What Health System Challenges Should Responsible Innovation in Health Address? Insights From an International Scoping Review

Document Type : Review Article

Authors

1 Department of Health Management, Evaluation and Policy, School of Public Health, University of Montreal, Montreal, QC, Canada

2 Institute of Public Health Research of University of Montreal (IRSPUM), University of Montreal, Montreal, QC, Canada

3 Department of Family Medicine, University of Montreal, Montreal, QC, Canada

4 Canada Research Chair on Patient and Public Partnership, Montreal, QC, Canada

5 School of Public Health, University of Montreal, Montreal, QC, Canada

Abstract

Background
While responsible innovation in health (RIH) suggests that health innovations could be purposefully designed to better support health systems, little is known about the system-level challenges that it should address. The goal of this paper is thus to document what is known about health systems’ demand for innovations.
 
Methods
We searched 8 databases to perform a scoping review of the scientific literature on health system challenges published between January 2000 and April 2016. The challenges reported in the articles were classified using the dynamic health system framework. The countries where the studies had been conducted were grouped using the human development index (HDI). Frequency distributions and qualitative content analysis were performed.
 
Results
Up to 1391 challenges were extracted from 254 articles examining health systems in 99 countries. Across countries, the most frequently reported challenges pertained to: service delivery (25%), human resources (23%), and leadership and governance (21%). Our analyses indicate that innovations tend to increase challenges associated to human resources by affecting the nature and scope of their tasks, skills and responsibilities, to exacerbate service delivery issues when they are meant to be used by highly skilled providers and call for accountable governance of their dissemination, use and reimbursement. In countries with a low and medium HDI, problems arising with infrastructure, logistics and equipment were described in connection with challenges affecting procurement, supply and distribution systems. In countries with a medium and high HDI, challenges included a growing demand for drugs and new technology and the management of rising costs. Across all HDI groups, the need for flexible information technologies (IT) solutions to reach rural areas was underscored.
 
Conclusion
Highlighting challenges that are common across countries, this study suggests that RIH should aim to reduce the cost of innovation production processes and attend not only to the requirements of the immediate clinical context of use, but also to the vulnerabilities of the broader system wherein innovations are deployed. Policy-makers should translate system-level demand signals into innovation development opportunities since it is imperative to foster innovations that contribute to the success and sustainability of health systems.

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Commentaries Published on this Paper

  • Who is Responsible for Responsible Innovation? Lessons From an Investigation into Responsible Innovation in Health; Comment on “What Health System Challenges Should Responsible Innovation in Health Address? Insights From an International Scoping Review”

          Abstract | PDF

  • The Need for a Dynamic Approach to Health System-Centered Innovations; Comment on “What Health System Challenges Should Responsible Innovation in Health Address? Insights From an International Scoping Review”

          Abstract | PDF

  • Innovation, Demand, and Responsibility: Some Fundamental Questions About Health Systems; Comment on “What Health System Challenges Should Responsible Innovation in Health Address? Insights From an International Scoping Review

          Abstract | PDF

  • Innovation Strategies and Health System Guiding Principles to Address Equity and Sustainability in Responsible Innovation in Health; Comment on “What Health System Challenges Should Responsible Innovation in Health Address? Insights From an International Scoping Review”

          Abstract | PDF

  • Nurturing Societal Values in and Through Health Innovations; Comment on “What Health System Challenges Should Responsible Innovation in Health Address?”

          Absrtact | PDF

  • The Co-Constitution of Health Systems and Innovation; Comment on “What Health System Challenges Should Responsible Innovation in Health Address? Insights From an International Scoping Review

          Abstract | PDF

Authors' Response to the Commentaries

  • Revisiting the Relationship Between Systems of Innovation and Health Systems: A Response to Recent Commentaries

