The role of open innovation in addressing resource constraints in healthcare: a systematic literature review

PURPOSE

The resource crisis in healthcare can be alleviated by engaging external stakeholders and resources in healthcare delivery. The authors use value and open innovation concepts to understand what motivates the stakeholders to join the healthcare innovation ecosystem and what value such an ecosystem brings to healthcare.

DESIGN/METHODOLOGY/APPROACH

A systematic literature review following the PRISMA framework method was applied to reach the research objective. Out of a total of 509 identified articles published till 2021, 25 were selected as relevant for this review.

FINDINGS

Six categories of actors were identified, including innovation intermediaries, which were so far neglected in the healthcare innovation literature. Furthermore, patients, healthcare providers, innovation suppliers, investors and influencers were described. The authors also distinguished internal and external stakeholders. The authors show why and how open innovation projects contribute to involving external stakeholders and resources in healthcare delivery by contributing to patient autonomy, relationship building, knowledge transfer, improving collaborative mindset and culture, advancing know-how and bringing additional finances.

ORIGINALITY/VALUE

This article is the first one to systematically describe the value of open innovation in healthcare. The authors challenge the positivist approach in value presented by value-based healthcare. The authors show how openness contributes to addressing the resource crisis by involving new stakeholders and resources in the care delivery process.

Exploring, Diversifying and Debating Sustainable Health (Care) Approaches

Today’s sustainability challenges have major implications for human health and health care. At the same time, the way health care is organized and conducted has major sustainability implications. Sustainable health and sustainable health care approaches in research, which engage with health and sustainability as intertwined phenomena, feature increasingly prominently in various literatures, i.e. (i) literature based on the premise of ‘(un)healthy environments result in (un)healthy people’ (e.g., planetary health); (ii) literature on the implications of ecological change for the sustainability of healthcare systems; and (iii) literature on healthcare systems’ sustainability in view of a range of socio-economic factors. However, an integrative elaboration of the manifold relationships between health and sustainability challenges in these literatures is currently lacking. This review paper therefore maps how these three literatures represent intertwinements between health and sustainability challenges, as well as their suggestions to address these challenges. In addition, we explore which themes and questions are pertinent, meaning they have remained largely unaddressed. By performing a qualitative mapping review, we find that calls for structural attention to inequality, to in-and exclusion, and to stakeholder needs and perspectives cut across these three literatures. Furthermore, we identify three cross-cutting key questions that require future research attention. First, how do divergent ideas on what is and divergent ideas on how can that be known give rise to different health- and sustainability visions and pathways? Second, what do abstract problem statements and solutions presented in agenda-setting work look like in practice in specific and diverse empirical contexts across the globe? And third, how are diverse health and sustainability dynamics historically and spatially interconnected? Moreover, we observe that some voices have so far remained largely silent in scientific debates on health and sustainability intertwinements, namely non-expert voices such as patients and citizens, voices from a variety of social scientific and humanities disciplines, voices from relevant domains beyond (environmental) health, and voices from the global South (from non-experts, social scientific and humanities researchers and domains beyond health). We conclude that a focus on inclusive and equitable engagement with intertwined health- and sustainability challenges is imperative. This requires moving away from developing universal knowledge to address generic problems, to foregrounding plurality in terms of problem statements, knowledge, solutions, and the values embedded therein.

Complexity and Knowledge in Organisational Context: Concepts, Approaches, Boundaries and Relations

The study sought to understand the relationship among organisations, knowledge and complexity so that managers could develop more effective strategies when working with organisational knowledge and complexity. The theoretical framework of the theme was elaborated from Web of Science and then an analysis of identified approximations, relations and boundaries was carried out. Aiming at greater consistency regarding the approximations and boundaries among the studied themes, we sought complex organisations that contemplated knowledge as a resource. The initial search retrieved 95 articles, and after content analysis was performed, we identified 25 articles considering complex organisations as social organisms and knowledge as a resource. In this sense, difficulties were observed regarding the definition of the concept of complex organisation, as well as regarding the understanding of knowledge as a resource. After the analysis of the 25 articles, eight pointed to some characteristic of complex organisations, and this corpus does now allow to relate and identify the impact of knowledge on complexity, or complexity on knowledge. From these considerations, we discuss ways to manage complexity and knowledge as elements inserted in the organisational context.

