadian and European participants: researchers (social scientists and health services researchers), designers (university based engineers and representatives of the medical device industry), and users (clinicians, R&D administrators and funding agencies). They shared key observations arising from their work on innovations and discussed ways to overcome current obstacles.
The workshop highlighted differences among the research, R&D and government sectors, and the need for further dialogue in order to improve not only the design of innovations, but also their adoption.
Innovation is often thought of in terms of technological innovation. However, most participants felt that social innovation is equally important to the goal of improving and maintaining health.
When participants discussed the “desirability” of health innovations, one question came up repeatedly: “Who are the users?” Although physicians and health care providers have always been key users of medical technology, recent advances in information technology as well as chronic care and home care treatment have lead to patients becoming primary users too.
Who decides what to invest in R&D? The agendas of multiple stakeholders, including researchers, governments and private interests, all shape R&D. Researchers carry out innovative research in areas that will help them obtain grants and pursue an exciting career. Health ministries are mostly interested in acquiring technologies that are cost effective, while other government branches support R&D in various promising niches. Private companies develop “high tech” products that are likely to seduce physicians and patients.
R&D investment is not always aligned with health care system needs and priorities. Why do some innovations receive more support than others? Some innovations that are clearly needed and appropriate, such as those in the fields of wheelchair and prosthesis development, do not receive sufficient support, while others appear overly “hyped,” such as nanotechnologies or innovations in genetics and genomics.
In Canada, many companies in the medical industry are small or medium in size. In order to be able to continue developing new technologies, they require reduced regulation and more support from the government in the form of funding, tax breaks and changes to the patent system.
Once a new device or technology enters the market, the adoption phase can be problematic for several reasons. First, the adoption of medical devices does not follow a linear pathway. Second, poor design decisions can have a considerable impact on the adoption process. Workshop participants pointed out that designers rarely seek feedback from end users and often test their devices “in house.” This was deemed inappropriate because the preferences of designers rarely match those of the device’s end-users. Seeking the feedback of end-users would make the innovation more user friendly and therefore facilitate its adoption. Users should be involved during both the design and adoption phases.
To improve adoption, designers should also take into account the social context. Social scientists could help designers better understand the real world use of innovations. Social scientific research can generate new kinds of evidence that go beyond cost and efficacy and also embrace the complexity of technology use.
To improve the adoption of innovations, we need early adopters and clinical champions. Health care environments that can foster change, adoption and reinvention have to be created and sustained.
The challenges facing industry centre around R&D funding models, which need to be revisited; reimbursement decision making processes; the role of Health Technology Assessment (HTA), which is produced by a variety of Canadian agencies through different processes; product standardization; and general inertia.
Health innovation triggers ethical questions: What innovation is appropriate and should be accessible? To whom? Who should decide which innovation is worth investing in? What criteria should apply? Should R&D spending go to areas of greatest therapeutic need as measured by number of patients? Are innovators giving too much hope to the population?
Industry invests in innovations for which it feels there is a market; however, their vision may be misguided. We need to create more space for discussion between industry, end users, researchers and government.
Although competition triggers improvement, it can be costly and counter productive. It can even be harmful; for example, the over diversification of products requires more training for health professionals, and the use of several different types of device can increase errors.
Involving end users in the design and adoption phases is key.
To read the full workshop report (Document N07-01) :
Based on : Tailliez, S., Lehoux, P., Urbach, D., Miller, F., Battista, R.N. (2007) Authors : S. Tailliez, Ph.D., P. Lehoux, Ph.D., D. Urbach, Ph.D., F. Miller, Ph.D., R.N. Battista, Ph.D.
Adapted by : Stéphanie Tailliez, Ph.D.