The In Fieri 7-year research program obtained funding through the highly competitive “Foundation Scheme” of the Canadian Institutes of Health Research (CIHR; 2015-2023).

Responsible Innovation in Health (RIH) was developed by leading multiple studies structured around three research streams:

A. The design of RIH
B. The emergence and contribution of RIH
C. The institutionalization of RIH

 

In Fieri Studies

Needs and challenges of health systems
Stream A— The design of RIH
RIH Assessment Tool
Stream A—The design of RIH
What is RIH, what it is not, and what it entails in practice
Stream A—The design of RIH
Design tools for RIH
Stream A—The design of RIH
Responsible food systems
Research training activities
Fiction and health innovations
Knowledge mobilisation activities
Goals, processes and scaling of responsible innovations
Stream B—The emergence and contribution of RIH
RIH in small- and medium-sized enterpreprises and entrepreneurship
Stream B—The emergence and contribution of RIH
Illustrated booklet of RIH
Stream B—The emergence and contribution of RIH
Role of social finance in RIH
Stream C—The institutionalization of RIH
Responsible digital solutions and AI
Stream C — The institutionalization of RIH
RIH Playbook
Stream C— The institutionalization of RIH

Prior Research

Design tools for RIH
Stream A—The design of RIH
Fiction and health innovations
Knowledge mobilisation activities
Goals, processes and scaling of responsible innovations
Stream B—The emergence and contribution of RIH
Illustrated booklet of RIH
Stream B—The emergence and contribution of RIH
Multimedia-based prospective public deliberation
Needs and challenges of health systems
Stream A— The design of RIH
Responsible digital solutions and AI
Stream C — The institutionalization of RIH
Responsible food systems
Research training activities
RIH Assessment Tool
Stream A—The design of RIH
RIH in small- and medium-sized enterpreprises and entrepreneurship
Stream B—The emergence and contribution of RIH

Experimenting and enhancing RIH design tools

How can we help health innovators who wish to work with RIH’s dimensions and attributes to design and develop responsible innovations?

To answer this question, we collaborated with the TransMedTech Institute of Polytechnique Montréal and implemented, in Fall 2019, a co-design project to identify tools that can design responsible innovations in health. Eight teams of health innovators from different professional fields, including rehabilitation, biomedical engineering, communication, design, and management were recruited, for a total of 17 participants. Working with the RIH framework as a design brief, participants conceptually redesigned an existing innovation in order to make it more responsible.

To do so, the 9 RIH attributes were transformed into “responsibility cards” and each team received 5 different cards as their design brief. For example:

To increase the innovation’s degree of responsibility, the teams identified tools (e.g., standards, norms, models, criteria, or processes) to support the design of responsible innovations. Then, they shared what they believed were the best tools to include in our RIH Design Toolbox. The latter was made publicly available to those wishing to develop responsible innovations in health in a book published in 2022:

 

Project Lead: Lysanne Rivard

In 2018, Palindrome —a magazine bringing together health and literature— concluded its proof of concept phase by successfully publishing two issues.

Magazine Palindrome, Vol. 1, no 1, mars 2018This magazine combines literary creations and scientific content from a new vantage point, underlining the social and cultural mutations that innovations in health can bring. A palindrome is a word that can be read from left to right as well as from right to left. Likewise, this magazine offers to travel back and forth between literature and health in a fruitful way.

Palindrome is based on an interdisciplinary approach, bringing food for thought to the readers about health innovations so as to strike their imagination. To that end, Palindrome is inviting writers, experts and researchers, both beginners and seasoned, to tell us their story about an innovation in health, whether technological or social, that has changed their life in a meaningful way. Practitioners are also welcome to contribute to the magazine.

Read Palindrome online: magpalindrome.ca

Former Project Lead: Frédérique Dubé

Contact for this project : Pascale Lehoux

The aim of this project was to take stock of the empirical studies that examined the motivations and processes that led to the development of responsible innovations (RIs) that have implications for health and social care.

An article that provides a synthesis of 17 qualitative studies and develops a model of the goals and processes of responsible innovations was published in the journal Innovations-Revue d’économie et de management.

Responsible Innovation (RI) goals and processes model

According to this model, the context of emergence stimulates the development of RI oriented towards a common good, whether it involves broad collective interests (e.g., wastewater treatment) or those of marginalized groups (e.g., making a building accessible to people with disabilities).

Actors include the leaders of the RI project, i.e., the individuals and organizations that design and develop it, and their partners, who may change according to the stage of innovation development (investors, representatives of municipal, regional or national public authorities, suppliers, potential users, community organizations, etc.).

