Post-Doctoral Research Fellow, University of Cape Town
Assessing stakeholder engagement in health innovation
Increasing pressure to improve health outcomes of populations with limited resources has prompted an emphasis on innovation. The innovation process has been proposed as a systematic approach to innovation in health, owing to its human-centred methodology that prioritises deep empathy for the end-users’ desires, needs and challenges, and results in a better understanding of the problem in order to develop more comprehensive and effective solutions. A key feature of the innovation process is stakeholder engagement. However, if stakeholders view their engagement as merely instrumental, innovation can be stifled and the relationship between the researcher and stakeholders may break down. Evaluating stakeholder engagement during the innovation process provides a basis from which to improve interaction with and between stakeholders. Drawing from participatory research in health, where stakeholder engagement is recognised as a core principle that facilitates the implementation of solutions, we can integrate stakeholder evaluation tools into the innovation process. We draw on typologies that describe levels of stakeholder engagement and their involvement in making decisions about their health, and propose a modified assessment framework to evaluate stakeholder engagement during the innovation process. The modified framework provides a simple and practical tool to evaluate stakeholder engagement, and can be used at different times and by different assessors. Evaluation of engagement in a health innovation project may be used to improve engagement, and therefore the uptake and sustainability of innovations. The framework may be used in innovation processes beyond health applications.
Abstract: •Socially responsible innovation represents a philosophical turn in medical innovation.•This innovation actualized by teams provides multiple opportunities for improvement.•This study compared three cases to illuminate thematic links in a content analysis.•Cycles of actualization includes naming problems, making changes, and reflecting.•With green medicine the patient's fiscal and physical health, and home environment are examined.
Pub.: 01 Nov '17, Pinned: 22 Nov '17
Abstract: This review of systems thinking (ST) case studies seeks to compile and analyse cases from ST literature and provide practitioners with a reference for ST in health practice. Particular attention was given to (1) reviewing the frequency and use of key ST terms, methods, and tools in the context of health, and (2) extracting and analysing longitudinal themes across cases.A systematic search of databases was conducted, and a total of 36 case studies were identified. A combination of integrative and inductive qualitative approaches to analysis was used.Most cases identified took place in high-income countries and applied ST retrospectively. The most commonly used ST terms were agent/stakeholder/actor (n = 29), interdependent/interconnected (n = 28), emergence (n = 26), and adaptability/adaptation (n = 26). Common ST methods and tools were largely underutilized. Social network analysis was the most commonly used method (n = 4), and innovation or change management history was the most frequently used tool (n = 11). Four overarching themes were identified; the importance of the interdependent and interconnected nature of a health system, characteristics of leaders in a complex adaptive system, the benefits of using ST, and barriers to implementing ST.This review revealed that while much has been written about the potential benefits of applying ST to health, it has yet to completely transition from theory to practice. There is however evidence of the practical use of an ST lens as well as specific methods and tools. With clear examples of ST applications, the global health community will be better equipped to understand and address key health challenges.
Pub.: 20 Nov '17, Pinned: 22 Nov '17
Abstract: Integrated care has been well-recognized as a solution to improve quality of care for patients with complex needs. As Singapore increasingly develops and promotes integrated models of care, it is unclear if providers, patients, and caregivers share similar understanding of changes in the healthcare system.This study aims at exploring three dimensions of care integration: a) understanding of integration; b) challenges and c) changes perceived as essential among three distinct stakeholder groups: providers, patients and caregivers.This qualitative study was conducted among 41 care providers (clinicians and administrators) and care consumers (patients and caregivers) in Singapore utilizing 29 semi-structured interviews and 2 focus group discussions. Study participants were selected by purposive, snowball sampling from various clinical settings. Data were transcribed, familiarized, coded and analyzed using a conceptual framework.Understanding of care integration was generally lacking among patient and caregivers. Most of them focused on healthcare costs and accessibility of services. Providers characterized care integration in clinical process terms and had a more systems view of the concept. Most participants viewed resource constraints as a key challenge in integrating care. Additionally, providers expressed the need for patients and their families to play a greater role in managing their health. Individuals and the community are key components of an integrated care system in the future. Reliance on the healthcare system alone is not sustainable.Patients, caregivers and providers have varying degrees of understanding towards care integration. The success of engaging stakeholders on the ground to be active participants in the healthcare system integration process requires policymakers and healthcare leaders to increase patient engagement efforts and to better appreciate the challenges faced by the healthcare workers in the rapidly changing national and global healthcare landscape.
Pub.: 28 Oct '17, Pinned: 31 Oct '17
Abstract: The IDEAL framework is an established method for initial and ongoing evaluations of innovation and practice for complex health care interventions. First derived for surgical sciences and embedded at a global level for evaluating surgery/surgical devices, the IDEAL framework is based on the principle that innovation and evaluation in clinical practice can, and should, evolve together in an ordered manner: from conception to development and then to validation by appropriate clinical studies and, finally, longer-term follow-up. This framework is highly suited to other complex, nonpharmacological interventions, such as physical therapy. This perspective outlines the application of IDEAL to physical therapy in the new IDEAL-Physio framework. The IDEAL-Physio framework comprises 5 stages. In stage 1, the idea phase, formal data collection should begin. Stage 2a is the phase for iterative improvement and adjustment with thorough data recording. Stage 2b involves the onset of formal evaluation using systematically collected group or cohort data. Stage 3 is the phase for formal comparative assessment of treatment, usually involving randomized studies. Stage 4 involves long-term follow-up. The IDEAL-Physio framework is recommended as a method for guiding and evaluating both innovation and practice in physical therapy, with the overall goal of providing better evidence-based care.
Pub.: 28 Oct '17, Pinned: 31 Oct '17
Abstract: Government policies to promote ageing in place have led to a growing frail population living at home in advanced old age, many of whom live alone. Living alone in old age is associated with adverse health outcomes, but we know little about whether it moderates the health impact of other risk and protective factors. Engagement in leisure activities is considered critical to successful ageing. We investigated whether the association between different types of leisure activities and survival in non-institutionalised older adults (aged 76 and above) differs by living arrangement and gender.We used the Swedish Panel Study of Living Conditions of the Oldest Old study from 2011 and the Swedish Cause of Death Register (until 30 June 2014) to conduct Cox regression analyses (n=669). Incident mortality was 30.2% during the follow-up period.Overall level of leisure activity was not significantly associated with survival in either living arrangement, but some specific leisure activities, and associations, were different across gender and living arrangement. More specifically, certain social activities (participation in organisations and having relatives visit) were associated with longer survival, but only in men living alone. In women, most results were statistically non-significant, with the exception of solving crosswords being associated with longer survival in women living with someone.In order to facilitate engagement with life, interventions focusing on leisure activities in the oldest age groups should take gender and living arrangement into consideration when determining the type of activity most needed.
Pub.: 29 Oct '17, Pinned: 31 Oct '17