Health in 2022: What we mean when we talk about innovation

Scientific breakthroughs and new technologies have been pivotal to the story of modern medicine. Take innovations such as the first antibiotics, advances in medical imaging and organ transplantation - each brought the bleeding edge of science and technology into clinical practice, delivering greatly improved health outcomes. 

Turning to 2022, discussions about innovation tend to centre on the promise of digital technology applied to healthcare and the life sciences, as well as other cutting-edge advances in biotech. So great is the focus on how digital technology will shape the future of healthcare, concepts from software engineering and silicon valley lore have permeated our thinking and our narratives about innovation for health.

For those working in healthcare, whether in clinical practice, academia or industry, it may be helpful to pause and reflect on the way that we talk about innovation. Our narratives are powerful because they shape our attitudes, define the scope of what is considered an innovation in this space and turn our focus towards certain types of innovations over others. In short, the way that we discuss innovation matters. 

This article takes a critical look at which innovations capture our attention and why, narratives around scaling in healthcare and what makes an innovation valuable. Assuming that the main goal of innovation is improving health outcomes for individuals and populations, this article goes on to ask whether our dominant narratives around innovation are serving us in pursuit of these goals.

Excitement, Skepticism and Digital Health

Many people have been waiting patiently for the era when digital technology will transform healthcare. However, anyone familiar with this space will know that there have been many false starts. The introduction of AI/ML in healthcare has to-date garnered as much hype as it has proof points and the best-intentioned government initiatives to digitise healthcare have yet to deliver on their promise. 

Despite this, there are many reasons to buy into the narrative that ‘this time is different’ for digital health. A mature, powerful set of digital tools now offer new opportunities to innovate and deliver a meaningful impact on human health. Medicine and biology seem well-positioned to finally be able to ride the wave of Moore’s law that has enabled previously unfeasibly expensive computation to become cheap and abundant, with interesting applications across healthcare. There is also the hope that digital technology can reverse Eroom's law to usher in an age of faster, smarter drug discovery and novel treatments.

At times, it can be easy to get caught up in the excitement about new advances in digital technology, because of course the opportunity to do something new and improve upon the status quo is an exciting challenge. At the same time, excitement can also garner skepticism. Some will roll their eyes at another announcement of the latest government-backed healthtech initiative or venture capital (VC) funding, knowing that many of these ideas and innovations will be unable to deliver on their promise or worse, may simply be shiny new solutions still looking for problems to solve. 

Innovation that talks loudest

It’s worth considering why technological innovation for health often grabs headlines and captures our attention. On one level, it may be as simple as who has the best PR. In regards to where the most noise and excitement is generated, VC plays a critical role in funding early-stage companies to bring new ideas, products and services to the healthcare ecosystem. This model looks for rapid growth, high risk and high returns, favouring innovations with the potential for the greatest possible growth and impact. 

With this funding comes sophisticated branding, marketing and an excited media looking to champion what's coming next. This may partly be a case of ‘money talks loudest’. On top of this, this excitement also taps into the romantic narrative of bold entrepreneurs with great ideas disrupting entire industries, a familiar and compelling story. With many examples from other industries where VC-backed innovations really have changed the world, why not healthcare next? These factors might contribute to why certain companies or technologies can dominate headlines and our conversations about innovation in health.

The value of innovations & market forces

Market forces can also shape how we think and talk about innovation for health. Our narratives are also partly a reflection of the way the market attributes economic value to a given innovation. Casting a critical eye on narratives of ‘value’, UCL’s Mariana Mazzucato argues that commonly used frameworks such as cost-benefit models may be too narrow and a flawed tool for understanding and measuring the broader impact (both positive and negative) of innovation for health.

The same factors that shape our narratives around innovation of course influence the dynamics of innovation itself. While financial incentives have always been strong drivers of innovation in healthcare and beyond, Mazzucato highlights the many occasions where optimal patient and public health outcomes are unfortunately misaligned from the market forces that often shape innovation. Financing for innovation often looks towards relatively shorter-term outcomes demanded by venture and equity markets. This impacts the flow of resources towards certain types of innovation that fit these timelines and potentially away from the longer term, big-vision, missions of innovation (goals that we would likely agree are essential for our future health).

The role of profit in healthcare innovation is a vast topic and beyond the scope of this article, but perhaps what is fair to say is that innovations promising great financial ROI may take greater prominence in our narratives than those that the market does not value (or attributes less value to). 

Start-ups, the system and ‘sustainable disruption’

For start-ups and scale-ups, product-market fit is critical. Healthcare is incredibly complex, which makes it difficult and relatively rare for a single product to be able to solve challenges that may be best understood at the system level. Digital start-ups can struggle in healthcare as they try to develop point-solutions for specific problems, when what health systems and payers/governments typically need are end-to-end, A-to-Z solutions that work within existing structures and address the needs of the vast number of interconnected stakeholders and interlocking pieces in the healthcare value chain.

What about "disruptive innovation"? Of course, few people would argue that “move fast and break things'' is not the right paradigm for health when patient care is involved. Truly disruptive innovations by definition compete with and create tensions with existing technologies and organizational cultures, reshaping older systems and ways of doing things. This means inherent tension between any specific new innovation and the broader health system. The benefits from any given innovation must be balanced against potential harms or externalities of the disruption and that the overall sustainability of the healthcare system must always be considered.

In healthcare, the stickiness of legacy systems, the resistance to change and the highly complex, entrenched status quo could therefore be considered more of a feature, not a bug. Healthcare’s resistance to change helps keep the system in check, putting brakes on any single area being too disrupted in order for the system to adapt and incorporate this change sustainably. Innovators in health must therefore consider the wider whole and the impact of that innovation within existing systems and structures - aligning the needs of so many stakeholders is no small task (particularly when the end-user is often not the customers). This reality flies in the face of those who claim they are going to ‘disrupt ABC in order to 10x Healthcare’, or bring an ‘AI revolution for disease XYZ’’. 

