Strategies in Healthcare Innovation Ecosystem

Healthcare Innovation Ecosystem

The devastating loss of human lives since COVID-19 pandemic, and the long-lasting challenges to healthcare ecosystems such as increased demand for direct care, low number of health providers, and inadequate supplies of personal protective equipment (PPE) in hospitals, have stirred a new shift to strategic healthcare management strategies—e.g. the adoption of telemedicine. Evidence-based studies show that lack of information sharing and technical capabilities among health providers have limited coverage of health services thereby lowering health outcomes for the populations. Indeed, modern-day health systems cannot withstand patients’ care demands without reliance on data-driven, scientific approaches to health care delivery. Worse still, physicians in many countries are being downsized due to unfavourable payment structures that rely on inefficient, outdated FFS billing methods bending the health care cost curve against patients. It is therefore a truism that the pandemic exposed previously known issues in global health systems; the only that changed is sense of urgency in care demands made on health providers, who are only a part of the large ecosystem (Ingerslev., 2016; Nabi et al., 2017).

An innovation ecosystem in healthcare management is comparable to the biological ecosystem comprising complex energy relationships between and among living species. But in contrast, innovation ecosystem involves interactions between economic variables where the objective is to innovate and create value for both organization and stakeholders. Two types of economies involved in innovation ecosystem are: (a) the knowledge economy (which depends on research and development) and the commercial economy that is comparable to a marketplace. Viewed comprehensively in the health care setting, the commercial economy refers to a setting/environment for clinical practice—e.g. hospitals, nursing homes or physician’s office)—where there is direct interaction between health providers and patients. The healthcare innovation ecosystem, thus, concentrates on building relationships between stakeholders in health systems, particularly between healthcare organizations and the entire system (Schnarr et al., 2015).

Strategies in Healthcare Innovation Ecosystem

The underlying purpose of healthcare innovation ecosystem is to improve efficiency of care delivery process, through maximal use of potentially scarce resources to provide quality health for the populations. Disruptive innovations within healthcare ecosystems therefore occur when new businesses are established or when new care delivery models displace more specialized and costly models previously existing in the marketplace. Some examples of strategies commonly adapted to enhance functioning of healthcare ecosystems are:

• Identifying, engaging and partnering with every potential ecosystem partner.
• Building a system culture that encourages creativity and transformation of ideas into innovations.
• Providing a strong, reliable and fully functional framework that empowers people to generate creative ideas.
• Reducing the quantity of resources utilized and time spent between when a creative idea transitions from the research phase to clinical and/or implementation stage.
• Constantly monitoring, scaling and sustaining innovation.

The U.S. Veterans Health Administration’s Innovation Ecosystem (VHA IE) is a good example of healthcare innovation ecosystem due to its remarkably successful model that supports the whole duration of innovation process/life span in large health systems—particularly the highly complex and integrated systems as found in the U.S. This study examines how the VHA IE model can be applied in all integrated health systems.

• Identifying, engaging and partnering with every potential ecosystem partner.

To successfully develop an innovative healthcare ecosystem, health organizations must lay emphasis on finding the right stakeholders in order to explore any available opportunities for partnerships. Potential collaborators comprise of suppliers, vendors, academia, government, public- and private-sector companies, and other healthcare organizations. Note must be taken, however, that every innovation ecosystem requires strong partnership and communication between and among stakeholders—as well as people involved in health care (i.e. patients) to develop new ideas, Healthcare innovation ecosystem is different from the commonly known network of people because there is mutuality among stakeholders and between healthcare organizations and care users. The relationship nurtured in healthcare ecosystems is therefore planned in a way that enables realization of strategic visions.

Accordingly, extensive collaboration among stakeholders in health systems promotes an open innovation setting where people are less burdened to bring creative ideas. Rather, an ideal healthcare innovation ecosystem provides a free environment where anyone can contribute meaningful thoughts. The underlying theory is more people, new ideas and improved communication yields more productive ideas. Therefore, emphasis in ecosystems is on how people can work interdependently and constantly support themselves thereby strengthening the degree of collaboration. This suggests that open innovation in healthcare ecosystems can be achieved by (a) outsourcing and networking (b) collaboration among stakeholders and with care users (c) increased investment in research and development (R&D (d) establishment of joint/independent business ventures, as well as licencing and patent pools (Pedersen., 2016).

