Pedro Pita Barros is Professor of Economics at the Universidade Nova de Lisboa; Jan De Maeseneer is Chairman of the European Forum for Primary Care (EFPC) and Chairman of the Department of Family Medicine and Primary Health Care at Ghent University; Walter Ricciardi is Professor of Hygiene and Public Health at the Catholic University of Sacred Heart
The concept of ‘disruptive innovation’ was initially developed in the United States. Given its novelty, the European Commission asked its Expert Panel on Effective Ways of Investing in Health to assess the relevance of the idea to health systems in the European Union.
The word ‘disruptive’ literally means innovative or ground-breaking, but not everything causing an industry to be shaken up and for previous incumbents to stumble should be considered a ‘disruptive innovation’.
The Commission’s Expert Panel ultimately defined disruptive innovation in healthcare as “a type of innovation that creates new networks and new organisations based on a new set of values, involving new players, which makes it possible to improve health outcomes and other valuable goals, such as equity and efficiency. This innovation displaces older systems and ways of doing things”.
A useful way to look at innovations is by their impact in existing domains, fields and markets. An innovation that improves a product or a service in an existing market in ways that customers are expecting is a ‘sustaining and continuous’ innovation. Whenever the innovation is unexpected but does not displace existing markets, it is a ‘sustaining and discontinuous’ innovation.
In contrast, a ‘disruptive’ innovation creates a new market or expands an existing market by applying a different set of values, which unexpectedly overtakes an existing market.
A disruptive innovation can often be recognised for improving health outcomes, creating new services and overcoming challenges regarding accessibility to existing or new services, leading to cost-effective methods that create new sets of values, improve access, promote person- and people-centred healthcare delivery, empower the patient, disorder old systems, create new professional roles and capacities, create new sets of values, and introduce transformative cultural changes.
High-technological content is neither necessary nor sufficient to constitute a disruptive innovation. In other words, an innovation with low-technological content (e.g. strengthening the position of the citizen/patient in the care process) but able to transform the culture and the way a service is provided will be disruptive, while a more technology-intensive innovation that retains the same culture and organisation will not.
A useful way to look at innovations is by their impact in existing domains, fields and markets
As such, policy support for disruptive innovations in health systems must not rely solely on recognising new technology, which will be relevant only to the extent that it contributes to the key features of a disruptive innovation.
All innovations carry some risk, but incremental and continuous innovations do have a higher predictability of success and effects. By its very nature, a disruptive innovation is unpredictable and often only identifiable after the event. Although there are relatively few examples of successful disruptive innovations, many potential ones fail to be adopted and diffused.
The successful implementation of a disruptive innovation greatly depends on several elements. A major one is the creation of new organisational models and management plans, for instance the shift from ‘top-down’ command-and-control towards horizontal ‘complex adaptive systems’ approaches.
The engagement of all relevant actors is also necessary. Framework adjustments need to accompany new organisational models, introducing or changing conditions that make it possible to finance new models of healthcare delivery.
These elements have counterpart potential bottlenecks that need to be addressed. If a new organisational model emerges, the decommissioning of older structures should follow. Such decommissioning will likely be harder in healthcare systems mainly based on public procurement or funding. It is also often noted that stakeholders of the traditional structures may have much to lose and therefore have a vested interest in blocking these changes.
The policy focus should be on mechanisms that facilitate the experimentation of potential disruptive innovations, accepting failure as part of the process and overcoming the barriers that may emerge.
Different approaches are needed to address workforce, cultural, organisational, institutional, economic and legal barriers
The high rate of failure requires caution in the roll out of new organisational and business models and pilot projects are a way of gaining information on the impacts on health, on the economy and on the feasibility of adoption. Such mechanisms should have a broad scope because disruptive innovations are often context-specific (socio-economic, political and cultural).
The implementation of any disruptive innovation should take into account the system-wide issues of relevance, equity (including access), quality, cost-effectiveness, people-centeredness and financial sustainability (including ecological, financial and social dimensions).
Different barriers will require different approaches, which need to address workforce, cultural, organisational, institutional, economic and legal barriers. For example, within workforce and cultural identity issues there is resistance by healthcare professionals to changing current practice to a more participative, proactive and prevention based system.
Also, on the patient side, there are cultural barriers to be addressed that limit user engagement in the development of innovative solutions. Mechanisms will likely involve developing tools to share information, training for professionals and building in transition periods to allow healthcare workers to adapt their working patterns. Other mechanisms need to address the training of end-users and increasing health literacy.
On the organisational front, mechanisms are needed to ensure interoperability between technological solutions. In addition, there need to be strategies for decommissioning services that are no longer useful or efficient. Payment mechanisms should not create barriers by rewarding volume, but should rather accommodate innovative delivery models that find new ways to integrate care. When legal and regulatory frameworks protect existing business models, this is a further barrier to innovation.
Finally, the role of political leadership and support is critical as is regular monitoring of the impact of changes on the system.
The three authors are part of the European Commission Expert Panel on Effective Ways of Investing in Health. This article does not necessarily reflect the views of the European Commission or its services.
This article is part of Friends of Europe’s upcoming discussion paper ‘Disruptive models of healthcare for Europe’, which brings together the views of Friends of Europe’s large network of health professionals, policymakers, scholars and business representatives on disruptive innovation for health. This discussion paper closes a series of three high-level roundtables that Friends of Europe organised last year to examine the steps needed to create “disruptive models” for overhauling and improving healthcare systems across the EU.
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