An ethical approach to healthcare innovation

In healthcare the stakes are high, negative consequences can range from nothing to poorer quality of life or severely reduced capacity or even death. Additionally patients are potentially in vulnerable situations. As has been demonstrated recently when incentives and values are not aligned it may feel like they are being taken advantage of. For these reasons it’s important that innovations are ethical, this gives healthcare systems, professionals, patients and public confidence in using innovation to improve healthcare.

But what is innovation?!
Innovation is an overused term with no agreed sentiment of what it is. An example of something innovative to one person is old news to another, when someone talks about an exciting innovation someone else often points out something similar that happened recently. What makes this worse is that innovation is often considered to be the realm of techies dominated by certain stereotypes, not for just anyone. But as I outlined here everyone has a part to play in innovation:

The human elements of innovation need just as much time and effort to develop as the technology side and the human elements are the ones that decide whether the innovation gets used or not. http://priteshmistry.ghost.io/making-change-succeed

So what do we mean by innovation? Often it’s equated to being new technology (apps, wearables, smart devices, point of care diagnostics) but innovation is much broader than this, what about business models, process improvements, use of language for behaviour change, social movements, drugs, improved materials and more. While there’s a big push for technology in healthcare arguably one recent highly impactful innovation is dietary interventions for Type 2 diabetes. This simple non-tech intervention has given patients more understanding and control over their health, reduced medications (saving money to the healthcare system) and even resulted in remission in some patients with type 2 diabetes. Although the definition of remission is still in progress, some patients are off medications and key indicators are within normal bounds. When I use the term innovation I mean a novel approach providing unique benefit in the real world. Where the novel approach could be an old technology (eg text message) combined with a novel structure of language (eg nudge interventions) to have an impact in the real world (eg medicine adherence or improving attendance to appointments).

As mentioned above the promise of innovation providing benefits to patients, carers, clinicians, healthcare professionals and healthcare systems is undeniably appealing but often we are uncertain on the motive and drivers which can lead to mistrust stopping improvements that could substantially improve care. We need to have an ethical approach to innovation in healthcare to instil confidence and trust.

Components towards ethical approaches

Ethical innovation should consider the following elements:

Co-development. An innovation addresses an unmet need and is co-developed by all impacted as equal partners. Often concerns and preferences can be ignored because an expert or lead believes it’s the best approach. Tribal thinking, deep sector expertise, profit and market targets, power relationships and fiefdoms need to be set aside to focus on the solution and the unmet need respecting the opinions and concerns of users.
Outcomes based. An innovation should be developed to address an unmet need measuring effectiveness against the outcomes as one part of the success measure. The outcomes might be multifaceted based on a combination of actual health indicators, patient reported information and clinician indicators. Measures are what are often optimised so if you measure activity you ensure that there's usage but that doesn’t necessarily translate into impact! Ideally the innovation success wouldn’t be measured by just engagement, as we’ve seen with social media engagement metrics don’t create a healthy connected ecosystem but systems tailored to be addictive to keep users on the platform. If your innovation is a digital intervention that uses engagement to improve adherence to improve health outcomes what are the negative impacts and how can they be negated?
Privacy. Any use of data and information captured respects the privacy preferences of the individuals involved. As mentioned above if there are concerns, listen and put the right safeguards in place to mitigate the concerns, co-development is key to this.
Honesty and transparency. The innovation function should be honest and transparent - not actual specific workings but the principals. If you don’t feel comfortable clearly and openly state what you’re doing and why eg data capture, data use, evidence, method etc then you need to examine why this is.
Matches values of users and professionals. Innovations are often developed because there is a good idea that potentially solves a problem. However there also needs to be consideration of how an innovation aligns to values of healthcare systems, professions and people. This might be values of inappropriate tests and medication, data use (see privacy above), evidence, best practice and quality.
Sustainability of the innovation and system it is intended. Profit is not unethical after all we want employees and innovators to earn a living and be able to live healthy lifestyles. Additionally users need to have confidence that innovations will continue to exist and be supported - a revenue stream helps both of these. The right metrics need to be selected to measure the success of an innovation or users fear change, for example over 150 products have been launched and quickly closed by Google. If profit maximisation is the only motive it most likely isn’t a good match to the values of healthcare professionals and could result in unethical practice such as selling on information to maximise profit. However we do want innovations to be sustainable and supported so they are reliable and of high quality. Similarly if the innovation upends part of the system what happens to those people and how are you supporting it to change? That’s not to say disruption is a bad thing but when it endangers people and quality of life what’s the mitigation process? Also in a climate change crisis innovations should mitigate the environmental impact.
Inclusiveness. Innovations should aim to be inclusive not exclusive from the outset this approach should underpin the co-develop to ensure the seldom heard voices are engaged. This opens doors for more diverse set of opinions and solutions that might not have been considered otherwise.

We’re lucky to be innovating at a time where social enterprises are increasing in popularity and mechanisms such as social impact bonds (a way of paying by results including improving society) are becoming more established. These enable innovations to have aligned incentives to value impact and outcomes alongside financial returns to benefit patients, system and public.

Ethical innovation values the impact and benefit also known as the social impact equally with profit, market share and growth. But it also considers the potential negative impact, its not about moving fast and breaking things its more about moving and improving but underneath it all it’s about doing the right thing.