Another example of a successful healthcare innovation ecosystem is the U.S. Department of Veterans Affairs (VA) which developed and applied innovative ideas within its organizations to foster relationship building among stakeholders in the innovation process. The VA introduced ‘Innovation Challenge Series’ that focused on designing prosthetic arms for war veterans. Results from the evidence-based study show how effective work process and high productivity levels can be achieved by integrating others into the innovation process—and ultimately developing new, better and realistic ideas. From ‘Innovation Challenge Series,’ the VA successfully designed quality prosthetic arm device made of several components that can be changed according to the needs of users or other circumstances. This achievement inspired development of another innovation ecosystem—the EHR model which unites and empowers people from different organizations to collaborate towards building strong health systems (Chi et al., 2012).

• Building a system culture that encourages creativity and transformation of ideas into innovations.

Healthcare organizations need to develop a culture of innovation in order to foster a highly motivated, efficient and effective ecosystem. Another purpose for developing an innovative culture is because such settings allow stakeholders and care users to think creatively and make significant contributions towards the growth of healthcare ecosystems. Thus, new ideas are easily accepted, and people are encouraged to innovate in such culture environments. An advantage of building an innovative culture in healthcare ecosystems is that stakeholders who are not previously recognized as innovators can boldly share their thoughts and ideas. In health organizations and broader areas of employment, more ideas are usually received from unlikely sources because employees with innovative culture tend to encourage and involve others in collaborations that yield better results.

The type of leadership in healthcare organizations also determines whether innovation is prioritized or not. In some situations, there may be need to shift organization culture to another that supports both success and failure, thus, the role of leadership in a healthcare ecosystem involves taking lots of risks and this explains why consultation, collaboration and communication are crucial. However, it is equally important to manage workspace/process, time and resources in a trial-and-error basis. Leaders also need to conduct regular assessments on organizational performance (through an Innovation Audit) to ascertain the system’s readiness for innovation. To achieve these objectives, leaders should that:

• Know that it is wrong and highly unproductive to disregard any individual or group. Creative ideas can come from anyone, anywhere.
• People (i.e. stakeholders and care users) want to be recognized, engaged and empowered to make contributions. It is an obligation for leaders to let their followers know that they are capable of making a difference. Likewise, health administrators should motivate stakeholders and patients within the healthcare ecosystem.
• Collaboration is key to achieving health objectives. Leaders should therefore create an enabling environment where people can work together to for higher productivity levels. It is advisable to assemble sub-groups around opinion leaders—often considered as centres of gravity—due to their representation of employee interests.
• It is important to keep the management team involved because they bridge the gap between health administrators and others (health providers, physicians, researchers etc) who directly and sincerely explain innovation efforts to employees within the healthcare ecosystem.
• They should celebrate their employees and reward them commensurably having the courage to offer innovative ideas.

Evidence-based research on employee engagement efforts in some companies Canada show that trade unions, employee groups, the effectiveness of training programs, the ability of workers to make reasonable decisions, and the degree of support received from leaders are key facilitators of success in a healthcare ecosystem (Clark et al., 2020). The case study on Canadian firms also identified the following as some of the major characteristics exhibited by organizations practising innovation culture:

Future goals:

• Independent thinking is encouraged
• Goals are big, realistic and properly communicated across the healthcare ecosystem
• People can clearly see the big picture and are empowered to work towards achieving the future vision
• There is a sense of empathy for care users and other members of the larger society who are considered as potential beneficiaries of innovations
• People are curious enough to make inquiries and ask probing questions

Company culture:

