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In the United States,the Food and Drug Administration (FDA) and the National Institutes of Health have noted a significant decrease in the number of innovative products reaching patients, in spite of a rapidly expanding basis of fundamental scientific knowledge. A recent FDA report proposes some solutions to this problem.
Technologies from diverse scientific disciplines are being combined to drive innovation in medical devices. How technology convergence and innovation could be further stimulated is explored here using developments in imaging and point-of-care devices as examples.
The health sectors in many countries have been increasing in relative size, and medical innovations have been identified by some as a factor contributing to the rise in health expenditures. This paper begins by reviewing the various approaches that economists have employed to determine the connection, if any, between rising health expenditures and new medical technologies. It is then argued that another way to approach the issue is to determine if innovations have substituted for previously existing technologies. Thus this method cannot be applied to product innovations: it is restricted to process innovations. This procedure is applied to the innovation of fibre optic colonoscopy, a procedure for diagnosing diseases/conditions in the lower gastrointestinal tract. The data relate to private medical practice in Australia which operates on a fee-for-service basis. The empirical results indicate no evidence of substitution of the 'new' for the 'old' technology. Thus, there is some reason to believe that this innovation will have contributed to rising health expenditures for diagnosis of the lower gastrointestinal tract. The paper concludes by considering policy options that could address the issue.
Everyone knows that the way things are formally organized in most companies (their processes) is not the same as the way things are actually done (their practices). The difference between the two creates tension that can be very difficult for managers to handle. Lean too much toward practice and new ideas may bubble up and evaporate for lack of a structure to harness them. Lean too much toward process and you may get no new ideas at all. The goal, then, is to tap into the creativity at work in every layer of an organization with a combination of process and practice. Take, for example, the community of people who fix Xerox machines. Large machines, it turns out, are not as predictable as Xerox's documentation would suggest. So when following the service manual is not enough, the reps come together--over breakfast, at breaks, at the end of the day--and talk about their own best practices. So far so good. But Xerox goes a step further. It has set up a process similar to an academic peer-review system to gather, vet, and share those best practices across the company. The reps get much-welcome recognition for their creativity, and local best practices are deployed companywide. Dot-com companies are a hotbed of innovative practices. But as they mature, they, like Xerox, may find that they need seasoned managers who can harness those practices through the judicious application of constructive processes.
When it comes to improving business performance, managers have no shortage of tools and techniques to choose from. But what really works? What's critical, and what's optional? Two business professors and a former McKinsey consultant set out to answer those questions. In a ground-breaking, five-year study that involved more than 50 academics and consultants, the authors analyzed 200 management techniques as they were employed by 160 companies over ten years. Their findings at a high level? Business basics really matter. In this article, the authors outline the management practices that are imperative for sustained superior financial performance--their "4+2 formula" for business success. They provide examples of companies that achieved varying degrees of success depending on whether they applied the formula, and they suggest ways that other companies can achieve excellence. The 160 companies in their study--called the Evergreen Project--were divided into 40 quads, each comprising four companies in a narrowly defined industry. Based on its performance between 1986 and 1996, each company in each quad was classified as either a winner (for instance, Dollar General), a loser (Kmart), a climber (Target), or a tumbler (the Limited). Without exception, the companies that outperformed their industry peers excelled in what the authors call the four primary management practices: strategy, execution, culture, and structure. And they supplemented their great skill in those areas with a mastery of any two of four secondary management practices: talent, leadership, innovation, and mergers and partnerships. A company that consistently follows this 4+2 formula has a better than 90% chance of sustaining superior performance, according to the authors.
We know the trends--budget cutbacks; shortage of skilled staff; alternative medicine; informed and demanding patients; and the increasing cost of medical equipment, technology and new drugs. Looking ahead, we know these challenges will not disappear. So we have two choices.
Knowledge translation articulates how new scientific insights can be implemented efficiently into clinical practice to reap maximal health benefits. Modern information and communication technologies can be effective tools to help in the collection, processing, and targeted distribution of information from which clinicians, researchers, administrators, policy makers in health, and the public can benefit. Effective implementation of knowledge translation through the use of information and communication technologies, or technology-enabled knowledge translation (TEKT), would benefit both the individual health professional and the health system. Successful TEKT in health requires cultivation and acceptance in the following key domains: Perceiving types of knowledge and ways in which clinicians acquire and apply knowledge in practice. Understanding the conceptual and contextual frameworks of information and communication technologies applied to health systems, particularly the push, pull, and exchange communication models. Comprehending essential issues in implementation of information and communication technologies and strategies to take advantage of emerging opportunities and overcome existing barriers. Establishing a common and widely acceptable evaluation framework in order that researchers can compare various methodologies in their rightful contexts in TEKT research and adoption. Achieving harmony and common understanding in these areas will go a long way in fostering a fertile and innovative environment to encourage research and advance understanding in this exciting domain of TEKT.
Major areas in which innovative approaches in medical education have been tried include student selection, learning strategies, and community orientation. It is relatively easier to implement innovations in a new institution. In established medical schools, running two simultaneous curricula tracks, the traditional and the innovative has emerged as a popular strategy for introducing new systems of education. Institutional commitment to the objectives and matching implementation effort determine the success of an innovative programme. Stronger links between the medical education and health service systems not only enhance the community orientation of the graduates, but also help improve the quality of health care provided to the community. There is a need to experiment with innovative approaches to education of physicians in our country. Establishment of medical education units in medical schools will be a practical beginning in the right direction.
