Kari J. Kværner and Thomas Hoholm (Eds.)
Handbook of Healthcare Innovation Research-based tools and methods for shaping the health service of the future
© CAPPELEN DAMM AS, Oslo, 2024 ISBN 978-82-02-83297-1 1. edition, 1. printing 2024 This book is an english edition of Håndbok i helseinnovasjon. Forskningsbaserte råd og verktøy for å forme fremtidens helsetjeneste © Cappelen Damm 2023 ISBN 978-82-02-79644-0 This publication and its content are protected by and subject to the provisions of the Norwegian Copyright Act. No part of this publication may be reproduced or disseminated further in any form or by any means whatsoever without the express prior written permission of the publisher, Cappelen Damm AS, in accordance with the law, or according to the terms of an agreement with the Norwegian reprographic rights organization, Kopinor. Any use of the whole or parts of the publication as input or as a training corpus in generative models that can create text, images, video, sound or any other content and expression is not permitted without a specific agreement with the rightsholders. Use of the publication's material in violation of law or agreement may lead to confiscation, liability for damages and punishment in the form of fines or imprisonment. Translation: Adam King Cover illustration and vignettes: Alberto Soriano / Halogen Cover design: Cappelen Damm AS Typesetting: Bøk Oslo AS Printing and binding: AIT Grafisk AS www.cda.no akademisk@cappelendamm.no
Preface
This book is the result of eight years of interdisciplinary research and innovation work in Norwegian healthcare in the Centre for Connected Care (C3), a centre for research-driven innovation funded by the Research Council of Norway. In addition to our research articles, doctorates, studies and many innovation projects, we wish to make the knowledge we have gained and our new research-based methods accessible to you. The methods and tools presented in this book will also be of use in other areas of the public sector. The book’s chapters have been written by a wide array of talented researchers from the Oslo School of Architecture and Design, the University of Oslo, Akershus University Hospital, BI Norwegian Business School and Oslo University Hospital. We would like to thank all contributors who devoted their energy and enthusiasm to the project. A special thank you goes to Josina Vink, Jon Bingen Sande and Per Ingvar Olsen for taking on editorial responsibilities within their areas of research. The tools and methods have been developed through research together with partners from the public sector (City of Oslo, Larvik municipality, Oslo University Hospital, Akershus University Hospital, Sunnaas Rehabilitation Hospital) and the business sector (Dignio, Diffia, CGI, Induct, Siemens Healthineers, Accenture, Sykehuspartner, Abelia and Norway Health Tech). While it has been demanding to identify common goals and directions so that our efforts are as productive as possible, it has also been a great privilege to work over such a long period of time with so many key figures in the field. Many thanks for your collaboration and our healthy discussions!
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Our thanks also go to Åsmund Eikenes and Eline Prytz Andersen at Halogen for their invaluable editorial support and good ideas! Without you this book project would not have been as good as it is. The quality of the healthcare services of the future depends on our ongoing contributions towards its renewal. We see healthcare personnel and service providers doing their part to contribute every single day. Our hope is that the book will act as inspiration and be of practical use. We encourage you to make active use of the book in your ongoing work towards the quality healthcare services of the future. Oslo, May 2023 Kari J. Kværner and Thomas Hoholm
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Preface
Contents
Preface. . ...............................................................................