Open Innovation in Medical and Pharmaceutical Research: A Literature Landscape Analysis

Open innovation in medical and pharmaceutical research has grown steadily over the last decade. However, the performance of the published literature in terms of the scientific impact and gaining social media attention remains largely unexplored. The scientific literature of open innovation was examined by means of bibliometric analyses to identify the most prolific authors, organizations, countries, journals, research areas, and recurring terms. By accessing the Web of Science Core Collection and Altmetric electronic databases, citation-related and Altmetric data were evaluated. Public-private partnerships and a selection of newly introduced potential novel drugs in the analyzed publications were identified. North America and Europe were the major literature contributors. Research outputs were mainly published in journals focused on business and economics, pharmacology and pharmacy, and engineering. Many pharmaceutical and biotechnological companies contributed to the analyzed publications, with higher mean citation counts and social media attention (Altmetric score) than nonindustry articles. Public-private partnerships fostered financial support, sharing of expertise and intellectual property, and research collaborations. In summary, open innovation might serve as a powerful strategy to both benefit the involved industry entities and accelerate the development of solutions and products for the betterment of human health.

The Italian Case of Lecco Innovation Living Lab: Stakeholders’ Needs and Activities to Contribute to the Technological Innovation Process in Healthcare

Healthcare technological innovation is a very complex process in which different actors interact with each other, creating a large number of interconnections and synergies in the design of technological innovations. Despite the increasing number of living labs (LLs) in healthcare, building and maintaining LLs for technological innovation in healthcare is challenging. Collaboration with stakeholders remains an issue of major concern in healthcare. The purpose of this paper is to identify stakeholders’ needs in building an LL in healthcare and to plan activities to foster the innovation process. The paper is based on an exploratory single case study investigating an Italian LL. Eight stakeholders’ needs were identified and validated. Specific activities were identified as improving the innovation process in terms of the stakeholders’ needs. The study contributes to the development of domain-specific knowledge and, as such, to the fostering of studies on and the implementation of LLs in healthcare.

Profile of Innovative Ideas Recorded by Nurses in an Ideas Bank of a Corporate Virtual Community of Open Innovation: A Cross-Sectional Study

PURPOSE

Nurses are well-positioned to play an active role in the development of innovation in health care. However, their contribution to health innovation is poorly recognized and often invisible. The aim of this study was to determine the profile of innovative ideas recorded by nurses in the Innòbics ideas bank, a corporate virtual community of open innovation.

DESIGN AND METHODS

We used a cross-sectional study design. We identified all the innovative ideas recorded in Innòbics from June 8, 2016, to July 6, 2018. To be eligible, the ideas had to be recorded by nurses. Each innovative idea recorded was assessed by the Certification Evaluation Committee of Innòbics. After collective discussion during the evaluation sessions, each committee member independently scored the idea. The screening decision was based on the overall average score. The following variables were collected from each innovative idea that was recorded: (a) level of health care where the idea originated (primary care or secondary care), (b) subject or category according to the classification of the Agency for Healthcare Research and Quality Health Care Innovations Exchange, (c) ratings relative to each screening criteria, and (d) the result of the screening decision: stored = ideas that were poorly developed and in which it was not possible to identify their potential for innovation; susceptible of improvement = potential ideas that needed to be improved and whose authors received comments from the evaluation committee; validated = ideas that continued the process to become innovation projects; forwarded = ideas that were not innovative but they were a complaint or a proposal for quality improvement (these were forwarded to the institutional department concerned).

FINDINGS

A total of 246 innovative ideas were recorded in the period of the study, 61 (24.8%) of which were recorded by nurses. The subjects and categories of these ideas were diverse, highlighting aspects such as patient-centered care, quality improvement strategies, preventive and chronic care, and primary care. Thirty-five (57.4%) of these innovative ideas were stored, 13 (21.3%) were susceptible to improvement, 11 (18.0%) were forwarded, and 2 (3.3%) were validated.

CONCLUSIONS

The results demonstrated that approximately a quarter of the ideas were recorded by nurses. Subjects and categories of these ideas were diverse, some of them closely related to the profession and nursing practice. Two ideas were identified as potential innovation projects. Innòbics can act as an organizational tool that promotes a climate for innovation in health care.

CLINICAL RELEVANCE

This study recognizes nurses' contribution to a healthcare innovation initiative and their interest in sharing innovative ideas. Its findings provide useful insights into a virtual community of open innovation such as an organizational tool for encouraging creativity and innovation in healthcare. Likewise, there is also a need for further development of nurses to master healthcare innovation as a basic competence.

