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Disruptive innovation for social change.

Countries, organizations, and individuals around the globe spend aggressively to solve social problems, but these efforts often fail to deliver. Misdirected investment is the primary reason for that failure. Most of the money earmarked for social initiatives goes to organizations that are structured to support specific groups of recipients, often with sophisticated solutions. Such organizations rarely reach the broader populations that could be served by simpler alternatives. There is, however, an effective way to get to those underserved populations. The authors call it "catalytic innovation." Based on Clayton Christensen's disruptive-innovation model, catalytic innovations challenge organizational incumbents by offering simpler, good-enough solutions aimed at underserved groups. Unlike disruptive innovations, though, catalytic innovations are focused on creating social change. Catalytic innovators are defined by five distinct qualities. First, they create social change through scaling and replication. Second, they meet a need that is either overserved (that is, the existing solution is more complex than necessary for many people) or not served at all. Third, the products and services they offer are simpler and cheaper than alternatives, but recipients view them as good enough. Fourth, they bring in resources in ways that initially seem unattractive to incumbents. And fifth, they are often ignored, put down, or even encouraged by existing organizations, which don't see the catalytic innovators' solutions as viable. As the authors show through examples in health care, education, and economic development, both nonprofit and for-profit groups are finding ways to create catalytic innovation that drives social change.

Diffusion of Innovation↗

[Innovation and obsolescence (author's transl)].

The economists analyse the facts of our everyday--or professional life to insert management--or anticipation rules from them. The progress of innovations and their obsolescence fall within these studies. Recent works have shown that the spreading of innovations in the medical fields was practically identical to that in the industrial field, and that its function in relation to time was written under the form of: P = K divided by 1 + e-(a+bt) P representing the proportion of departments which adopted an innovation at the time t, K representing the proportion of those which will adopt this innovation (a and b are constants). The derivated coefficient in relation to t, that is to say the variation of the proportion of departments adopting innovations in relation to time, measures the speed of diffusion of this innovation (Louise B. Russel, 1977). But can this equation be applied in the field of health, to organisational innovations as well as to those which have a material, therefore industrial support? On the other hand do techniques and equipments become obsolete simultaneously? Finally does the public or the private hospital slow down or speed up the appearance of innovations and their obsolescence? Such are the problems we will endeavour to set... before being able to solve them.

Animals↗

Ethics of innovative surgery: US surgeons' definitions, knowledge, and attitudes.

BACKGROUND: Innovative surgery is not clearly defined, nor is it formally regulated by governing bodies as is the development of drugs and medical devices. This unclear status and the subsequent questionable applicability of existing federal guidelines for human subject research pose an ethical concern. To clarify its position, we solicited US surgeons' definitions of, opinions toward, and attitudes about innovative surgery. Surgeons were also invited to self-report knowledge about current federal regulations guiding human subject research and rules for informed consent for and IRB review of clinical research. STUDY DESIGN: A group of US surgeons received a 46-item questionnaire addressing the definition of innovative surgery versus those for research and practice, regulations for human subject research, need for specific informed consent, and IRB review of surgical innovations. RESULTS: A total of 665 responses were used in the content analysis. Respondents expressed a fairly prudent stance when judging hypothetical innovative scenarios. Hallmarks for experimentation and clinical research as modes of innovation were defined more clearly for the surgical situation. CONCLUSIONS: Defining criteria exist that prompt added scrutiny and previous review of surgical innovations. Some forms of innovation clearly fall under the current regulations for human subject research; others might not fully meet the definition but could still require some additional oversight.

Attitude of Health Personnel↗

The introduction of innovative nursing and midwifery roles: the perspective of healthcare managers.

