Role of values and expertise in innovation
Needs and challenges of health systems
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.
Figure 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
Review of Policy Research
This article examines the rules that characterize economic policy, capital investment, and regulatory approval as well as the way these institutions enable and constrain the development of ventures at an early stage.
Lehoux, P., Daudelin, G., Denis, J.-L., Miller F.A. (2017). A Concurrent Analysis of Three Institutions that Transform Health Technology-Based Ventures: Economic Policy, Capital Investment, and Market Approval, Review of Policy Research.
Critical Public Health
This paper examines how members of the public define the legitimacy of cognitive and behavioural enhancement.
Lehoux, P., Williams-Jones, B., Grimard, D., Proulx, S. (2017). Technologies of the self in public health: insights from public deliberations on cognitive and behavioural enhancement, Critical Public Health.
Éthique, Médecine et Politique Publique
This study uses structuring theory to explore how members of the public anticipate the potential and limitations of prevention in the context of predictive medicine and to clarify the underlying reasoning processes.
Lehoux, P., Cheriet, I., Grimard, D. (2017). Que pense le public de la prévention dans le contexte de la médecine prédictive? Éthique, Médecine et Politique Publique.
Technological Forcasting and Social Change
Building on insights from sociology of expectations and institutions, this paper elicits how specific institutional requirements provide potency to the expectations that pave the health technology development pathway.
Lehoux, P., Miller, F.A., Daudelin, G. (2016). Converting clinical risks into economic value: The role of expectations and institutions in health technology development, Technological Forcasting and Social Change.
PLoS ONE
This study explored interactions with device industry representatives among physicians who use implantable cardiovascular and orthopedic devices to identify whether conflict of interest (COI) is a concern and how it is managed.
Gagliardi, A., Lehoux, P., Ducey, A., Easty, A., Ross, S., Bell, C., Trbovich, P., Urbach, D. (2017). We can’t get along without each other: Qualitative interviews with physicians about device industry representatives, conflict of interest and patient safety, PLoS ONE.
International Journal for Quality in Health Care
This study identified that patients are not engaged in discussions or decisions about implantable medical devices.
Gagliardi, A. R., Lehoux, P., Ducey, A., Easty, A., Ross, S., Bell, C. M., & Urbach, D. R. (2017). Factors constraining patient engagement in implantable medical device discussions and decisions: Interviews with physicians, International Journal for Quality in Health Care.
Patient Involvement in Health Technology Assessment
This chapter provides readers with clear guidance on the ways in which particular qualitative methods can help HTA practitioners to elicit patients’ perspectives, experiences and preferences.
Lehoux, P., Jimenez-Pernett, J., (2017). Making sense of patients’ perspectives, experiences and preferences in HTA (pp.215-224). In Facey, K., Hensen, H.P., Single, A.N.V. (Eds). Patient Involvement in Health Technology Assessment (HTA). Singapore: Springer.