Healthcare and scaling 

There is also the problem of scale. Another reason that advances in technology spring to mind first is that they offer the promise of impact at scale. The idea of "scale" is often wrapped up in how we conceive of what makes innovations successful. 

Crudely speaking, medicines scale (provided they can be manufactured, distributed and accessed at the required volume). One of software's most powerful features is that it scales - that’s sort of the whole point (although how successfully certain types of ML models can scale across different contexts and populations within healthcare is yet to be determined). 

It is understandable that we tend to think first of those innovations with the greatest reach, those that can touch as many people as possible. By comparison, innovations to models of care or process innovations for clinical pathways (more on this below) can struggle to scale, largely due to the complexity of healthcare systems and geographical variability in care delivery. This means that an innovation that works well and delivers improved outcomes in one region, hospital or department is by no means guaranteed to deliver the same benefits outside of this setting. Great ideas and new approaches in healthcare delivery often don’t break out of silos, despite the potential for the academic literature to share best practice.

Innovations from one academic discipline also tend to struggle crossing over from one field to another, even if innovation in area A is highly relevant and applicable to area B. The old adage goes that no problem is truly novel and everything has already been solved in one discipline or another, but as long as knowledge and insights from different geographies and disciplines do not easily cross-pollinate, some great innovations will be destined to stay local for now.

The low-hanging fruit

By focusing on biomedical breakthroughs and the latest technology, we risk overlooking the abundance of low-hanging fruit in our health systems where inefficiencies, low quality, poor user experience and suboptimal outcomes remain far too common.

Process innovations, new models of care and quality improvement initiatives make smarter use of existing resources, technology and personnel to deliver improved outcomes. Sometimes, these do scale. Think about innovations as simple as WHO Surgical Checklist, which has been shown to reduce surgical complications and mortality by over 30%. In low-resource settings, training community health workers can deliver essential step-changes in health outcomes. Smart, simple initiatives can move the needle in terms of quality and safety.

The reality is that Ignaz Semmelweis pioneering hand-washing has delivered tremendous patient benefit and more impact than so many more technologically advanced innovations that have followed. It is crude to say that there is no VC-backed version of hand-washing, but this tongue-in-cheek point may help illustrate some bias in the way that market valuations or the hype around technology can skew our perception of where the greatest innovations lie.

How many other brilliant ideas that aren’t getting attention because they fall outside of the typical innovation narratives, because they don’t scale and the value they offer may not be easily captured in market terms? Even when process innovations or innovations in care delivery help to deliver brilliant outcomes, we can imagine why they may get less airtime. We should celebrate and shine light on any innovation that positively impacts health outcomes and that facilitates healthier, happier, better, longer lives. 

Innovation for the health of populations

There is a growing recognition that what happens within healthcare is actually a relatively small driver of the overall health of populations. Instead, population health depends primarily upon the most favorable and empowering socioeconomic conditions. Factors such as education levels, economic status and housing are some of the key determinants of health.

Coming back again to which outcomes we are innovating for - if such a large part of what creates health is socially derived, then it makes sense to focus our efforts further upstream if we want to move the needle for the largest number of people. 

An example of this comes from California, where a large health provider has announced a $400million investment in quality, affordable housing for parts of the population it covers. The same health system has also made steps towards fully integrating social services for its members. As the ultimate owners of the patient journey and costs of care, this is a healthcare system addressing upstream factors that affect health for the biggest ROI in improved outcomes (and cost savings). This initiative exemplifies bold, smart ways to promote health, even if that means innovating outside of the traditional boundaries of healthcare.    

This shift ‘from healthcare to health’ (away from treatment, towards prevention) while not new, represents fertile grounds for innovation. Population health focuses on the health of specific communities and is all about the holistic health needs of local populations (whereas public health can be understood at the societal or national level). The NHS’s reorganization into Integrated Care Systems (ICS) places population health at the heart of this strategy and has the potential to enable greater innovation to address local health needs. Knowledge sharing between different ICSs may offer the potential for disseminating best practice across the UK and with it, the opportunity for scaling innovations (where this is possible).

Returning again to digital health, these technologies certainly have a role to play in delivering smart, responsive population health. Digital tools can be leveraged for health promotion, behaviour change and screening for disease. Sharing, integrating and gleaning actionable insights from health-related data has the potential to play a crucial role in keeping populations healthy. The NHS has all the right ingredients to deliver this cohesive vision for upstream use of digital innovation, but the use of these technologies must be anchored to a broader, thoughtful health and social policy approach. Innovating to address complex health challenges requires a skilled and nuanced policy response, so innovative health policy, public health initiatives and investments in the social determinants are critical. Innovating for health encompasses all of the above and our discourse around innovation needs to reflect this.

What we mean when talk about innovation

Advances in digital technology applied to healthcare hold tremendous promise and are certainly worthy of our attention and excitement. What is paramount, however, is that our attention is focused on the greatest areas of impact. This means ensuring that our efforts, resources and latest capabilities are focused upstream on keeping people healthy as well as downstream on diagnosing and treating disease.

There can be a willingness to believe that innovations in biomedical science and digital health alone can deliver us from the vast, complex, even existential challenges to our health. New technology is of course necessary, but it is not sufficient. Innovation for health also means acknowledging the real impact that many local, relatively simple, low-tech and non-scaling innovations can have along with bold, innovative health and social policy. It is important to champion the value of all innovations that meet the greatest patient or population need, and not only those that have been determined as valuable by the market, those that can scale or that deploy the latest technology. The most impactful innovations may not always be the most exciting.