“Anyone can look around and see that hospitals are trying to become more efficient,” says Sacha Bhatia, director of the Women’s College Hospital Institute for Health System Solutions and Virtual Care (WIHV). “How do we modernize our health care system to respond to the demands of an older population in the face of increasing economic pressures, while still making it sustainable? Innovation has to be part of that.”
Hospital-affiliated innovation hubs have become ubiquitous in the Canadian health care landscape. With phrases like “living laboratory,” “design thinking,” and “system disruption,” they tout “creative solutions that transform the way health care is delivered and experienced.” Although innovation hubs may be new to health care, they are not a new idea; they have been in the private realm for a long time. Hospitals have now adopted them out of necessity, as a way to deal with system-wide challenges that require new ways of thinking and new solutions.
“People are seeing gaps in the system,” says Jill de Grood, director of the Ward of the 21st Century (W21C) in Calgary. “Some programs are showing you can make an impact as a result of these multi-sector collaborations.”
W21C is one example of a hospital-affiliated innovation hub that began with the renovation of an outdated hospital ward. The new ward was designed with best practice principles in mind and sought to be a live testing site for new technologies and models of care. It has now grown into a large, complex organization with its own space, while still maintaining its affiliation with its parent hospital.
Other hubs look a lot different. The University Health Network’s OpenLab in Toronto is a much smaller operation that has been able to conduct many projects despite a lack of guaranteed funding. The Joint Centres for Transformative Healthcare Innovation (JCTHI) is a partnership between seven large community centres in the Greater Toronto Area. It relies primarily on collaboration to test and scale solutions to common issues. Trillium Health Partners’ Institute for Better Health, on the other hand, is unapologetically seeking to transform the entire health care system.
In this flurry of aspiration and activity, one wonders what problems these hubs are trying to solve, how their approaches differ from previous attempts to change health care, and how their work is affecting patients.
The importance of “mixing it up”
In an article titled Innovative Environments in Health Care, David Bates, chief of general internal medicine at Brigham and Women’s Hospital in Boston, discusses several factors that every innovation hub must have in order to succeed. Most notably, he says that organizations must make innovation a strategic priority, develop a framework to address challenges and foster partnerships, insulate innovation teams from routine operational demands, and ensure that teams are truly interdisciplinary.
Several Canadian leaders echo his thoughts. “To truly work at the transformational level, you need space,” says Dante Morra, chief of staff at Trillium Health Partners. “You need to be away and separate from the current environment, so you can attack the current business model.”
In highlighting the necessity and effectiveness of multidisciplinary teams, John Conly, founder of W21C, points to a falls-reduction program from his site. When asked to tackle a patient safety issue, a team of nurses and pipeline engineers came up with a method of using infrared cameras to create an invisible field near patients who were at high risk of falling. When patients got up without assistance, they would break an invisible barrier and trigger an alarm, which would bring nurses to the bedside and prevent potential falls.
How are innovation hubs funded?
Despite agreement from Canadian hospital leaders about the importance of investing in innovation hubs, several funding models exist and the amount of funding varies widely.
Some of the bigger centres, like W21C, with a dedicated staff of almost 40 people, have a hybrid funding model. Government, academic grants, and industry each provide about a third of funds respectively (approximately $3 million every three years), according to Conly.
In comparison, the JCTHI have a single full-time employee aside from the director. Each of the six founding hospitals contributed approximately $20,000 in starting this partnership, explains JCTHI director, Jo-anne Marr. Hospitals apply primarily for external funds to support their individual projects, while the Joint Centres provide avenues for collaboration, implementation, and dissemination.
UHN’s OpenLab acquires all of its funding, including full-time employee salaries, from grants and external sources. For example, for their patient-oriented discharge summary (PODS)—a set of guidelines and templates meant to reduce medical errors, improve communications, and facilitate transitions of care—OpenLab secured approximately $1.3–1.5 million. According to Shoshana Hahn-Goldberg, co-creator of PODS, these funds were obtained from a combination of government and academic grants. They were initially used to pilot-test this initiative in eight hospitals before spreading it to over 50 organizations in the province. About half of these organizations received a part of the original funding to help implement PODS at their sites.