AIM: This paper reports a study exploring issues arising from the introduction of innovative nursing and midwifery roles from the perspective of healthcare managers. BACKGROUND: In recent years, the number of innovative roles in nursing and midwifery has increased dramatically across all areas of health care. A comprehensive literature review has shown that there is a scarcity of empirical studies to inform policy or the organizational context of this rapidly changing situation. METHOD: Semi-structured interviews were conducted with all Directors of Nursing, Chief Nurses and Directors of Primary Care in the Health and Social Services Trusts and Boards in Northern Ireland. This study formed the first phase of a larger exploration of innovative roles. Data were collected from July to October 2004. FINDINGS: The findings confirm that in recent years there has been a considerable increase in the number and type of innovative nursing and midwifery roles. Themes that emerged from the data included professional identity and number of innovative roles; stimuli for role development; service commissioning; infrastructure support; and perceived value for money. CONCLUSION: Analysis of the impact of innovative nursing and midwifery roles on other members of staff, notably healthcare assistants, is needed. The internationally increasing number of innovative roles need to be evaluated further with regard to their effect on care outcomes for patients, their families and communities, their cost-effectiveness and to how best to secure the support and commitment of colleagues. Further study should also be undertaken to determine whether innovative role-holders are pioneers in the development of future nursing, or whether they are responding to the workforce needs of the medical profession or to the requirements of the health service to cut costs.

Administrative Personnel↗

Implicit theories of creativity: laypersons' perceptions of the creativity of adaptors and innovators.

Kirton has put forward a theory of creativity style in which he maintains that people with more adaptive or more innovative orientations possess equal creative potential. The purpose of this study was to compare Kirton's explicit theory with laypersons' implicit theories of creativity. Laypersons and students were asked to read descriptions of adaptors and innovators and then, using their own personal conceptions of creativity, rate adaptors and innovators on creativity. Analysis showed that the innovative style was perceived as significantly more creative. Furthermore, individuals who possessed a more innovative style were much more likely to rate the innovative orientation as more highly creative. Potential reasons for the implicit view that innovators are more creative are offered. In particular, cultural biases towards the innovative style are discussed.

Adaptation, Psychological↗

Research review: a comparison of two theories of resistance to innovation in baccalaureate level health information management programs.

Health information management (HIM) practitioners and educators must keep abreast of changing technologies in the health care environment as well as in education. The study reported compared two explanations of resistance to innovation to determine which one best explains the variance in receptivity and proposed innovations among faculty members in HIM programs. The psychological explanation holds that organization members' receptivity to change is a function of their personalities. The sociological explanation holds that members respond to specific innovations and that they do so in terms of whether the innovation would increase or reduce their present status. The 138 faculty members of all HIM baccalaureate degree programs in the United States were queried to measure their receptivity to computer-assisted instruction and televised courses. The data were collected using four semantic differential scales. The findings revealed that status variables accounted for the greatest variance in receptivity for each innovation. Significant relationships between selected status variables and receptivity to each innovation were found. The data indicated that the respondents were moderately receptive to the innovations of computer-assisted instruction and televised courses. The study also concluded that faculty were inclined to have a positive attitude toward change.

Attitude to Computers↗

The why, what, and how of management innovation.

For organizations like GE, P&G, and Visa, management innovation is the secret to success. But what is management innovation? Why is it so important? And how can other companies learn to become management innovators? This article from expert Gary Hamel answers those questions. A management breakthrough can deliver a strong advantage to the innovating company and produce a major shift in industry leadership. Few companies, however, have been able to come up with a formal process for fostering management innovation. The biggest challenge seems to be generating truly unique ideas. Four components can help: a big problem that demands fresh thinking, creative principles or paradigms that can reveal new approaches, an evaluation of the conventions that constrain novel thinking, and examples and analogies that help redefine what can be done. No doubt there are existing management processes in your organization that exacerbate the big problems you're hoping to solve. So how can you learn to identify them? Start by asking a series of questions for each one. For instance, Who owns the process? What are its objectives? What are the metrics for success? What are the decision-making criteria? How are decisions communicated, and to whom? After documenting these details, ask the people involved with the process to weigh in. This exploration may reveal opportunities to reinventyour management processes. A management innovation, the author says, creates long-lasting advantage when it meets at least one of three conditions: It is based on a novel principle that challenges the orthodoxy; it is systemic, involving a range of processes and methods; or it is part of a program of invention, where progress compounds over time. So far, management in this century isn't much different from management in the previous one, says Hamel. Therein lies the opportunity. You can wait for a competitor to come upon the next great management process and drive you out of business-or you can become a management innovator right now.

Commerce↗

Developing a paradigm of drug innovation: an evaluation algorithm.