          Abstract | PDF

Keywords

Main Subjects

References

  1. van Oudheusden M. Where are the politics in responsible innovation? European governance, technology assessments, and beyond. Journal of Responsible Innovation. 2014;1(1):67-86. doi:10.1080/23299460.2014.882097
  2. von Schomberg R. A Vision of Responsible Research and Innovation. In: Owen R, Bessant J, Heintz M, eds. Responsible Innovation: Managing the Responsible Emergence of Science and Innovation in Society. Wiley; 2013:51-74. doi:10.1002/9781118551424.ch3
  3. Stilgoe J, Owen R, Macnaghten P. Developing a framework for responsible innovation. Res Policy. 2013;42(9):1568-1580. doi:10.1016/j.respol.2013.05.008
  4. Demers-Payette O, Lehoux P, Daudelin G. Responsible research and innovation: a productive model for the future of medical innovation. Journal of Responsible Innovation. 2016;3(3):188-208. doi:10.1080/23299460.2016.1256659
  5. Hirsch-Kreinsen H. Financial market and technological innovation. Industry and Innovation. 2011;18(4):351-368. doi:10.1080/13662716.2011.573954
  6. Lehoux P, Miller FA, Daudelin G, Urbach DR. How venture capitalists decide which new medical technologies come to exist. Sci Public Policy. 2015;43(3):375-385. doi:10.1093/scipol/scv051
  7. Robinson JC. Biomedical innovation in the era of health care spending constraints. Health Aff (Millwood). 2015;34(2):203-209. doi:10.1377/hlthaff.2014.0975
  8. Roncarolo F, Boivin A, Denis JL, Hebert R, Lehoux P. What do we know about the needs and challenges of health systems? A scoping review of the international literature. BMC Health Serv Res. 2017;17(1):636. doi:10.1186/s12913-017-2585-5
  9. World Health Organization (WHO). Medical devices: managing the mismatch: an outcome of the priority medical devices project. Geneva: WHO; 2010.
  10. Gelijns AC, Russo MJ, Hong KN, Brown LD, Ascheim DD, Moskowitz AJ. Dynamics of device innovation: implications for assessing value. Int J Technol Assess Health Care. 2013;29(4):365-373. doi:10.1017/S0266462313000561
  11. Lawler PR, Norheim OF. Clinical Practice Guidelines as Instruments for Sound Health Care Priority Setting. Am J Cardiol. 2015;116(9):1481-1482. doi:10.1016/j.amjcard.2015.07.076
  12. Fineberg HV. A successful and sustainable health system—how to get there from here. N Engl J Med. 2012;366(11):1020-1027. doi:10.1056/NEJMsa1114777
  13. Marchildon G. Canada: Health system review. Health Syst Transit. 2013;15(1):1-179.
  14. Adler-Milstein J, Jha AK. Sharing clinical data electronically: a critical challenge for fixing the health care system. JAMA. 2012;307(16):1695-1696. doi:10.1001/jama.2012.525
  15. Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O, Peacock R. Storylines of research in diffusion of innovation: a meta-narrative approach to systematic review. Soc Sci Med. 2005;61(2):417-430. doi:10.1016/j.socscimed.2004.12.001
  16. Dixon-Woods M, Amalberti R, Goodman S, Bergman B, Glasziou P. Problems and promises of innovation: why healthcare needs to rethink its love/hate relationship with the new. BMJ Qual Saf. 2011;20 Suppl 1:i47-51. doi:10.1136/bmjqs.2010.046227
  17. Henshall C, Schuller T. Health technology assessment, value-based decision making, and innovation. Int J Technol Assess Health Care. 2013;29(4):353-359. doi:10.1017/s0266462313000378
  18. Brown AD, Alikhan LM, Sandoval GA, Seeman N, Baker GR, Pink GH. Acute care hospital strategic priorities: perceptions of challenges, control, competition and collaboration in Ontario's evolving healthcare system. Healthc Q. 2005;8(3):36-47.  
  19. DiSesa VJ, Kaiser LR. What's in a Name? The Necessary Transformation of the Academic Medical Center in the Era of Population Health and Accountable Care. Acad Med. 2015;90(7):842-845. doi:10.1097/acm.0000000000000749
  20. Millar J, Bruce T, Cheng SM, Masse R, McKeown D. Is public health ready to participate in the transformation of the healthcare system? Healthc Pap. 2013;13(3):10-20.
  21. Jacobs M, El-Sadr WM. Health systems and health equity: the challenge of the decade. Glob Public Health. 2012;7 Suppl 1:S63-72. doi:10.1080/17441692.2012.667426
  22. Gardner CA, Acharya T, Yach D. Technological and social innovation: a unifying new paradigm for global health. Health Aff (Millwood). 2007;26(4):1052-1061. doi:10.1377/hlthaff.26.4.1052
  23. Garber S, Gates SM, Keeler EB, et al. Redirecting Innovation in U.S. Health Care: Options to Decrease Spending and Increase Value. Rand Health Q. 2014;4(1):3.
  24. Lehoux P, Williams-Jones B, Miller F, Urbach D, Tailliez S. What leads to better health care innovation? Arguments for an integrated policy-oriented research agenda. J Health Serv Res Policy. 2008;13(4):251-254. doi:10.1258/jhsrp.2008.007173