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Introduction......................................................................... 14 Kari J. Kværner and Thomas Hoholm
Part I Shaping the Health Services of the Future. 21 1
Everything We Cannot See. . ............................................ 27 The iceberg model for drawing attention to, understanding and shaping social structures Josina Vink
2 Competing Logics........................................................... 34 An approach for mapping and discussing diverse rationales within health services Josina Vink, Shivani Prakash and Felicia Nilsson
3 The Power of User Participation...................................... 41 Seven different ways to involve and include users Betina Riis Asplin and Thomas Hoholm
4 Value-Driven Innovation................................................. 50 A new alliance between practitioner and patient Keith Peavy, Thomas Hoholm and Bjørn Erik Mørk Contents
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5 Mindfully Navigating Conflict. . ........................................ 55 Holding tensions with the help of service design Josina Vink
6 Diverse Bodies in the Health Services of the Future........ 60 Critical and speculative design strategies for equality and diversity in digital healthcare Marie Louise Juul Søndergaard
7 Everyday System Shaping............................................... 68 Seeing yourself as a force for transformation Josina Vink
Part II Making the Right Decisions.. ....................... 75 8 Leading Innovation Processes......................................... 79 Reflection as the key to steadfast and inclusive leadership Kari J. Kværner
9 Early Health Technology Assessment (Step Up).............. 88 From qualified assessment to knowledge-based decisions Kari J. Kværner and Linn Støme
10 Evaluating to Improve Health Service developments...... 101 What to consider before setting a pilot project in motion Kari J. Kværner and Linn Støme
11 Computer Simulation to Optimize Patient Flow and Resource Use in the Health Service................................. 112 The value of data in exploring opportunities and making decisions Lene Berge Holm and Tone Breines Simonsen
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Contents
12 Innovation Through Embedded Design........................... 121 A guide to establishing embedded service design labs in healthcare organizations Jonathan Romm
13 Implementation Roadmapping....................................... 129 A method for planning and anchoring the next steps Frida Almqvist
Part III The Route Through a Procurement Process................................... 139 14 What is the Problem with Public Procurement?.. ............. 141 Challenges and opportunities for effective partnerships with private-sector suppliers Jon Bingen Sande
15 Guide to Complex Problem-Solving in Procurement Projects. . ................................................ 151 Step by step towards success Jon Bingen Sande
16 How to Use Relational Contracts in Public Procurement... 157 Good advice for successful collaborations between public- and private-sector actors Jon Bingen Sande
17 Requirement Specifications in Procurement Projects in the Health Service.. ........................................ 165 Checklist for involving suppliers at the right stage in the process Anna Stepanova
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18 Innovation Partnerships.................................................. 171 What they can and cannot accomplish Morten H. Abrahamsen and Per Ingvar Olsen
19 How Do We Achieve Innovation-Friendly Digital Infrastructures?.. .................................................. 180 Advice and criteria for successful digital development processes Margunn Aanestad, Polyxeni Vassilakopoulou and Miria Grisot
20 How Do Start-Ups Sell Healthcare Innovation?. . .............. 190 Eight tips to succeed as a supplier Susanna Pinnock and Maria Grazyna Hviding
Part IV Seeing the Evidence of Change. . ............. 197 21 A New Way for Patients and Healthcare Personnel to Interact. . ..................................................... 199 Consequences of introducing digital remote follow-up care Miria Grisot, Alexander Moltubakk Kempton and Margunn Aanestad
22 The Contrast Between Plan and Reality........................... 207 Observation as a method to juxtapose concept and practice Zhipeng Duan
23 The Security to Change Professional Identity. . ................ 216 What we’re asking for when we ask employees to be more innovative Keith Peavy, Thomas Hoholm and Bjørn Erik Mørk
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24 The Challenges of Agreeing on Innovation Management Tools........................................ 226 Solid advice for measuring and sharing innovation experiences across hospitals and sectors Trust Saidi, Per Ingvar Olsen and Kari J. Kværner
25 Scaling New Digital Health Services in Times of Crisis. . ... 233 Lessons learned from the COVID-19 pandemic in the City of Oslo Per Ingvar Olsen and Morten H. Abrahamsen
26 How Do We Facilitate Implementation?.......................... 242 Six measures for adopting and using digital cloud-based solutions Per Ingvar Olsen
27 Adopting New Healthcare Technologies – Experiences from the UK.............................................. 247 Three pieces of advice to strengthen the Norwegian health service Gilbert Kofi Adarkwah and Per Ingvar Olsen
Conclusion........................................................................... 254 About the Authors............................................................... 260
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Interviews