Assessment of drug innovation is a burning issue because it involves so many different perspectives, mainly those of patients, decision- and policy-makers, regulatory authorities and pharmaceutical companies. Moreover, the innovative value of a new medicine is usually an intrinsic property of the compound, but it also depends on the specific context in which the medicine is introduced and the availability of other medicines for treating the same clinical condition. Thus, a model designed to assess drug innovation should be able to capture the intrinsic properties of a compound (which usually emerge during R&D) and/or modification of its innovative value with time. Here we describe the innovation assessment algorithm (IAA), a simulation model for assessing drug innovation. IAA provides a score of drug innovation by assessing information generated during both the pre-marketing and the post-marketing authorization phase.

Algorithms↗

Reasons for applying innovations for scaffolding work.

In this paper reasons for applying and for not applying technical and organisational innovations in scaffolding work are studied. In a participatory ergonomic approach these innovations were developed to reduce problems concerning physical load of scaffolders. In this study reasons for the adoption of the innovations in the scaffolding sector are evaluated in 2 studies, in 48 companies. More than half of the scaffolding sector in the Netherlands adopted the innovations. Reasons for applying innovations concerned improvement of work and health and satisfaction with usage. The reason for not applying the innovations concerned specific situations, such as offshore work, in which innovations were not applicable.

Architecture↗

On the impediments to innovation in the European assistive technology industry.

This paper identifies and analyses some critical aspects of the European assistive technology industry which characterize innovation and determine its type, direction and diffusion. It is argued that innovation in this field is restricted because of (i) the limited and inefficient interaction between certain distinctive market elements, namely research, development, production, trade, service delivery, procurement and usage; (ii) the structural characteristics and general economic environment of the European assistive technology market; and (iii) the lack of a concise set of complementary and supportive actions towards the promotion of an environment favourable to industrial innovation and the transfer of new technology towards the European assistive technology market. The major conclusion from the investigation of the above factors is that innovation is not well served, while the limited innovative activity which is currently observed takes place mainly within institutions where the overall level of research seems to be concentrated and is of an occasional rather than permanent nature. Typically, this limited amount of innovation originates outside the assistive technology market and takes the form of 'induced' innovation.

Commerce↗

Implementing comprehensive health education: educational innovations and social change.

The effectiveness of health education is ultimately determined by whether it is implemented, and how it is implemented. Although a given health education innovation may be designed and experimentally assessed to promote well-being with some measure of effectiveness and efficiency, the actual impact of the innovation will depend upon the manner in which it is disseminated, initiated, and maintained. The implementation of health education programs in schools or elsewhere is a function of the types of innovations available, certain characteristics of those innovations that influence their use, and the manner in which the innovations are brought into practice. This paper has been prepared to review, synthesize, and apply current and relevant information about educational innovations and social change to provide a conceptual base for the design, execution, and analysis of efforts to implement health education in schools. The American system of public and private schools could be an agent vitally important to the realization of a second public health revolution. Indeed, in a democratic society, the implementation of health education in schools seems a condition necessary for such a revolution. By analyzing and learning from our own health education efforts, as well as the efforts of those experienced with implementing other types of educational innovations in schools, we might ensure that future populations are informed sufficiently about factors that influence their health and well-being.

Adolescent↗

Value innovation: the strategic logic of high growth.

Why are some companies able to sustain high growth in revenues and profits--and others are not? To answer that question, the authors, both of INSEAD, spent five years studying more than 30 companies around the world. They found that the difference between the high-growth companies and their less successful competitors was in each group's assumptions about strategy. Managers of the less successful companies followed conventional strategic logic. Managers of the high-growth companies followed what the authors call the logic of value innovation. Conventional strategic logic and value innovation differ along the basic dimensions of strategy. Many companies take their industry's conditions as given; value innovators don't. Many companies let competitors set the parameters of their strategic thinking; value innovators do not use rivals as benchmarks. Rather than focus on the differences among customers, value innovators look for what customers value in common. Rather than view opportunities through the lens of existing assets and capabilities, value innovators ask, What if we start anew? The authors tell the story of the French hotelier Accor, which discarded the notion of what a hotel is supposed to look like in order to offer what most customers want: a good night's sleep at a low price. And Virgin Atlantic challenged industry conventions by eliminating first-class service and channeling savings into innovations for business-class passengers. Those companies didn't set out to build advantages over the competition, but they ended up achieving the greatest competitive advantages.