Actors pursue goals that are not all related to a common good and may include particular interests (establishing one’s own network of contacts, developing a market, increasing a city’s influence, etc.). Anchoring refers to the actions through which leaders and partners manage (or not) to increase the relevance of RI along its development, experimentation and appropriation, and this is achieved by reconciling the goals pursued.

Resource work is characterized by both ideological and material flexibility. This process combines three activities that enable the production of RI by promoting learning, collaborative work within networks and the emergence of a protective “niche.” It is indeed important to create a material and socio-cultural space that allows a RI to develop and establish its place on the market despite —or thanks to— its non-standard character. To the opposite, letting established market forces play out without working on the conditions of the construction and reception of a given RI reduces its possibilities of emergence.

Ultimately, RIs can succeed in occupying a market of their own by remaining a unique case, by being reproduced (for example, a bike-sharing system is set up in another city) or by being more widely and institutionally diffused (a mass-produced electric car captures a market segment). In this way, RI contributes to modifying its context of appropriation, making it more conducive to the deployment of activities that consolidate its anchoring.

Former Project Lead: Geneviève Daudelin

Contact for the project: Pascale Lehoux

This illustrated booklet produced by In Fieri is intended for innovation ecosystem actors in Quebec and elsewhere in the world. It explains the nine attributes of responsibility that can guide the development of an innovation in health or be used to evaluate the level of responsibility of existing solutions. Eloquent examples and counter-examples are also presented. Download it!

Em defesa da inovação responsável em saúde. Um livreto ilustrado para os atores do ecossistema de inovação no Quebec e em outras partes do mundo está disponível em português.

The aim of this project was to take stock of the scientific literature that examined the needs and challenges of health systems across the world and that can inform the design of RIH.

While health services research is increasingly concerned about the way health systems can adopt innovations, little is known about the system-level challenges that innovations should address in the first place. This project thus explored the “demand” for RIH by: 1) reviewing the available body of scientific knowledge on the challenges health systems across the world face; and 2) analyzing the ways in which the principles of RIH help to address these challenges and support more sustainable technological development in health systems.

To gather a multidisciplinary scientific literature, we performed a structured search on 8 bibliographic databases covering health services and policy research, public health, management, public administration and political science. We screened all scientific papers published between January 2000 and April 2016 and included 292 articles in our scoping review.

The challenges reported in the articles were classified using the dynamic framework of van Olmen and colleagues (2012), which connects the key components that influence how a health system successfully reaches its goals.

HS_Analysis_modelFigure 1 – Analytical model for health system analysis

Figure adapted from: van Olmen et al. (2012). The health system dynamics framework: The introduction of an analytical model for health system analysis and its application to two case-studies. Health Culture and Society, 2(1):1-21.

 

The countries where these studies were conducted were classified using the Human Development Index (HDI), which combines indicators that are relevant to population health: life expectancy at birth, mean years of schooling and expected years of schooling, and gross national income per capita.

A 1st article identified the kind of research that has been conducted on health system challenges, where it was performed, in which health sectors and on which populations. This article provides a quantitative description of the categories of challenge that have been researched, illustrate the key challenges reported by researchers and examines how these challenges vary across countries whose HDI is very high, high, medium or low.

A 2nd article that focuses more specifically on the challenges that Responsible Innovation in Health (RIH) should seek to address was subsequently published.

Former project lead : Federico Roncarolo

Project contact : Pascale Lehoux

Over the past decade, digital health solutions and those relying on artificial intelligence (hereafter called “D/AI solutions”) have exponentially grown and expanded research and health care practices in ways that were previously unthinkable. As health care providers and health systems worldwide will be on the frontline tackling the health effects of climate change and growing social and economic disparities, our team aimed to develop a rigorous tool that can measure the degree of responsibility of D/AI solutions by adapting the multidimensional and already validated Responsible Innovation in Health (RIH) Tool.

To do so, we conducted a three-phase mixed method study:

  1. In Phase 1, we performed a scoping review of practice-oriented tools (n=57) developed since 2015 to support the development and use of responsible and ethical D/AI solutions. We extracted from these tools up to 40 principles that were mapped against the RIH Tool to identify issues that are specific to D/AI solutions and were not covered in the RIH Tool. This mapping process led to a preliminary version of the ‘Responsible D/AI Solutions Assessment Tool.’
  2. In Phase 2, an international two-round e-Delphi expert panel rated on a five-level scale the importance, clarity, and appropriateness of the new Tool’s components (i.e., its premises, screening criteria, and assessment attributes).
  3. In Phase 3, two raters independently applied the revised Tool to a sample of D/AI solutions (n=25), interrater reliability was measured, and final minor changes were brought to the Tool.