Sunnaas Rehabilitation Hospital: ‘We think and work differently because of C3’....................... 24 Larvik municipality: ‘C3 has been a great help getting started’............................. 73 Oslo University Hospital: An inspiring and impactful collaboration............................... 77 Diffia: ‘C3’s research is crucial to success in innovation’................... 149 Sykehuspartner Hospital Trust: Trust as a bridge-builder for effective collaboration. . ............. 164 Norway Health Tech: ‘Collaboration requires a better understanding of roles’......... 179 CGI Norway: ‘It’s a long road from talk to action’....................................... 189 Dignio: ‘What we’ve got out of it has been very good’.. ..................... 222 Induct: ‘An incentive to spread innovation’........................................ 224 Siemens Healthineers: Digital interaction – an unfulfilled potential?. . ........................ 232 Abelia: ‘It is only now that society is seeing the value of C3’s work’.. ... 252
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Introduction Kari J. Kværner and Thomas Hoholm, Oslo University Hospital and BI Norwegian Business School
The health sector is coming under increasing pressure. We are living longer and lifestyle diseases are becoming more and more common; meanwhile, our expectations towards healthcare only grow. The fact that we have too few hands on deck is becoming the greatest future challenge. In order for all those who need help to receive it, we must quite simply dare to think about the healthcare system of the future in a completely new way. Innovation in healthcare is about envisioning the need for new products and services – but not that alone. It also involves seeing new opportunities to harmonize existing products and services. If we are to solve tomorrow’s health challenges, we will also have to develop effective healthcare services that are better adapted to each individual patient’s needs and daily life. In 2015 the World Health Organization (WHO) drew up a global strategy on people-centred, integrated health services placing people and communities at the centre of health services. Healthcare systems ought to be integrated and people-centred, with treatment and care coordinated around what is important to the patient. Health services should be grounded in knowledge of the patient and the environment in which the patient lives, and this requires coordination of these services around the patient. The provision of proper services is an ongoing process that demands systematic work in regard to patient safety and quality improvement. At present, healthcare in municipalities and hospitals is prioritized on the basis of three criteria: the severity of illness, the efficacy of interventions and their cost-effectiveness. From a health perspective, these services must be of good quality, meaning that they must be effective, safe and secure, and that they must involve users, be coordinated, fairly distributed, and make efficient use of resources. Meanwhile, as citizens and users of health services, we must do more ourselves: we must prevent disease and take a proactive role in changes to our lifestyles and exercise habits so that we are better able to cope. We must also take an active role in decisions concerning what is important to us, including in the treatment of serious illness. Achieving the aim of a people-centred health service requires knowledge about how we facilitate change in the way we shape, deliver and organize health services. Introduction
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INDIVIDUAL
Other sectors
Pe rs
L
Service provider
ntred health -ce on l commu se n a oc amily it F
s ice rv y
Health sector
National situation and developmental status
Figure I.1. A model for comprehensive and person-centred health and care services
In today’s health service, however, assessments of the potential utility of innovation and new health services are not being prioritized – despite the fact that innovation in health services is a crucial prerequisite for us to solve the challenges that the health sector faces. Developing more integrated people-centred care systems has the potential to generate significant benefits to the health and health care of all people, including improved access to care, improved health and clinical outcomes, increased satisfaction with care and reduced overall costs. But it requires that we take action.
What becomes of the changes? Developing comprehensive patient services requires innovation and collaboration across sectors, organizations and the business community. Such collaboration is often managed by the public health sector, which procures services via agreements with both public and private actors. All other collaboration partners are thus engaged by the public health sector, and must prioritize according to guidelines and the tasks 16
Introduction
assigned. This way of organizing innovation partnerships often creates restrictive frameworks for budgets and tasks, and in many cases may even counteract innovation. One of the major challenges facing innovation in the health sector is that, even in environments where there is a great willingness to innovate, new solutions are difficult to implement in day-to-day operations. Why do so many innovation projects conclude without there being any discernible change? One possible explanation is that when an organization introduces new technology or a new treatment plan, the organization of the services around the patient also needs to change. This entails changing the routines of all employees with a role in the patient care journey – changes that require a solid foundation, planning, follow-up and management. For example, video consultations and home-based care services not only affect the way we work in the health service, but also the role of the patient. Changes like these require that we have a shared understanding of what we are seeking to change and that we are working towards a common goal. This raises the question of whether we might sometimes perceive the challenge and the need differently to others who provide or receive the service. In such cases, it is difficult to assign common priorities and effect the necessary changes. When it comes to innovation in the health sector, there is however a major need for knowledge. In order to ensure effective innovation processes that lead to real change, we need to understand how to: • • • •
organize the healthcare system so that there is space for innovation; ensure that we find the right solutions to the challenges; ensure that innovations are implemented in day-to-day work; measure the effects of innovation.