  25. van Olmen J, Criel B, Van Damme W, et al. Analysing health systems to make them stronger. Studies in Health Services Organisation & Policy. 2010;27:2-98
  26. Wallace J, McNally S, Richmond J, Hajarizadeh B, Pitts M. Challenges to the effective delivery of health care to people with chronic hepatitis B in Australia. Sex Health. 2012;9(2):131-137. doi:10.1071/sh10137
  27. Wang HH, Wang JJ, Zhou ZH, Wang XW, Xu L. General practice education and training in southern China: recent development and ongoing challenges under the health care reform. Malays Fam Physician. 2013;8(3):2-10.
  28. Charlton M, Schlichting J, Chioreso C, Ward M, Vikas P. Challenges of Rural Cancer Care in the United States. Oncology (Williston Park). 2015;29(9):633-640.
  29. Lucassen A, Houlston RS. The challenges of genome analysis in the health care setting. Genes (Basel). 2014;5(3):576-585. doi:10.3390/genes5030576
  30. Pacifico Silva H, Lehoux P, Miller FA, Denis JL. Introducing responsible innovation in health: a policy-oriented framework. Health Res Policy Syst. 2018;16(1):90. doi:10.1186/s12961-018-0362-5
  31. Arksey H, O'Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19-32. doi:10.1080/1364557032000119616
  32. Rumrill PD, Fitzgerald SM, Merchant WR. Using scoping literature reviews as a means of understanding and interpreting existing literature. Work. 2010;35(3):399-404. doi:10.3233/wor-2010-0998
  33. Levac D, Colquhoun H, O'Brien KK. Scoping studies: advancing the methodology. Implement Sci. 2010;5:69. doi:10.1186/1748-5908-5-69
  34. Salim S. Work for Human Development. United Nations Development Programme; 2015.
  35. Miles MB, Huberman AM. Qualitative Data Analysis: An Expanded Sourcebook. Sage; 1994.
  36. United Nations Development Programme (UNDP). Human Development Report 2016: Human Development for Everyone. United Nations Development Programme; 2016.
  37. Lindskog BV. Natural calamities and 'the Big Migration': challenges to the Mongolian health system in 'the Age of the Market'. Glob Public Health. 2014;9(8):880-893. doi:10.1080/17441692.2014.940361
  38. Kugel C, Zuroweste EL. The state of health care services for mobile poor populations: history, current status, and future challenges. J Health Care Poor Underserved. 2010;21(2):421-429. doi:10.1353/hpu.0.0303
  39. Patterson J, Hovey DL. Family-centered care for children with special health needs: Rhetoric or reality. Fam Syst Health. 2000;18(2):237-251. doi:10.1037/h0091849
  40. LeMay NV, Bocock PJ. Building a national model for knowledge exchange in Malawi: findings from a health information needs assessment. J Health Commun. 2012;17 Suppl 2:64-78. doi:10.1080/10810730.2012.666623
  41. Sheiman IM, Shishkin SV. Russian Health Care: New Challenges and New Objectives. Problems of Economic Transition. 2010;52(12):4-49. doi:10.2753/PET1061-1991521201
  42. Forbes DA, Edge DS. Canadian home care policy and practice in rural and remote settings: challenges and solutions. J Agromedicine. 2009;14(2):119-124. doi:10.1080/10599240902724135
  43. Thomason J, Kase P, Ndugwa N. Working together to get back to basics--finding health system solutions. P N G Med J. 2009;52(3-4):114-129.
  44. Melo DG, Sequeiros J. The challenges of incorporating genetic testing in the unified national health system in Brazil. Genet Test Mol Biomarkers. 2012;16(7):651-655. doi:10.1089/gtmb.2011.0286
  45. Al-Sharqi OZ, Abdullah MT. "Diagnosing" Saudi health reforms: is NHIS the right "prescription"? Int J Health Plann Manage. 2013;28(4):308-319. doi:10.1002/hpm.2148
  46. Chopra M, Lawn JE, Sanders D, et al. Achieving the health Millennium Development Goals for South Africa: challenges and priorities. Lancet. 2009;374(9694):1023-1031. doi:10.1016/s0140-6736(09)61122-3
  47. Warsame A, Handuleh J, Patel P. Prioritization in Somali health system strengthening: a qualitative study. Int Health. 2016;8(3):204-210. doi:10.1093/inthealth/ihv060
  48. Yip W, Hsiao WC. The Chinese health system at a crossroads. Health Aff (Millwood). 2008;27(2):460-468. doi:10.1377/hlthaff.27.2.460
  49. Cowan J, Greenberg Cowan J, Barnhart S, et al. A qualitative assessment of challenges to tuberculosis management and prevention in Northern Ethiopia. Int J Tuberc Lung Dis. 2013;17(8):1071-1075. doi:10.5588/ijtld.12.0240
  50. Morhason-Bello IO, Odedina F, Rebbeck TR, et al. Challenges and opportunities in cancer control in Africa: a perspective from the African Organisation for Research and Training in Cancer. Lancet Oncol. 2013;14(4):e142-151. doi:10.1016/s1470-2045(12)70482-5