The results of the scoping review were published (see below) and confirmed the need for a comprehensive, valid, and reliable tool to assess the degree of responsibility of D/AI health solutions. Because regulation remains limited in this rapidly evolving field, we believe that the new tool we developed has the potential to change practice towards more equitable as well as economically and environmentally sustainable digital health care.

Publications of interest to this project:

Project Team Members: Lysanne Rivard

Robson Rocha de Oliveira

Hassane Alami

Pascale Lehoux

Renata Pozelli is currently pursuing her doctoral research project on the responsible production and consumption of food.

Our food is produced, processed and distributed within “food systems.” Currently, the way such systems are organized in most countries is characterized by the presence of “dominant” organizations and practices, developed during the Industrial Revolution, in a context of demographic and economic growth. However, previous studies have already shown the negative effects of these dominant practices on human health and on the environment. To change this situation, a transition to better practices in food systems is currently taking place. Initiatives that incorporate attributes of responsibility are emerging all around the world. They include, for example, rooftop agriculture and organic basket networks, among others. However, the current state of knowledge is limited since little is known about how these innovations are emerging and how a transition to more responsible food systems can be achieved.

To fill this gap, this doctoral thesis aims to better understand food system transitions in the context of an established and an emerging economy: the province of Quebec and the state of São Paulo. These regions face different food security challenges, but both show a high dependency upon the dominant food system and an increased interest in innovative systems. A multiple case study design is applied and combines interviews with organizations in both regions with secondary data analysis. The results of this thesis, which is comprised of four articles, contribute to the consolidation of organizations and food practices that contribute to health and, therefore, responsible food systems.

 

Project Lead : Renata Pozelli

The goal of this research project was to develop and validate a tool to assess the degree of responsibility of health innovations, what we call the In Fieri RIH Assessment Tool.

The Tool is based on the RIH framework, which makes explicit the value domains and attributes to be considered throughout the life cycle of an innovation and in light of the context in which the users of the innovation are located. The project was based on two methodological components.

First, international experts participated in a two-round Delphi prioritization exercise that took place on a secure web-based platform. Four categories of experts participated in the study: 1) scholars in the field of Responsible Research and Innovation; 2) engineers working in the health sector; 3) bioethicists; and 4) health technology assessment professionals. These experts used closed-ended questions to assess the level of importance of the attributes of a draft version of the tool, the clarity of its definitions, and the appropriateness of its scales. Free-text fields were used to comment and suggest additional relevant attributes. In Round 2, the experts received the results of the previous round, a redesigned version of the tool, and again commented on the level of importance and clarity of the attributes. Expert participation was anonymous. The tool was enriched and consolidated in each round with the feedback received. The results of the study have been published in this article.

The second component of the project aimed to assess the reliability of the tool by applying it to 25 different innovations and measuring the degree of inter-rater agreement. The study consisted of the following steps: (1) information sources were collected and validated for clarity and relevance; (2) the ratings of the two evaluators were independently entered into a database; (3) descriptive and analytical statistics to establish the degree of agreement for each of the attributes were generated; and (4) discrepancies in the ratings were discussed to identify possible sources of confusion. The results of this study can be found in this article, which makes the final version of the Tool available.

A user guide has been developed to support the application of the tool. Please do not hesitate to write to us if you have any questions about the Tool or would like to share your appreciation.

User Guide

Guia do usuário da Ferramenta de avaliação da Inovação Responsável em Saúde (IRS) também está disponível em português.

Project Lead: Hudson Silva

This project aims to identify how alternative business models and hybrid entrepreneurship can support the design, development and commercialization of RIH.

This project consists of a longitudinal case study of high-impact enterprises developing RIH in Quebec, Ontario and the state of Sao Paulo in Brazil. Sixteen small- and medium-sized enterprises with responsibility features described in the RIH framework were recruited in 2017 and 2018 and have been monitored over a period of 4 years. Diversification criteria included organizational structures and types of innovation developed. An overview of the cohort of enterprises participating in this project can be seen in the following infographics.

This project is based on in-depth interviews with members of the organization’s management team or employees directly involved in the design or development of the innovation. Additional data is collected through a secure web-based platform that allows: 1) to upload public documents related to the organization (financial reports, business plan, etc.) and 2) to complete the organization’s “digital diary” twice a year.

Articles have been published and others are currently under review or in preparation:

Project Lead: Hudson Silva