From insulin to the pacemaker, Canada has proven itself a global leader in invention. Yet, we rank in the bottom quartile of OECD countries for innovation – a stark contrast to our record on invention. Why? Perhaps it is the challenge of defining innovation, and then measuring its impact so that Canadian health systems can achieve transformational change and sustainability. You know the old adage…you can’t manage what you can’t measure.
Organizations, institutions, and companies in Canada never hesitate to advertise their products and services as “innovative” – but do we fully understand what this means, or is “innovation” just another buzzword that cannot be meaningfully measured?
One way to define innovation is “new and better ways of doing valued things”. We could get into what is meant by “valued”, but that’s a topic for another blog. How can we know if an innovation makes a health system “better” if we don’t measure its impact? Metrics for measuring innovation would create valuable evidence for transformative change at the health system level and would enable knowledge translation across provincial health systems so that all Canadians can benefit from innovation.
Establishing criteria that assess impact at the health system level is an important first step towards documenting innovation outcomes. Such criteria may include:
Magnitude: Can the innovation be leveraged to transform how care is provided across the continuum of care, scalable to the health system level?
Geography: To what extent is the innovation achievable and valuable for urban populations as well as rural and remote communities? Can the entire Canadian population benefit from the innovation?
Durability/Sustainability: What are the conditions required for the innovation to thrive, build momentum, and infiltrate the health system so that it has longevity?
Economy: What economic value will the innovation achieve at the system level? Reduced costs? Enhanced productivity? Revenue generation?
Workforce Capacity: Can clinicians lead the uptake and adoption of the innovation across the continuum of care? Can it be integrated into best practice guidelines to achieve system level adoption
The traditional proof of concept innovation measurement approach in Canada is not addressing all of these criteria. We must switch to a more robust measurement strategy that captures proof of relevance, proof of value and proof of reimbursement. There are several challenges inherent in developing such a strategy to evaluate a health care system as complex as Canada’s.
For instance, how can we measure the relevance of an innovation? Assuming that a consumer-based health care system creates demand, and that demand leads to innovation adoption, which leads to better health outcomes, we could address this measurement challenge by having patients evaluate the relevance of an innovation and then assess its adoption and post-adoption outcomes. This has been achieved by Southcentral Foundation in Alaska, whose award-winning “Nuka System of Care” is owned, managed, directed and designed by its consumers. Patients identify what health issues are most relevant to them and then strategies are designed to address disparities. One example would be their complete redesign of the primary care system, which has yielded same-day access to care leading to cost-saving achievements including a 40% decrease in costly emergency room and urgent care visits, not to mention improvements in health outcomes, and patient and staff satisfaction.
This also poses the question of who should be responsible for measuring innovation outcomes. It’s time to add some accountability to the word “innovation”, and make those who use it responsible for its validation. If Canada is to strengthen its innovation track record globally, we will need to document the return on investment for innovation initiatives at the health system level. This approach will provide an important framework for informing the decisions of key health system stakeholders who can use that evidence to lead innovation and establish a global reputation for outstanding quality, productivity and sustainability for Canadian health systems.
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Canadians generally are late technology adopters and generally suspect of large scale systems change. One would think that with a two hundred billion dollar health economy at almost 13% of GDP that innovation would be funded in a ‘one stop shop’ for streamlining new technology and proven health care systems applications. This innovation funding model is commercially exercised in every other sector of the economy, but health care is regressive in outlook and attitude. Regrettably we will see no adoption of systemic change in Canada until the health -care beast collapses from its own lethargic inertia.
“Nuka System of Care” and “Mom and Baby depot” shared the same values and used patient voices to determine what and how services were provided. In Canada, MBD was unique and is now no-more. It was innovative. It improved outcomes. It saved healthcare dollars.
Legislation/Regulation and “best practices” are too far apart to make meaningful patient-centered system change in Ontario.