Global Diffusion of HealtHcare innovation

Unlocking the benefits of healthcare innovations involves scaling those innovations up so that they can be used to improve health outcomes for the many, rather than the few. Our new research into the Global Diffusion of Healthcare Innovation (GDHI) aims to provoke discussion and debate amongst healthcare leaders worldwide about what can be done to encourage the spread of innovation and contribute to system transformation in healthcare. It presents a global assessment of the factors that support the spread of healthcare innovation and how these are at play in eight very different countries’ health systems: Australia, Brazil, England, India, Qatar, South Africa, Spain and the United States.
Our research draws on over 100 personal interviews with senior-level experts who were able to give an overview of their healthcare systems, as well as quantitative surveys of more than 1,500 healthcare professionals and more than 750 industry professionals from the fields of pharmaceuticals and medical technology.
The study examines the importance and prevalence of a set of specific enablers and cultural dynamics (or organizational behaviors) as they are applied in the eight countries. These enablers and cultural dynamics were first identified as a framework for the diffusion of healthcare innovation by the Institute of Global Health Innovation (IGHI), Imperial College London.1

CounTRIES aRE TaKInG DIFFEREnT RouTES
Our findings show that countries are using different mixes of enablers to encourage the spread of innovation in healthcare. In the US, for example, experts are clear that “incentives and rewards” have played an important role and they see the diffusion of innovation as being tied to the payment system. In England, by contrast, it is healthcare “standards and protocols” that are noted for having helped the spread of innovation by encouraging organizations to put in place innovative ways of improving their healthcare delivery rocesses.
The experts we interviewed in all countries cite one common enabler – “information communications technology (ICT) capability” – as having helped the spread of innovation over the past five years. ICT has been a particularly important enabler in the emerging economies of Brazil, India and South Africa, where eHealth (healthcare practice and information supported by ICT) and mHealth (healthcare-related services
through mobile technology) are helping to transform healthcare delivery.
Our quantitative survey of healthcare professionals suggests that, at an organizational level, enablers such as the use of “standards and protocols” and “specific resources to identify and promote innovation” are also widespread.

From innovation to transformation, Institute for Global Health Innovation, June 2013.
Our findings indicate that the eight enablers identified in the IGHI framework represent the wide range of institutional tools and agencies that are being used in the countries we examined. This “portfolio” of enablers is available to be employed, discriminately and appropriately, within the context of each country’s particular health system.

THERE aRE Common FRonTLInE CuLTuRaL DynamICS
Our survey shows that healthcare professionals across most of the countries we examined view the same cultural dynamics as being the most prevalent within their organizations in relation to the adoption of healthcare innovations, regardless of different national and health system characteristics and of different mixes of enablers. The results of our survey show that the cultural dynamics that relate to the role of people in spreading innovation are those that healthcare professionals in most countries believe are most prevalent in the organizations for which they work. They see “identifying and supporting champions” as being the most prevalent cultural dynamic in the diffusion of innovation. This is closely followed by “harnessing the
efforts of patients and the public as co-producers of well-being.” In-depth interviews with experts also highlight the fundamental role that the cultural dynamics as a whole can play in spreading innovation in healthcare. Much of the diffusion of innovation is about winning the hearts and minds of those working on the front line. For many experts, these organizational attitudes and behaviors are equally as important as national or institutional enablers, or even more so. They are also more readily developed, influenced and managed by those at the front line of healthcare.
The experts we interviewed speak of the importance of engaging those delivering frontline care, the role that healthcare professionals take as champions or leaders of change and the need to address the concerns of these professionals. What this tells us is that a focus on the front line – where care is delivered and where change most needs to be fostered – can be very powerful in bringing about a more rapid diffusion
of innovation.

THERE IS nEED FoR ImPRovEmEnT
Our findings also indicate, however, that there is still scope for considerable improvement in embedding the cultural dynamics within healthcare organizations in the future. Four of the dynamics – “creating space”, “adapting innovation”, “improving the next journey of system transformation” and “eliminating old and ineffective ways of working (or delayering)” – may not have been rated by healthcare professionals
overall as being as prevalent as the two dynamics we have previously discussed. Yet these factors are important: “Creating space for learning”, for example, can be the forum in which clinical engagement can be most productive. Healthcare organizations can do much more to ensure that healthcare professionals have dedicated time to learn about new ideas.
The survey shows that those healthcare professionals who are advocates for their organizations are more likely to rate that organization highly on the prevalence of the cultural dynamics. This underlines the importance, in promoting more effective diffusion of innovation, of ensuring frontline staff feel engaged with their organizations.4 Global Diffusion of Healthcare Innovation 2013
Unlike healthcare professionals, the industry professionals that we surveyed in some countries (Brazil, India and Qatar) highlight dynamics that relate to processes rather than people as the most prevalent cultural dynamics within the healthcare organizations with which they work. In Brazil and India, the highest ranked
dynamic is “improving the next journey of system transformation,” while in Qatar, it is “eliminating old and ineffective ways of working.” Overall, there is much more diversity in industry professionals’ views than there is in healthcare professionals’ views across the countries.

THE PREvaLEnCE oF EnaBLERS anD CuLTuRaL DynamICS IS CLoSELy maTCHED
In all countries in the study, healthcare professionals rate their organizations’ prevalence of enablers and of cultural dynamics at broadly similar levels. Where the prevalence of one set of factors – enablers or cultural dynamics – is high, so is the prevalence of the other; where it is low, both are low. Indeed, across all eight
countries, a correlation exists here. To effect change in the diffusion of innovation across a health system, it appears to be important to focus on developing and using both local enablers and cultural dynamics simultaneously. The increased prevalence of one seems to go hand-in-hand with the increased prevalence of the other.
Healthcare professionals and industry professionals view all enablers as important for healthcare organizations, with the development and renewal of standards and protocols particularly so. In all countries other than Qatar, however, a gap is apparent between how important these professionals believe the enablers to be and how prevalent they see them as being within their own organizations. In India and the
US, this gap is relatively small, though consistent, while a slightly larger gap exists in Australia, Brazil and South Africa. Closing this gap will require additional effort to marry reality with expectations, particularly in countries such as Spain and England where the gap is largest.

movInG FoRWaRD, ExPERTS IDEnTIFy FouR aREaS oF EvoLuTIon
Our experts identified four areas where developments currently underway are likely to promote more rapid diffusion of innovation in future. Three relate to the enabling factors that countries or healthcare systems can put in place. Progress in ICT is one key area, where developments such as the spread of innovations enabled by the cell phone platform are expected to bring about real improvements. A second area sees government-led initiatives set a clear vision and strategy of what healthcare innovation can achieve as having the potential to lead to improved diffusion of innovations. The allocation of specific resources to identify and promote healthcare innovation is a third area that it is anticipated can help facilitate change in many
countries.
The fourth area of evolution identified by experts globally underscores the importance of the cultural dynamics. Developing and maintaining a keen sense of openness to and interest in innovations among healthcare professionals on the front line is seen as essential in helping to spread innovation everywhere. Fostering an innovation culture presents a real but potentially rewarding challenge to those seeking to
improve healthcare delivery and health worldwide.