Abstract
Success or failure of implementation of innovation in healthcare depends on many factors which determine the efficiency of government healthcare policy. When it comes to large and nation-scale projects of reform and renovation, the government and its policies have a direct influence on whether or not these reforms will work or not while on a micro-scale factors such as a compatibility, observability, complexity, and relative advantage for particular innovations determine their success. A comprehensive approach is required to make an innovation last. In the paper at hand, the Three Box Solution is used to review the existing innovations based on their effectiveness at the present moment and their sustainability in the future.
The innovations around various issues in healthcare as outlined in the robotic surgery reveal that government policy plays a pivotal role in the process. A review of the London HASU units indicates that government policy is critical in establishing funding and also providing the expertise required for monitoring and evaluating innovations in healthcare. The review of the American Health Reforms and the Brazilian Government handling of the HIV pandemic reveals that government commitment as established through its policy initiatives can lead to the success or failure of healthcare innovations.
Healthcare Innovation and Government Policy
Modern medicine is a scientific field that is considered to be driven by innovation.
Healthcare personnel are well versed with the rigours of research and as a result, they have created a pool of ideas that can be applied to drive the innovation agenda in health to greater heights. However, even with the increasingly growing number of resources that could facilitate the initiation of both small-scale and large-scale healthcare innovations, there is still a delay in the implementation of strategies to drive innovation. Bureaucratic processes and elaborate need for verification procedures to ensure the safety of the innovations stand out as the main hindrances to the process of innovation in healthcare. Lack of adequate financing is another obstacle that the researchers typically have to overcome concerning healthcare innovations, a situation that is dependent on government policies.
At the centre of these two main challenges are government operations driven by the policies that it rolls out concerning healthcare innovation. One of the fundamental roles that policies play is to create a path for the distribution of funds and allocation of budget money towards its numerous branches, including healthcare. Even when the government does not have direct control over healthcare organizations and facilities, it still has the power to introduce laws and policies that have the potential to either inhibit or promote innovation. As a result, government action or inaction based on its policy decisions can either promote innovation in healthcare or stifle any progress in this area. The goal of this paper is to analyze the extent to which different innovations in healthcare can be nurtured through government policy.
Healthcare Innovations
Innovations in healthcare constitute changes in ideas, products, processes and procedures that are introduced to benefit the patients, society at large as well as the staff in the industry. As a result, healthcare innovations can be broadly classified as new services, new technology and new ways of working. Healthcare innovations lead to the provision of quality services that leads to better health and reduced suffering from the patient’s perspective. From an organizational perspective, the benefits obtained include enhancing operational efficiency and improved quality of healthcare delivery.
Once an innovation in healthcare has been identified, several factors determine its implementation and adoption within the associated organizations. Almost every innovation offers some kind of improvement or an advantage over the existing practices, be it in reductions in costs or increase of effectiveness. The complexity of innovation has a large impact regarding its adoption and implementation within healthcare organizations. Given that difficulty could arise from staff inexperience with the new technology or limitations that said innovations impose, most healthcare personnel are keen on ensuring that innovations are not complex before implementing them in their organizations. The compatibility of healthcare innovations based on the alteration of the existing patterns is easier to adopt. Innovations that have visible results based on their level of the existing medium of observation are more likely to impress both the healthcare practitioners and their patients. The best approach of reviewing is through the use of the Three Box Solution with each box defining a specific criterion as outlined in the table below:
Table 1: Three Box Solution.
The Government and Healthcare Innovation
In most countries, governments are large, hierarchical, democratic organizations. Governments are comprised of different positions of varying importance and occupied by individuals with different backgrounds, education, and social and political views. While every official within the government structure is allowed a certain degree of independence, all the important decisions involving all improvement and innovation are taken collectively. There is always a board of professionals that has to assess any potential innovation, its feasibility, its evidence, its costs, and ethical aspects. For example, any widespread initiative regarding abortions is going to be met with resistance from either pro-life or pro-choice groups within a particular commission.
Government serves as an instrument of public control over medicine and healthcare. This is especially true in countries where healthcare is fully funded by taxpayers. The extra layer of responsibility puts an additional inhibition on any potential innovation, as they need to pass scrutiny in order even to have a chance of being considered. The government boards have to sort out between numerous researches and innovation proposals. Evidence-based medicine practices promote individual research. The government cannot support them all at once, which creates a queue. How quickly innovation is implemented depends on many factors, ranging from the importance of the study to its findings, its practicality, and the authority of the researchers involved.
