Abstract
Welcome to this special edition dedicated to the theme of innovation in healthcare. Don envisioned this special edition after reading Dan’s book “Innovation in Real Places: Strategies for Prosperity in an Unforgiving World.” The book won both main Canadian prizes for public policy: the Balsillie Prize given by the Writers’ Trust of Canada and the Donner Prize awarded by the Donner Foundation, demonstrating Canada’s deep feeling of unease with its own performance and place in a rapidly changing world.
The book was timely and important because it addressed the questions surrounding innovation-based growth. What are the best development paths? How can communities follow a path that leads to meaningful change and widespread prosperity and not just profits for the few? How can public policies, practices, and institutions be helpful or a hindrance to innovation? Do periods of crisis offer an opportunity to retool with different thinking and practices?
This was the spirit in which Don invited Dan to co-lead this edition, an opportunity to identify novel ways that health leaders can address many of the recalcitrant issues we face.
To do so, we mobilized the resources of the Canadian Institute for Advanced Research (CIFAR) Innovation, Equity and the Future of Prosperity (IEP) group to identify ways in which new perspectives could be brought to the healthcare policy table. IEP is a unique group of researchers gathered from the humanities, engineering, social sciences, and law focusing on creating a common language to allow meaningful multidisciplinary research about innovation and equity. Apart from engaging with CIFAR’s IEP, we also identified key experts from the Canadian health system and asked them to write pieces based on their deep knowledge of our health system. This edition is the result of those efforts.
Canadian healthcare systems have been in varying states of crisis over the last two decades and COVID-19 exacerbated this situation. Health reform is challenging as policies and practices are baked into the systems in a path-dependent process. Canada lacks a primary care system, six million Canadians are without an assigned family practitioner, waitlists for surgery span years, emergency departments are overrun, and private pay-to-gain-access options are gaining ground. It is our hope that the following articles provide a fresh perspective and deliver innovative ideas, policies, and practices that will improve the access, quality, and value that Canadians receive from their healthcare systems.
Schrank’s article on the One Health perspective underscores the potential threats and synergies among human, animal, and environmental health sciences. The concept of One Health was pioneered in Canada but, like many innovations, it was “exported” and took root in other jurisdictions. Schrank highlights the historical successes and current impediments to cross-disciplinary collaboration. With lessons from the response to the COVID-19 pandemic, the article offers policy recommendations for Canada to reclaim leadership in the One Health movement which is commensurate with the concept of planetary health in addressing issues of climate change and infectious diseases.
The COVID-19 pandemic catalyzed a significant uptake of assistive technologies in long-term care which is the topic of Nejat and her co-authors’ article. Healthcare workers face demanding workload pressures resulting in burnout from high patient volumes, administrative burden, and long hours. There are also safety and health risks as well as professional challenges due to staffing shortages and scope of practice issues. This comparative study emphasizes the importance of supporting caregivers facing these challenges through assistive technologies. Barriers to adoption are identified, and policy measures to encourage integration of socially assistive robots to improve quality of care in long-term care homes are offered.
Legislators, policy-makers, and public health leaders have queried whether nationalist framing of public health measures during a pandemic could influence public health behaviours. Through their original two-wave panel study in the United Kingdom, Ansell and co-authors reveal that nationalist messaging did not significantly influence vaccine uptake. The study cautions public health authorities against relying on nationalist framings as they may be ineffective and counterproductive.
In her article, Zelmer emphasizes the need for health leaders to scale innovative care models, policies, and technologies to deliver true value in health systems. The article advocates a dual approach: addressing immediate health system challenges while fostering a culture of continuous improvement and transformation. Zelmer’s insights highlight the importance of practical strategies coupled with evidence-informed approaches to achieve sustainable health system improvements.
Phillips and co-author provide a comprehensive overview of the evolving role of health leaders in addressing complex interconnected issues manifested as threats to planetary health, workforce resiliency, and erosion of public trust. Drawing on examples from Health Standards Organization and Accreditation Canada, the article illustrates how standards and assessment programs can act as catalysts for innovation. Phillips advocates the need for a radical rebuild of our health systems to enhance patient and workforce safety, integrated team-based care, and community health.
The crisis surrounding access to physicians, diagnostic procedures, surgery, and treatment services in Canada is leading citizens to seek services by paying for them out of their pockets. The Canada Health Act was meant to ensure that Canadians would not have to pay to access services. Quest Diagnostics recently struck a deal to buy LifeLabs from OMERS for approximately $1.35 billion (Canadian dollars). Feldman and her co-author critically examine how private equity profit-driven motives conflict with the patient-centred orientation of healthcare. They raise concerns about the commodification of healthcare in Canada and call for policies and regulations that prioritize patient health outcomes over short-term financial gains.
Pelletier and his co-authors investigate the deployment of artificial intelligence in Canadian hospitals, focusing on metropolitan areas. The study highlights the critical role of local research ecosystems and the international collaborations surrounding them in artificial intelligence adoption. Their findings provide valuable guidance for policy-makers and health leaders to incentivize artificial intelligence integration, emphasizing the importance of local research capabilities and hospital collaborations.
Canada, once a pioneer in the development of primary healthcare, is today a laggard. Glazier’s article addresses the crisis in primary care access in Canada. He argues that incremental policy responses are insufficient to achieve the goals of primary care for all. Glazier calls for a committed and explicit policy goal to ensure high-quality, well-organized primary care for everyone. The consequences of incremental fiddling will be escalating costs, emergency department and hospital overcrowding, and the growing inequitable burden of preventable illness.
Lazonick’s article examines the financial practices of pharmaceutical companies based in the United States and their impact on drug prices and innovation in Canada. The article documents how high payouts to shareholders through dividends and buybacks divert funds from investment in innovation. Lazonick’s analysis sheds light on the implications for Canada, highlighting the need for policies and regulations that promote pharmaceutical research and development, and those that address high drug prices.
Ramadi and co-authors recognize the challenges associated with the development of innovation clusters—successful ones are extremely challenging to replicate. The authors envision an opportunity to strengthen the innovation pipeline in Canada by focusing on grassroots mobilization of innovation in community hospitals. In the past, major teaching hospitals have been the bedrock of innovation, but the authors suggest looking to micro-level innovations and the role of community hospitals at that level as a way to improve access and quality of healthcare.
This collection of articles presents a compelling account of the challenges and opportunities in healthcare innovation. They underscore the necessity for courageous, evidence-informed approaches, and collaborative efforts to transform healthcare systems. We hope this edition inspires health leaders, policy-makers, and practitioners to embrace innovative solutions and work towards a healthier future for all.
Footnotes
Don Juzwishin, BA, MHSA, PhD, FCCHL, is the former Director of Health Technology, Assessment and Innovation for Alberta Health Services. He holds adjunct Associate Professor positions at the Universities of Alberta, Calgary, and Victoria. He is a Co-Lead of the Networks of Centres of Excellence AGE-WELL initiative which strives to create real-world solutions that will make a meaningful impact on the lives of older Canadians and their caregivers.
Dan Breznitz, PhD, is a Professor of the University of Toronto and holds the Munk Chair of Innovation Studies, with appointment at the Munk School, where he is also the the Co-Director of the Innovation-Policy Lab, and the Department of Political Science. He also serves as a Co-Director and Fellow of CIFAR’s program on Innovation, Equity and the Future of Prosperity.