How funding and strategic decisions are made also varies widely, depending on how closely each hub is aligned with a hospital’s leadership and organizational strategy. For centres that are tightly linked, like the JCTHI and the Institute for Better Health at Trillium, funding decisions usually originate from the top and strongly influence the hub’s direction and objectives. For centres that are more loosely affiliated, like OpenLab, there is minimal influence from the organizational leadership (neither is there any guaranteed funding). This affords the hub freedom to explore initiatives and ideas that are not directly linked to the hospital’s strategic plan.
It is also important to note that most hubs are non-profit organizations that, unlike their counterparts in the U.S., do not seek to make money from selling new products, technologies, patents, and intellectual property.
What do the critics say?
While innovation hubs are all the rage, many question their role and whether their approach is truly new. Some wonder whether “innovation” is just a trendier word for quality improvement (QI) or research, with opportunities for better branding. Indeed, in many hospitals, innovation, QI, and research are often placed under the purview of the same department. Academic grants remain a common form of project-specific funding, while research trials and publications persist as the key method of demonstrating impact and disseminating knowledge. This leads to the same problems that have slowed progress in the past: an overall lack of funding, exceptionally low rates of success in attaining grants and publications, long review and turn-around times, and limited dissemination of knowledge.
Although traditional QI and research methods are often used to evaluate innovations, the goal of innovation hubs is usually to develop or assess new models of care, not improve current processes. Many hubs indicate a focus on philosophies like “Care at Home,” and are exploring novel ideas for outpatient care, such as virtual hospitals or home monitoring and treatment devices. This is different from traditional QI efforts, which have primarily focused on improving efficiency, reducing costs, and enhancing patient safety within hospitals.
Confusion over the terminology is not unique to innovation, says Morra. Like research—which can refer to anything from conducting a survey to discovering a gene—innovation can mean different things to different people. To some, it describes a culture; to others a process or an outcome. However, the lack of clarity is not purely one of linguistics. “There is a science to how you do this, and most organizations haven’t done the research, they haven’t studied the field,” says Morra. “They have no strategy.”
In addition to questions about the role of hospital-affiliated hubs, there are also questions about their ability to make an impact, especially at the health-system level where much of their focus and ambition lies. Indeed, despite millions of dollars, thousands of ideas, and hundreds of pilot projects, there are only a few initiatives that have been successfully implemented on a broad scale, many of which have yet to demonstrate an impact on costs or patient outcomes.
PODS, for example, is a cost-neutral initiative, explains Hahn-Goldberg, although a clinical trial investigating its impact on patient health outcomes is currently under way. A similar project by W21C, the electronic transfer of care (e-TOC) tool, was widely implemented due to patient and provider preference, but failed to show a significant impact on patient morbidity and mortality.
Should every hospital have an innovation hub?
As the number of innovation hubs grows, one wonders whether every hospital needs one.“If you don’t have a large enough place, people who are supposed to be innovating end up getting cannibalized to do routine maintenance,” warns Bates.
As they do with research and QI, smaller sites may be able to engage in innovation by forming larger partnerships (like the JCTHI), serving as tests sites, or encouraging staff to attend events and bring back ideas that are ready for implementation.
But as with research and QI, there is always the concern that this is yet another project, the burden of which will fall on front-line providers who are already overwhelmed with clinical duties.
While this may be the case during the initial stages of new initiatives, many providers are likely to accept and engage with these projects in the long term. After all, many recognize that the current system of care is not sustainable and that major changes are necessary and inevitable. Transformative change is precisely what these innovation hubs are ultimately aiming for, and with that, the hope for better patient care. Because the work of innovation hubs is “so grounded in what the patient wants and needs,” says Hahn-Goldberg, “it is a hard thing for anyone to say no to.”