Another pivotal role that the government plays regarding healthcare innovations is to regulate the funding of different research activities. The primary challenge under this role is based on the fact that the government does not have the funds to support all healthcare research. As a result, to acquire support the limited funds that are available the researchers must show clear benefits in research as well as a high probability of success. Government interests based on their political manifesto also has a bearing regarding how the innovations are facilitated. For example, when a government is supportive of the innovation in question, it is capable of removing obstacles in the path of progress and ensuring that it is implemented statewide. Based on this realization, it can be concluded that the government’s role in implementing and promoting innovation in healthcare is twofold. It can create obstacles with the bureaucracy but at the same time can significantly widen the scopes and hasten the implementation of innovation and reforms.
Innovations in Robotic Surgery
Use of robotics in surgery has been theorized since the early 1980s. However, despite advances in computer technology, telemonitoring, telepresence, and robotics, robotic surgery still employs 19th-century techniques. Based on the criterion that is outlined in the first box, the technology is not efficient and the techniques involved are relatively complex. As evidenced in the literature, a successful robotic surgery requires experienced surgeons to be able to operate using internal cameras and telemonitoring. The efficiency of the technology also lacks given that it has been shown to lack relative advantage based on the increased costs associated with its implementation.
The technology also fails to meet the second evaluation criterion which indicates that a healthcare innovation should seek to facilitate the drop of older practices and facilitate the adoption of new processes. The literature on robotic surgery demonstrates that the majority of the surgeons have no experience with the new technology and would require ample instructions and re-education. The documentations in literature based on the practices surrounding the use of robotic surgery innovation indicate the uses technology that was developed in the 19th century despite the advances that have been achieved following the growth of the computers related innovations.
Government involvement in the case of advancing the adoption of robotic surgery as a helpful innovation in healthcare could be influential in the realization of the desired outcomes. Policy approaches can create room for the allocation of the funds to facilitate healthcare personnel to meet the educational needs required to enable them to use the technology that is required for robotic surgery to be successful. The literature on the determinants of innovation within healthcare organization indicates that the extent to which the involved technology agrees with the existing legislation and rules is fundamental in achieving the full implementation. Based on this construct, the government has a pivotal role to play in the process of developing robotic surgery as a standard innovation in the healthcare industry. For example, the literature indicates that in most places across the globe, robotic surgery has only been approved for limited surgical processes hence stifling the need to continually innovate in this area. The lack of insurance coverage in most jurisdictions is also an indication of the socio-political goodwill to facilitate the development of the innovation around robotic surgery used as a major approach in the delivery of quality care.
London’s HASU (Hyper Acute Stroke Units)
The developments of the innovations around London’s HASU Units were as a response to the increasing number of mortalities from a stroke. The literature indicates that the implementation of methods of treatment is largely regulated making it increasingly slow but the innovations and transformations within the parameters of the existing systems are much quicker to be adopted by the respective healthcare institutions. A background check on the local hospitals in London revealed that they were often unequipped to properly deal with stroke patients, forcing them to be transferred to hospitals located in London’s centre, which took time and diminished the chances of survival. The reform, proposed by Professor Ara Darzi, suggested the creation of eight HASU centres around the city, where stroke patients were to be delivered.
Based on the first criterion, the innovation proved to be efficient given that the medical personnel that specialize in strokes will not have to significantly alter their procedures as the strategies involved required the redesigning of the existing processes. The techniques involved in the implementation of the innovation were efficient requiring minimal use of resources. Based on the second criterion, the proposed innovation had no major flaws as it sort to establish a method to deal with the current practices such as transporting patients to the major centres in London.
By doing so, the innovation was responding to the existing need which could create value for the patients as they would be in a position to access care in their local areas hence reducing the costs involved in the process. The results from the centres met the criteria of observability given that in three months after the implementation of HASU units, death rates from stroke fell by 25% compared to the previous levels. The innovation also had a relative advantage as the reformed HASU units offered quality stroke care for lower prices. The establishment of the HASU units was futuristic in its implementation as it required that the establishment of new centres would remain for a longer period to serve the clients.
The government role in ensuring the innovation of the HASU units was evident. First, the proposal was based on a body that had been established to oversee the review of health service provision in London. Policy role of the government, in this case, was evident given that it facilitated the process of conducting the review. Government’s financial support has been enlisted as one of the main factors that can facilitate the establishment of innovations in healthcare. For example, in the case of HASU innovation, the government allocated approximately $30 million in funding which was critical in the development of the enhanced payment tariffs to meet the costs of providing the required level of service quality.
Other than providing the facilitation in the initiation of a healthcare project, the government can also influence the success of this innovation through the provision of resources to monitor the impact of the established healthcare innovations as seen in the case of the HASU units. Government involvement in the HASU project was also evident in the reconfiguration of the National Health System operations to accommodate the new model of healthcare delivery hence ensuring the success of the initiative.