The Centre for Connected Care (hereafter C3) was established in 2015 as a centre for research-driven innovation, with funding from the Research Council of Norway. The objective of C3 has been to identify effective methods and gather relevant experience concerning how to manage service development in the health sector. In collaboration with business partners and the health service itself, the centre’s researchers Introduction
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have investigated the design, procurement and scaling of personalized and integrated health services. The principal focus of C3 has been digital remote follow-up and homebased hospital care, with a vision to develop, test and utilize new solutions that enable the patient to manage their own health and treatment. Through collaboration with municipalities, hospitals and business actors, C3’s research has generated knowledge about how design can contribute towards developing methods and tools for the health service which are particularly suited to remote follow-up and home-based hospital care. The work has produced knowledge about how public procurement is carried out and how successful innovation partnerships are formed. The research has furthermore helped to shed light on how new services can be scaled to both hospitals and municipalities, so that even more patients can benefit from the innovations.
A handbook in four parts This book is a compilation of C3’s research results over many years and provides the tools you need to contribute to innovation in the health service. The book is divided into four parts and demonstrates how you can: • • • •
involve the people who use and deliver the services; make solid decisions along the way; navigate public procurement processes; document the evidence of change as it occurs.
Each part contains easily accessible chapters where researchers share the most important results from their work, followed by practical tools that make it easy to apply this knowledge to everyday activities. Each of the four parts also includes short interviews with partners in the business sector, hospitals and municipalities, who share success stories and specific advice on how to achieve innovation in the health services in practice. The book can be read from cover to cover or you can look up the parts that are best suited to solving the challenges you are facing right now. Combined, the four perspectives in the book provide a comprehensive overview as well as practical advice for succeeding in innovation processes – both large and small – in the health service. 18
Introduction
The book will be useful to readers who work in the municipal health service, in hospitals and in health service administration. The tools and various approaches may also be applicable to other service areas in the public sector. The book is designed to support readers who are seeking to create effective services and would like to know more about how to contribute to innovation and change.
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[START DEL]
PART I SHAPING THE HEALTH SERVICES OF THE FUTURE
Introduction The first part of this book introduces what we mean by a person-centred and holistic perspective on the health services of the future. These chapters provide an overview of the role we as individuals play in the health service and the systems we wish to improve, and of how our various experiences and viewpoints can contribute to innovation. The goal of person-centred health services cannot be achieved without extensive collaboration between users, healthcare professionals and technology providers. In that regard, this part of the book describes how to involve users and other stakeholders in the development of new health services. It also provides insight into the roles, expectations and challenges associated with shaping fair and accessible health services, backed up by examples and reflection questions that contribute to learning and development. This part of the book begins with an interview with managers and innovators at Sunnaas Rehabilitation Hospital, who share their experiences of working closely with students and researchers from C3. The collaboration has led to lasting changes in how they think about and work towards shaping and improving services at the hospital. In the chapter ‘Everything We Cannot See’ you will learn to use the iceberg model as a method of raising awareness and shape invisible social structures in health care. You will then be given an overview of different logics at play in the health service. The overview will enable you to identify and understand better the various ways of thinking about, and the various approaches to, what constitutes good health and care services. The subsequent two chapters provide an enhanced understanding of the role and place of users in research. First, we provide an overview of different ways to include users and their representatives, supplemented by a simple checklist you can use in your own development projects. Then we introduce the concept of value-based innovation, which focuses on the new alliance between practitioner and patient. Multiple perspectives on innovation processes makes it natural for conflicts and opposing views to arise. The chapter ‘Mindfully Navigating Conflict’ advises you on how to use resistance as a positive force for change. Then follows a critical perspective on design for health care, where the physical body is placed at the heart of design processes. The 22 Part I
following chapter presents a simple model that helps you to understand your own role as a change agent in day-to-day working life. Part I concludes with an interview with an experienced innovator in Larvik municipality, who describes the value of innovation partnerships with these words: ‘It’s a fantastic opportunity to tackle major challenges in the health service and to work across levels with researchers to find new and innovative solutions.’ The chapters will deliver insights into how you can develop organizations and fellow employees throughout the process, so that together you can facilitate successful innovation processes.
Shaping the Health Services of the Future
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