BACKGROUND: A patient care notebook that patients take with them to different care settings improved disharge planning and patient education during a pilot find, organize, clarify, understand, select-plan, do, check, act (FOCUS-PDCA) project on a 15-bed rehabilitation unit. The 296-bed rehabilitation hospital expanded the notebook's use to all hospital programs through a second PDCA cycle. ADAPTING THE NOTEBOOK: The three-ring binder notebook sections were modified from the pilot notebook to three sections standardized for all programs. Materials included information about hospital services and patients' rights and medical information about future appointments, specific diagnostic information, home medications and exercises, and equipment and home modifications. Staff were educated about the notebook through in-services and an educational video. RESULTS: When patients and their families who were discharged with home services were contacted, more than two-thirds reported that the notebooks were useful and easy to use. As staff became more familiar with the notebook, 75% or more reported that the notebooks were useful and easy to use and improved the discharge process. The notebooks were still used two years after their introduction. DISCUSSION: An innovative and helpful new care process, the patient care notebook can improve a rehabilitation hospital's patient education and discharge planning processes. It represents a better practice in health care provider/patient communication.
Following proposals in 1987 and 1988, several medical journals have provided more informative abstracts ("structured abstracts") for articles of clinical interest. Structured abstracts for original studies require authors to systematically disclose the objective, basic research design, clinical setting, participants, interventions (if any), main outcome measurements, results, and conclusions; and for literature reviews the objective, data sources, methods of study selection, data extraction and synthesis, and conclusions. More informative abstracts of this kind can facilitate peer review before publication, assist clinical readers to find articles that are both scientifically sound and applicable to their practices, and allow more precise computerized literature searches. We review the feasibility, acceptability, and dissemination of structured abstracts, reassess the underlying strategy, and describe modifications of the approach. This innovation can aid communication from scientists to clinicians, and other clinical journals are invited to join this effort.
The results of a survey in the United Kingdom in the late 1980s indicated that many occupational health nurses were not being sent for formal training because of the length of time nurses needed to be away from their employment and the difficulty employers had in finding nurse replacements during training. To meet the needs of occupational health nurses and their employers, the Robert Gordon Institute of Technology (RGIT) instituted a modular training course that offers full time attendance or distance learning options. RGIT's course consists of six modules over a 1 to 3 year period, which students can take in any order after completing a short Return to Study course. Using the innovative distance learning option, occupational health nurses can earn a Diploma in Occupational Health Nursing while completing most of their courses at the workplace, thus avoiding conflicts between training and work schedules.
Set against a backdrop of medical industry competitiveness and growth, the forthcoming MEDICA event will present ample opportunities for international exchange of ideas on a range of healthcare technology issues, says Horst Giesen, project leader, Messe Düsseldorf GmbH.
Patents do not always promote innovation, particularly when they restrict access to fundamental scientific discoveries and the tools of basic research. However, there are legal and policy approaches that may help to ameliorate problems associated with patenting these sorts of inventions.
Moves to bridge the gap between research and practice have heightened interest in how service innovations are adopted. This paper reports on a peer-based hospital diversion program that provided short-term respite care, clinical monitoring, connection or re-connection to other mental health services, and peer support. The program was successful in providing services to the target population and was viewed as highly desirable by service recipients and clinical agencies. However, full adoption of this innovation was not realized and it closed barely a year after opening. Lessons learned from both the "life" and "death" of this program are offered.
Developing research-based clinical practice is a challenging goal. Practice based on rigorously acquired knowledge is preferred to tradition, trial and error, or simply the advice of a colleague. The use of a systematic approach for this process will facilitate the clinician's ability to reach such a goal. An eight-step method is described as a basic guide to complete the process--from problem identification to dissemination of the results of the experience. Other important steps include summarizing the related research, development of an innovation, analysis of the setting, planning and implementing the change process, and evaluation of the outcomes. Rewards for engaging in this activity as well as limitations are addressed.
While computer technology has revolutionized industries such as banking and airlines, it has done little for health care so far. Most of the health-care organizations continue the early-computer-era practice of buying the latest technology without knowing how it might effectively be employed in achieving business goals. By investing merely in information technology (IT) rather than in IT capabilities they acquire IT components--primarily hardware, software, and vendor-provided services--which they do not understand and, as a result, are not capable of fully utilizing for achieving organizational objectives. In the absence of internal IT capabilities, health-care organizations have relied heavily on the fragmented IT vendor market in which vendors do not offer an open architecture, and are unwilling to offer electronic interfaces that would make their 'closed' systems compatible with those of other vendors. They are hamstrung as a result because they have implemented so many different technologies and databases that information stays in silos. Health systems can meet this challenge by developing internal IT capabilities that would allow them to seamlessly integrate clinical and business IT systems and develop innovative uses of IT. This paper develops a comprehensive conception of IT capability grounded in the resource-based theory of the firm as a remedy to the woes of IT investments in health care.
Nurses have always been great innovators. Whether they have cared for patients in busy city hospitals, or remote rural clinics, they have often had to deal with too few resources, a lack of staff or out-moded clinical practices.
Turning clinical research and innovations into actual practices that enhance quality care--at both the hospital level and the health system level--can be challenging. But many organizations are finding creative ways to get those ideas on the front line.