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You have an idea, now what?

The innovation process is often more important than the original idea, particularly when the ultimate goal is to improve patient care through technologically advanced products. Many physicians have great ideas; unfortunately, many of these great ideas are never translated to patient care improvements because of a misunderstanding of "the next step." In many cases, the next step is a step backward to understand the real clinical problem: "the clinical need." With the clinical need in hand, the most efficient path to a product for improved patient care can then be derived. Often, the most efficient pathway involves an appreciation of many issues, including intellectual property, regulatory pathways, finance, and clinical trial strategies. The integration of these issues underlies innovation in biomedical technology.

Commerce↗

Retrofitting technology to nursing: the case of electronic fetal monitoring.

OBJECTIVES: To describe how nurses put electronic fetal monitoring to use in the 1960s and 1970s and the dilemmas this caused. DESIGN: Social history. RESULTS: Nurses used electronic fetal monitoring to improve the watchful and comfort care of childbearing women, and they saw it as validating nursing. They retrofitted, or worked to reconcile machine monitoring with natural, prepared, and participative childbirth, and with attentive and embodied nursing. CONCLUSION: Electronic fetal monitoring was another in a long line of technological innovations that fell to nurses to put into use and to make work. The remarkably rapid way electronic fetal monitoring became routine in the United States depended, in large part, on the articulation work of nurses. However, like all such work, what nurses did to make electronic fetal monitoring work for patients, physicians, hospitals, and manufacturers was largely invisible. Retrofitting efforts often entail unrecognized innovation and risks for nursing.

Diffusion of Innovation↗

Innovation in medical technology: reading the indicators.

Investment in medical technology innovation has enabled significant advances in patient care. An understanding of the dimensions and measures of innovation is critical in fully assessing the implications of many policy initiatives under debate. This Data Watch presents several indicators of inputs and outputs associated with medical device innovation, including public- and private-sector research and development (R&D) investment, patent activity, product regulatory clearance patterns, and market acceptance trends. Changes in these selected indicators point to a potential shift occurring in both the nature of and the investors in the innovation process.

Device Approval↗

Innovation versus complexity: what is too much of a good thing?

What's the number of product or service offerings that would optimize both your revenues and your profits? For most firms, it's considerably lower than the number they offer today. The fact is, companies have strong incentives to be overly innovative in new product development. But continual launches of new products and line extensions add complexity throughout a company's operations, and as the costs of managing that complexity multiply, margins shrink. To maximize profit potential, a company needs to identify its innovation fulcrum, the point at which an additional offering destroys more value than it creates. The usual antidotes to complexity miss their mark because they treat the problem on the factory floor rather than at its source: in the product line. Mark Gottfredson and Keith Aspinall of Bain & Company present an approach that goes beyond the typical Six Sigma or lean-operations program to root out complexity hidden in the value chain. The first step is to ask, What would our company look like if it made and sold only a single product or service? In other words, you identify your company's equivalent of Henry Ford's one-size-fits-all Model T-for Starbucks, it might be a medium-size cup of coffee; for a bank, a simple checking account-and then determine the cost of producing that baseline offering. Next, you add variety back into the business system, product by product, and carefully forecast the resulting impact on sales as well as the cost implications across the value chain. When the analysis shows the costs beginning to overwhelm the added revenues, you've found your innovation fulcrum. By deconstructing their companies to a zero-complexity baseline, managers can break through organizational resistance and deeply entrenched ways of thinking to find the right balance between innovation and complexity.

Diffusion of Innovation↗

Educational innovation in a time of change.

At Columbia University School of Nursing, excellence in clinical practice has always been a major mission. The upheaval and rapid change in the current health care climate make meeting this goal difficult, especially in implementing educational innovations which might better prepare students for the practice world. This article explores the market forces, professional issues, and collaborative interactions that create both positive and negative influences on educational innovation.

Diffusion of Innovation↗

Focus groups with school staff to explore asset-building innovativeness.

OBJECTIVE: To assist with interpretations of findings from a survey assessing the diffusion of an asset-building innovation in 3 school districts. METHODS: Eight focus groups were conducted with 69 school administrators, teachers, and guidance counselors in 3 school districts. Three reviewers examined transcripts for common themes. RESULTS: The themes that arose related to effective communication channels, barriers that prevent diffusion in the schools, the need for improved relationships, and addressing of students' needs. CONCLUSIONS: The study illustrates the advantages of linking qualitative and quantitative methods when performing evaluations by enhancing both the validity and usefulness of findings.

Administrative Personnel↗

[Interest in and limitations of economic assessment applied to the evaluation of medical strategies: examples in oncological hematology].

Using examples of economic assessment of medical innovations in the field of oncology, haematology and safety of blood products, the article shows that most of these innovations follow a law of diminishing returns: increasing levels of resources must be devoted in order to obtain an additional unit of health benefit (such as a life-year saved by a medical intervention). The article argues that, in such a context, cost-benefit analysis, a standard method in public economics, can be a useful tool to determine the 'optimal' level of resources that should be allocated by society for various medical interventions. In some instances, cost-benefit analysis can help to identify barriers to optimal diffusion of medical innovations that are due to inappropriate incentives and constraints in the management of the healthcare system.

Cost-Benefit Analysis↗

Diffusion of published cost-utility analyses in the field of health policy and practice.

OBJECTIVES: The diffusion of cost-utility analyses (CUAs) through the medical literature was examined, documenting visible patterns and determining how they correspond with expectations about the diffusion of process innovations. METHODS: This study used 539 CUAs from a registry. It includes data elements comprising year of publication, the research center in which the study was performed, the clinical area covered by the CUA, and the specific journal. Finally, each paper was assigned to a journal type that could be one of the three categories: health services research, general medicine, or clinical specialty. RESULTS: When the average number of publications is plotted against time, the plot reveals an S-shaped curve. It appears that, whereas CUAs initially were published more frequently in general medical or health services research journals, there was a clear increase in the diffusion of CUA into subspecialty journals over time. The concentration ratio for research centers as measured by the Herfindhal-Hirschman Index decreased over time. CONCLUSIONS: The spread of CUA through the medical literature follows patterns identified for the diffusion of other new technologies and processes. Future research should focus on what impact this spread has had on the practice of medicine and formulation of health policy.

Cost-Benefit Analysis↗