• Employees of healthcare organizations often show they are enthusiastic and meaningfully engaged in their duties
• They are willing to take risks a safe and conducive work environment
• Failure is accepted as an opportunity to learn and improve; and the experience is widely shared to broad adjustments
• Learning becomes employees’ way of life
• Employees monitor events within and outside the business environment to continually make meaningful contributions
• Communication between employees is encouraged including relationships with care users whose problems they are trying to solve. Thus, healthcare employees are free to share information and ideas among themselves.
• Employees are empowered to find solutions to health care management issues
• Employees collaborate to solve organizational problems and achieve set goals—without any form of grudge, defensiveness, secrecy or blame
• Employees input discretionary ideas and efforts because they share personal connection with healthcare leaders and everyone believes it is possible to make a difference
• Implementation of goals is streamlined and efficiently managed by a responsible and accountable leadership
• Employees can freely have honest communications with their colleagues and managers because there are no scared cows
• The creative tension is positive in nature, and employees have the courage to engage in constructive arguments with respect and loyalty to the organization

 Leadership style:

• Leaders in innovative healthcare ecosystems don’t micromanage employees. Instead, clear goals are set and regularly monitored—with guidance provided and adjustments made where necessary
• Leaders in healthcare organizations have the positive opinion that every employee has untapped potentials that can be harnessed to achieve goals
• The leaders are ware that what is considered ‘true innovation’ remains a concept until it is practically proven
• There is a conscious effort to discover loopholes in existing or future innovations
• The organization ensures that employees have necessary training and work tools required for optimal performance and continuous improvement
• Experimentation is allowed and employees are encouraged to ‘think out of the box’

• Providing a strong, reliable and fully functional framework that empowers people to generate creative ideas.

One of the proven ways to generate creative thinking and innovative thoughts is by involving stakeholders within the ecosystem—including care users. However, this objective requires a structure that supports the innovative process and creates room for all ideas to be heard at all levels of the organization. The healthcare ecosystem should also have an innovative mechanism through which ideas are successfully implemented, and people are empowered to collaborate as well as play relevant, complementary roles in the innovation process.

Some of the tools (facilitation models) used to spark creativity in the healthcare ecosystem are as follows:

• Heuristic ideation
• Six Thinking Hats
• TILMAG
• TRIZ
• Reverse brainstorming

• Reducing the quantity of resources utilized and time spent on transitioning/implementing creative ideas

Healthcare ecosystem functions with a complex, high-impact and interrelated elements that influence the time between development of ideas and their implementation. The time lag, commonly known as the ‘valley of death,’ is best explained with the duration of medical research by the academia and time of implementation in clinical practice—a challenge in healthcare innovation ecosystem that should be reduced. The urgency of these objective hinges on the fact that many useful ideas crafted in the knowledge economy often fail to reach the commercial economy due to systemic delays that could be avoided.

An innovative healthcare ecosystem therefore requires extensive collaboration between crucial areas of the health system to ensure that creative ideas are easy to be implemented in clinical practice. But health administrators should consider privacy issues and intellectual property rights in order to avoid situations that might stall process and affect scheduled timelines. This emphasizes the relevance of formal agreements with parties to ensure mutual understanding of roles and responsibilities.

• Constantly monitoring, scaling and sustaining innovation.

While implementing strategies to enhance the employee’s ability to innovate within healthcare organizations, it is equally importance to assess performance regularly. Healthcare administrators are therefore encouraged to use reliable measurement tools such as ‘Innovation Audit’ due to its suitability for ascertaining an organization’s preparedness to move forward. And as applicable in any other business establishment focused on higher returns on investment (ROI), healthcare managers should not ignore their target—higher returns on innovation. This implies that the impact of innovation should be quantified to ensure that better value for financial investments for developing and operating healthcare ecosystems are recovered on time. Assessment of health innovation should include use of a Balanced Scorecard together with other metrics that analyse:

• Financial investments
• Care users’ experience
• Effectiveness of safety standards and quality of care
• Efficiency of clinical practice

Healthcare administrators should properly document process within the innovation ecosystem—particularly employee participation and related activities. Documenting various levels of participation within an organizational strategy is key to defining clear lines of accountability and ownership, especially for implementation, evaluation and sustainability purposes (Fisher et al., 2007; Clark et al., 2020).