A framework for value-creating learning health systems

BACKGROUND

Interest in value-based healthcare, generally defined as providing better care at lower cost, has grown worldwide, and learning health systems (LHSs) have been proposed as a key strategy for improving value in healthcare. LHSs are emerging around the world and aim to leverage advancements in science, technology and practice to improve health system performance at lower cost. However, there remains much uncertainty around the implementation of LHSs and the distinctive features of these systems. This paper presents a conceptual framework that has been developed in Canada to support the implementation of value-creating LHSs.

METHODS

The framework was developed by an interdisciplinary team at the Institut national d'excellence en santé et en services sociaux (INESSS). It was informed by a scoping review of the scientific and grey literature on LHSs, regular team discussions over a 14-month period, and consultations with Canadian and international experts.

RESULTS

The framework describes four elements that characterise LHSs, namely (1) core values, (2) pillars and accelerators, (3) processes and (4) outcomes. LHSs embody certain core values, including an emphasis on participatory leadership, inclusiveness, scientific rigour and person-centredness. In addition, values such as equity and solidarity should also guide LHSs and are particularly relevant in countries like Canada. LHS pillars are the infrastructure and resources supporting the LHS, whereas accelerators are those specific structures that enable more rapid learning and improvement. For LHSs to create value, such infrastructures must not only exist within the ecosystem but also be connected and aligned with the LHSs' strategic goals. These pillars support the execution, routinisation and acceleration of learning cycles, which are the fundamental processes of LHSs. The main outcome sought by executing learning cycles is the creation of value, which we define as the striking of a more optimal balance of impacts on patient and provider experience, population health and health system costs.

CONCLUSIONS

Our framework illustrates how the distinctive structures, processes and outcomes of LHSs tie together with the aim of optimising health system performance and delivering greater value in health systems.

Co-creating value with suppliers: a conceptual framework

Purpose

This study aims to put forward a conceptual framework to promote strategies for exploring and exploiting value co-creation with suppliers through dynamic capabilities development.

Design/methodology/approach

The conceptual framework was developed by applying deductive logic to blend the theoretical perspectives of value co-creation and dynamic capabilities concerning interaction and innovation.

Findings

The suggested framework emphasized that to co-create value with suppliers, health-care organizations need to integrate innovation abilities with interactional abilities for assimilating mutual processes and resources. The study also points out the crucial role of middle managers to articulate the diverse value perspectives and act as change catalysts.

Practical implications

This paper provides a roadmap for health-care managers to develop internal bundles of resources and integrate inter-organizational processes in the direction of co-creating value. The approach suggests the use of project pipelines and performance measures as managerial tools for aligning value co-creating initiatives with suppliers.

Originality/value

The study is a pioneering attempt to develop a conceptual framework for co-creating value with suppliers and, consequently, to provide innovative services to patients. The study aligns with previous value co-creation and dynamic capabilities works in terms of interaction and innovation development. However, based on the interrelation of these two dimensions, the study puts forth four interrelated processes (experimenting new possibilities of value creation; articulating value alignment initiatives; implementing mutual benefits; and executing and managing performance improvement) attached by mutual change mechanisms.

Open to All: Dementia, Creativity, and Open Ecosystem Innovation

In the health arena, open innovation approaches strive to address real-world complexity through driving multi-stakeholder collaborative activities that can better identify and respond to complex health needs. This paper will argue for the value of an open ecosystem innovation approach, one that explores the full implications of what it means to be "open" in a health innovation context. To these ends, the paper will outline the origins of open innovation in the health arena, suggesting that it has become an important site for pushing the limits of open methods and challenging mainstream conceptions of the targets of health innovation. Five guiding principles for open ecosystem innovation will then be proposed, drawing on learning from the Knowledge Exchange Hubs for the Creative Economy funded by the UK's Arts and Humanities Research Council. These principles point to a configuration of open activities that are maximally sensitive to (1) knowledge diversity in innovation work; (2) the consequences of adopting an open-orientation across all stages of innovation programming; (3) the value of deepening and broadening the targets of innovation activity; (4) the role of mediation in supporting cross-sector partnerships; and, (5) the importance of operating in an adaptive and sustainable manner in the long-term. A follow-on project from the AHRC Hubs-Dementia Connect-sought to apply this learning to an important health focus: dementia and the role played by creative participation in delivering important health outcomes. Through Dementia Connect, the applicability of open ecosystem innovation thinking was assessed, revealing the conditions under which it might deliver innovation-led improvements to the quality of life for those living with a dementia diagnosis. A detailed blueprint for conducting open ecosystem innovation is then proposed in full-a new and comprehensive response to the complex reality of living with a dementia diagnosis today.