American Healthcare Reform
The reform of the American healthcare system launched under President Obama in 2010 was perhaps one of the most controversial healthcare innovations in the recent past. The innovation failed not only due to certain flaws in its implementation and design but also due to the government’s influence in defining the processes involved. First, the government failed to take a monolithic position during the American Healthcare Reform as it should have done to ensure that success of the process. The Affordable Healthcare Act, also known as Obamacare, was largely supported by the Democratic Party and opposed by the Republicans.
An evaluation of the initiative based on the 3 box model reveals that there was some ineptness on the part of the government in the implantation of the innovation. However, based on the principles outlined in the first box, the reform of healthcare suggested many improvements be implemented in public healthcare, to improve methods of distribution and accessibility, lowering the number of people without health insurance, improving the quality of service and health outcomes, and upgrading the financial, technological, and clinical base of the system. As such the innovation around the delivery of care as proposed by Obamacare was relatively strategic and would result in increased efficiencies.
With no side having a definite advantage in the Congress or Senate, the government was split in half in regards to whether they should go through with the reforms or not. In Florida, Texas, Alabama, Arizona, Oklahoma, and Missouri refused to implement certain proposals of the healthcare act. Non-cooperation movements became widespread and completely halted the implementation of the system. Based on the evaluation of the criteria outlined in the second box, Obamacare represents a situation where the government policy does not promote innovation but hinders it instead. For example, the Affordable Care Act introduces hefty taxes on innovations that would lead to the development of new drugs essentially making branded drugs a mirage for most patients.
Despite the seeming unpopular components of the Obamacare, the involvement of the government in the process of its development and implementation is testimony towards the role that a government can play to facilitate the healthcare innovations whether they are deemed as good or bad. For example, based on the government conviction that the innovation would be beneficial, there was increased lobbying to ensure that it was well established. As outlined in the literature, when a government seeks to support a particular innovation, it allocates a considerable amount of funds which as evidenced in the case of Obamacare the amount was spent in political lobbying and also carrying out extensive research to determine the approaches that were to be included in the Act.
Brazilian Response to the HIV Epidemic
Following the reporting of the first case of HIV in Brazil back in 1982, the country was struck by a wave of the HIV epidemic. Therefore an urgent response and innovative social and healthcare strategy were required to prevent the epidemic from spreading on a nation-wide scale. The newly formed government following a period of military dictatorship was keen on ensuring that it resolved the emerging crisis as soon as they were detected. The model adopted by the government to stop the spread of infection and keep it within manageable parameters was highly innovative and implemented numerous innovative policies in healthcare and the social spheres to promote awareness about the new disease and encourage the use of protection.
How the government dealt with the HIV pandemic in Brazil is an outright representation of an innovation that satisfies the criteria innovation evaluation criterion. The innovation fulfils the first box criterion given that it sort to introduce universal anti-retrovirus drugs, which significantly helped reduce the total amount of potential HIV-infected, up to 20% by some popular estimates. Based on the second criterion, the innovation was critical in that it allowed the introduction of new approaches to the practice of managing HIV pandemic. For example, the strategies sort to launch an aggressive information campaign against HIV while at the same time seeking the promotion of the use of condoms and other measures that increased safe sex. The innovation met the principles in the third box of looking into the future to ensure that it was sustainable. The Brazilian government focused its efforts on the vulnerable population groups, such as the poor and the homeless. These people were most likely to suffer from HIV due to lack of knowledge. The government-subsidized producers of contraceptives and managed to drop the prices for condoms by about half the original price.
The manner, in which the movement was engaged in managing the scourge resulting from the HIV pandemic in Brazil, is a good example of how government involvement can facilitate the innovations in healthcare. First, the Brazilian government launched fundraising approaches that were effective to support the process. The Brazilian government raised funds domestically and took out loans from the World Bank. Given that the project had received the support of the government, there was increased policy support to ensure that the approach in solving the pandemic was carried out in a multiagency manner. The existing literature indicates that the use of multiagency in solving healthcare issues is largely dependent on the existing laws as they are a critical component in enhancing healthcare cooperation. The Brazilian government managed to involve its existing NGOs such as the International Red Cross Organization and other local bodies to assist them in fighting the epidemic.
Conclusion
Government through its policies is critical in the facilitation of healthcare innovations. As evidenced in the literature, the government plays a critical role in either stifling the adoption of innovations in healthcare or facilitating their adoption. A review of the case of the issue surrounding robotic surgery reveals that the lack of clear regulations on how the processes should be integrated into the current healthcare models has led to the slow growth of the innovations required. The case of the London based HASU units has demonstrated that government support healthcare innovations through the creation of bodies that can develop new projects and also create new avenues for funding. Base on the review of Obamacare the literature demonstrates that when a government is convinced that a particular innovation would be beneficial, it is likely to institute measures to establish the required political lobbying. The Brazilian government response to the HIV pandemic in the country was an indication of the role of government initiatives through policy to ensure that an environment for multi-agency cooperation is established to finance and operationalize healthcare innovations.
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