Administrative Personnel↗

The changing environment for technological innovation in health care.

A distinguishing feature of American health care is its emphasis on advanced technology. Yet today's changing health care environment is overhauling the engine of technological innovation. The rate and direction of technological innovation are affected by a complex of supply- and demandside factors, including biomedical research, education, patent law, regulation, health care payment, tort law, and more. Some distinguishing features of technological innovation in health care are now at increased risk. Regulatory requirements and rising payment hurdles are especially challenging to small technology companies. Closer management of health care delivery and payment, particularly the standardization that may derive from practice guidelines and clamping down on payment for investigational technologies, curtails opportunities for innovation. Levels and distribution of biomedical research funding in government and industry are changing. Financial constraints are limiting the traditional roles of academic health centers in fostering innovation. Despite notable steps in recent years to lower regulatory barriers and speed approvals, especially for products for life-threatening conditions, the Food and Drug Administration is under great pressure from Congress, industry, and patients to do more. Technology gatekeeping is shifting from hundreds of thousands of physicians acting on behalf of their patients to fewer, yet more powerful, managed care organizations and health care networks. Beyond its direct effects on adoption, payment, and use of technologies, the extraordinary buying leverage of these large providers is cutting technology profit margins and heightening competition among technology companies. It is contributing to unprecedented restructuring of the pharmaceutical and medical device industries, leading to unprecedented alliances with generic product companies, health care providers, utilization review companies, and other agents. These industry changes are already having considerable effects on investment patterns and the development, adoption, and use of new technologies. Until recently, new technologies that offered the prospect for health benefit, however, marginal or unproven, were paid for with little or no regard to cost. Technical wizardry alone no longer carries the day in health care. Today's health care market increasingly demands what other markets do--measurable improvements in benefits at acceptable costs--and innovators have begun to respond accordingly. Even so, certain key venues for health care innovation are at risk.

Biomedical Technology↗

Impact of formularies on clinical innovation.

It is important to consider, in light of how innovation has so often occurred, whether today's managed care environment is conducive to continued psychopharmacologic innovation. The initial step in the development of a new area in psychopharmacology has historically relied in large part on individual clinicians who pursued unconventional methods of treatment. When a set of guidelines such as a formulary (a list of drugs eligible for reimbursement compiled by a managed care organization) becomes restrictive, it decreases clinician innovation. In addition to this long-term threat to innovation, studies have found greater restrictiveness in formularies to be associated with higher health care utilization. Thus, restricted formularies that are based on a naive interpretation of "therapeutic equivalence" may slow the advance of medical science without even achieving the only goal that could possibly justify such restrictions-cost control. If innovation is to flourish, formularies must be flexible and advisory, not restrictive. Preserving the climate for innovation in health care requires the management culture to focus on the long-term impact of policies on quality and innovation as well as on the overall health cost in the system.

Antipsychotic Agents↗

The new rules for bringing innovations to market.

It's tough to get consumers to adopt innovations--and it's getting tougher all the time. That's because more and more markets are taking on the characteristics of networks. The interconnections among today's companies are so plentiful that often a new product's adoption by one player depends on its systematic adoption by other players. Consider the disparate companies involved with the popularization of digital photography: software vendors, camera manufacturers, broadband communications companies, printer manufacturers, and so on. By contrast, Kodak was pretty much the sole player involved with popularizing film photography. The traditional levers executives use to launch products--such as targeting unique customer segments or developing compelling value propositions--don't work as well in this new environment. Instead, innovators must orchestrate a change of behaviors across the market, unraveling the status quo so that a large number of players adopt their offerings and believe they are better off for having done so. In this article, Monitor Group's Bhaskar Chakravorti outlines a four-part framework for doing just that. The innovator must reason back from a target endgame, implementing only those strategies that maximize its chances of getting to its goal. It must complement power players, positioning its innovation as an enhancement to their products or services. The innovator must offer coordinated switching incentives to three core groups: the players that add to the innovation's benefits, the players that act as channels to adopters, and the adopters themselves. And it must preserve flexibility in case its initial strategy fails. Chakravorti uses Adobe's introduction of its Acrobat software as an example of an innovator that took into account other players in the network--and succeeded because of it.