  51. Cristofalo M, Boutain D, Schraufnagel TJ, Bumgardner K, Zatzick D, Roy-Byrne PP. Unmet need for mental health and addictions care in urban community health clinics: frontline provider accounts. Psychiatr Serv. 2009;60(4):505-511. doi:10.1176/appi.ps.60.4.505
  52. Merican MI, Rohaizat Y, Haniza S. Developing the Malaysian health system to meet the challenges of the future. Med J Malaysia. 2004;59(1):84-93.
  53. Morariu A. The management of the human resources in the public health system: The complexity and the Euro-global socio-economic challenges. Rev Cercet Interv Soc. 2014;44:266-278.
  54. Peiro M, Barrubes J. New context and old challenges in the healthcare system. Rev Esp Cardiol (Engl Ed). 2012;65(7):651-655. doi:10.1016/j.recesp.2012.02.019
  55. Ruff B, Mzimba M, Hendrie S, Broomberg J. Reflections on health-care reforms in South Africa. J Public Health Policy. 2011;32 Suppl 1:S184-192. doi:10.1057/jphp.2011.31
  56. Davari M, Haycox A, Walley T. The Iranian health insurance system; past experiences, present challenges and future strategies. Iran J Public Health. 2012;41(9):1-9.
  57. McGrail K, Zierler A, Ip I. Getting what we pay for? The value-for-money challenge. Healthc Pap. 2009;9(4):8-22.
  58. Hanlon C, Luitel NP, Kathree T, et al. Challenges and opportunities for implementing integrated mental health care: a district level situation analysis from five low- and middle-income countries. PLoS One. 2014;9(2):e88437. doi:10.1371/journal.pone.0088437
  59. Groman RF, Rubin KY. Neurosurgical practice and health care reform: moving toward quality-based health care delivery. Neurosurg Focus. 2013;34(1):E1. doi:10.3171/2012.9.focus12308
  60. Halfon N, Conway PH. The opportunities and challenges of a lifelong health system. N Engl J Med. 2013;368(17):1569-1571. doi:10.1056/NEJMp1215897
  61. Lehoux P, Miller FA, Daudelin G, Denis JL. Providing Value to New Health Technology: The Early Contribution of Entrepreneurs, Investors, and Regulatory Agencies. Int J Health Policy Manag. 2017;6(9):509-518. doi:10.15171/ijhpm.2017.11
  62. Batayeh BG, Artzberger GH, Williams LDA. Socially responsible innovation in health care: Cycles of actualization. Technol Soc. 2018;53:14-22. doi:10.1016/j.techsoc.2017.11.002
  63. Lindley MC, Shen AK, Orenstein WA, Rodewald LE, Birkhead GS. Financing the delivery of vaccines to children and adolescents: challenges to the current system. Pediatrics. 2009;124 Suppl 5:S548-557. doi:10.1542/peds.2009-1542O
  64. Lewis S. A system in name only--access, variation, and reform in Canada's provinces. N Engl J Med. 2015;372(6):497-500. doi:10.1056/NEJMp1414409
  65. Jenkins R, Othieno C, Okeyo S, Aruwa J, Kingora J, Jenkins B. Health system challenges to integration of mental health delivery in primary care in Kenya--perspectives of primary care health workers. BMC Health Serv Res. 2013;13:368. doi:10.1186/1472-6963-13-368
  66. Greenhalgh T, Fahy N, Shaw S. The bright elusive butterfly of value in health technology development: Comment on "Providing value to new health technology: the early contribution of entrepreneurs, investors, and regulatory agencies." Int J Health Policy Manag. 2017;7(1):81-85. doi:10.15171/ijhpm.2017.65
  67. Hamidi S, Shaban S, Mahate AA, Younis MZ. Health insurance reform and the development of health insurance plans: the case of the Emirate of Abu Dhabi, UAE. J Health Care Finance. 2014;40(3):47-66.
  68. Nishtar S. The Gateway Paper--proposed health reforms in Pakistan--interface considerations. J Pak Med Assoc. 2006;56(12 Suppl 4):S78-93.
  69. Yip WC, Hsiao WC, Chen W, Hu S, Ma J, Maynard A. Early appraisal of China's huge and complex health-care reforms. Lancet. 2012;379(9818):833-842. doi:10.1016/s0140-6736(11)61880-1
  70. Kerr A, Hill RL, Till C. The limits of responsible innovation: Exploring care, vulnerability and precision medicine. Technol Soc. 2018;52:24-31. doi:10.1016/j.techsoc.2017.03.004
  71. Lehoux P, Daudelin G, Williams-Jones B, Denis JL, Longo C. How do business model and health technology design influence each other? Insights from a longitudinal case study of three academic spin-offs. Res Policy. 2014;43(6):1025-1038. doi:10.1016/j.respol.2014.02.001
International Journal of Health Policy and Management
Volume 8, Issue 2
February 2019
Pages 63-75

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History

  • Receive Date: 12 March 2018
  • Revise Date: 08 November 2018
  • Accept Date: 10 November 2018
  • First Publish Date: 01 February 2019

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