Commerce↗

Darwin and the demon: innovating within established enterprises.

As commercial processes commoditize in a developed economy, they are outsourced or transferred offshore, leaving onshore companies with unrelenting, Darwinian pressure to come up with the next wave of innovation. But innovation is a broad term. There are many types, from the ballyhooed disruptive innovation to more mundane forms such as process and experiential, which might involve, respectively, doing such things as streamlining the supply chain and delighting customers with small modifications of products. Many executives find it hard to decide which kind to focus on. The best way to choose is to consider the phases of a market's life span. In a market's earliest phase, a new technology attracts enthusiasts and visionaries. Eventually, the market reaches the Main Street section of its life, when growth slows, flattens, and finally subsides. Different types of innovation produce more bang for the buck at different points in the life cycle. Disruptive innovation, for example, is rewarded most during the earliest phase. Once the life cycle advances to Main Street, however, the marketplace is no longer willing to yield the revenue or margin gains necessary to fund that type of innovation, so other forms, including process and experiential, yield better returns. But attempts to change the company's direction are often thwarted by the inertia that success creates. To overcome the inertia demon, managers must introduce new types of innovation while aggressively extracting resources from legacy processes and organizations. By running the two efforts in parallel, they can defeat the demon and renew the company.

Commerce↗

Ethical regulations for innovative surgery: the last frontier?

BACKGROUND: There are no clear federal regulations governing innovative surgery, even though general guidelines regulating research with human subjects do exist. We hypothesized that US surgeons are unaware of Department of Health and Human Services regulations, rarely seek IRB review, generally oppose outside regulation of innovative surgery, and are uncertain what constitutes innovation and research. These circumstances, if true, would pose a significant ethical problem and present potential harm to patients as unwitting subjects of research. STUDY DESIGN: In a pilot study we reviewed 527 issues of US surgical and medical journals, selecting 59 articles published between 1992 and 2000, that described innovative surgery. Corresponding authors from university hospitals (71%) and other facilities (29%) were sent an anonymous questionnaire. RESULTS: The survey was conducted between November 2000 and May 2001. Twenty-one questionnaires were returned, completed with responses, constituting a 35% overall response rate. Fourteen authors confirmed their work was research, yet only six had sought prior IRB review. The majority of authors (15 of 21) did not submit their protocol to IRB. Only seven authors had mentioned the innovative nature of the procedure in the informed consent form. Seven authors claimed familiarity with Office for Human Research Protections definitions of research and human subject. Two-thirds of the respondents stated that government regulations for the protection of human subjects of innovative surgery would not be appropriate. CONCLUSIONS: The current system of definitions, ethical theories, and voluntary professional guidelines may be inadequate to meet the challenge of surgical innovation. Further research is proposed to examine the adequacy of the existing guidelines.

Ethical Review↗

Innovations in the nursing care of the chronically ill: a literature review from an international perspective.

This literature review focuses on substitution-related innovations in the nursing care of chronic patients in six western industrialized countries. Differences between primary and secondary care-orientated countries in the kind of innovations implemented are discussed. Health care systems are increasingly being confronted with chronic patients who need complex interventions tailored to their individual needs. However, it seems that today's health care professionals, organizations and budgets are not sufficiently prepared to provide this kind of care. As a result, health care policy in many countries targets innovations which reduce health care costs and, at the same time, improve the quality of care. Frequently, these innovations are related directly to the 'substitution of care' phenomenon, in which care is provided by the most appropriate professional at the lowest cost level, and encompass advanced nursing practice, hospital-at-home care and integrated care. The main conclusion of this paper is that integrated care innovations are implemented in both primary care as well as in secondary care-orientated countries. However, innovations in hospital-at-home care and advanced nursing practice are primarily implemented in primary care-orientated countries. Whether these innovations positively influence the quality of care, costs of care or patients' use of health care facilities remains rather unclear.

Canada↗