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Home > Focus > Responsible Innovation in Health. A book review.

Responsible Innovation in Health. A book review.

by Jonathan Hankins [1], 24 October 2022

Responsible Innovation in Health. Concepts and Tools for Sustainable Impact [2] draws on RRI literature and approaches to develop the concept of Responsible Innovation in Health (RIH) and a toolbox for its implementation. It is free to download here [3] and here [4] (under OUTCOMES).

The publication grows out of the authors' work in the In Fieri Research Program at the Université de Montréal [5] (funded by the Canadian Institutes of Health Research), but the trail of their ideas can be followed back through several articles published in the JRI: Pascale Lehoux co-authored the 2016 publication Responsible research and innovation: a productive model for the future of medical innovation [6], empirically testing Stilgoe et.al's framework for RRI; When desirability and feasibility go hand in hand: innovators' perspectives on what is and is not responsible innovation in health [7] (with co-author Lysanne Rivard) gathers together the practical insights of professionals who design, develop and commercialize health innovations in order to address the problem that practice in RRI remains underrepresented in academic literature and more generally poorly understood; Also published in 2020, all three book authors (alongside fellow Fieri researcher Robson Rocha de Oliveira) interrogate the complementarity between formative and summative assessment tools in RRI in The responsible innovation in health tool and the need to reconcile formative and summative ends in RRI tools for business.

This book logically follows this research development path, once again building on empirical research to construct a methodology proposal for conducting responsible innovation across health systems. Following the practical approach they call for throughout the book, rather than proposing that innovators 'be' responsible, the book aims to enable them to 'do' responsibility by applying nine measurable responsibility attributes throughout the innovation lifecycle, from ideation to assessment.

The publication is structured into three distinctive parts. I will focus predominantly on the first as it both underpins and builds the roadmap proposed in the book, and then offer a short overview of the second and third sections.

Part 1, RIH Concepts

The authors begin by highlighting the importance of the health sector in terms of its capacity to 'trailblaze an innovation path that delivers inclusive and sustainable solutions to twenty-first-century challenges', highlighting a series of values different innovations bring and which could then be subject to what we might call an RRI analysis. These values are then characterized by a series of nine responsibility attributes that could influence society's ability to meet collective needs while addressing health inequalities, which are addressed through the following points and questions in terms of five values:

Population Health Value. RIH should increase our ability to meet collective needs while addressing health inequalities.
Health relevance: Does the innovation address a relevant health problem?
Ethical, legal, and social issues (ELSIs): Was the innovation developed by seeking to mitigate its ethical, legal, and/or social issues?
Health inequalities: In what ways does the innovation reduce health inequalities?
Health system value. RIH should provide an appropriate response to system-level challenges.
Inclusiveness: Were the innovation development processes inclusive?
Responsiveness: Does the innovation provide a dynamic solution to a health system need or challenge?
Level and intensity of care: Are the level and intensity of care required by the innovation compatible with health system sustainability?
Economic value. RIH should deliver affordable high-quality products.
Frugality: Does the innovation deliver greater value to more people using fewer resources?
Organizational value. RIH should rely on business models through which more value is provided to society.
Business model: Does the organization that produces the innovation seek to provide more value to users, purchasers, and society?
Environmental value. RIH should reduce as much as possible the environmental impacts of health innovations.
Eco-responsibility: Does the innovation limit its negative environmental impact throughout its lifecycle as much as possible?

I am sure that regular readers will recognize the similarities between many of the underlying ideas addressed here and those found in the broader RRI literature, and in particular the accent on care that is so prevalent in Jack Stilgoe, Richard Owen and Phil Macnaghten's various collaborations.

The questions related to values cited above lead the book authors into the construction of a Responsible Design Compass whose aim is to help innovators reflect on their underlying assumptions. The compass offers those developing health innovation the possibility of addressing tensions within the five value domains as described below:

Population health value tension: Is it better to address the most prevalent population health needs or to fill key gaps in individual patient care (for instance, for those who suffer from rare or orphan diseases)?
Health system value tension: Is it better to support solutions developed by end users or to ascribe greater importance to experts' abilities?
Economic value tension: Is it better to aim for a higher degree of frugality or to exploit leading-edge technologies?
Organizational value tension: Is it better to prioritize a lucrative business model or to prioritize health impacts for a greater number of people?
Environmental value tension: Is it better to focus on health requirements or to take into consideration the environmental impact?

The compass construction and use bring thoughts of Jeroen van den Hoven's description of the dilemma of moral overload [9], an innovator facing a spectrum of moral imperatives that are impossible to fully satisfy. The compass offers a direct sliding scale between two values that are seen as opposed, bringing discussion and practice into design.

This section then moves on to explain the practicalities of how all of this can be used to develop a responsible health innovation idea, a design brief and all importantly a rating scale that offers a structure that can be used to work towards responsibility through design and practice. There are lots of examples, with each followed by a section describing how to boost the degree of responsibility for any innovation idea.

In a logical step the authors then move on to describing how their approach can be applied (using examples from their research), before concluding the section by addressing the step of designing a responsible solution.

Part 2, Tools to Make and Measure RIH

Part 2 opens with an explanation and description of a multi-disciplinary tool box built by researchers and practitioners and which aims to address the RIH attributes: inclusiveness, business model, frugality, eco-responsibility and ethical, legal and social issues.

The tools are drawn from a variety of sources, the FDA, the Certified B Corporation Program and MIT Sloan School of Management to name just a few. They are presented in categories: Tools to engage with relevant stakeholders; to provide more value to users, purchasers and society; to deliver greater value to more people using fewer resources; to limit the environmental footprint throughout the lifecycle; and to mitigate potential negative impact on users.

The toolbox description and explanation are followed by a section on bringing all of the above together through strategic design decision-making, with Part 2 concluding with a summary of how the tools integrate into the RIH process and can be used within an evaluation and reporting process. This section is central to the book as it really does bring all of the practical approaches aimed at addressing the issues described above together into a process that can be constructed and tweaked according to needs.

Part 3, A Sustainable Path for RIH

In this section the authors firstly examine how leaders of what we call "intermediating platforms" (e.g., innovation hubs, technology transfer offices, accelerators) can orchestrate RIH (with a focus on obstacles and drivers for the process) before making a rallying cry for the co-production of innovation processes and solutions.

Issues related to support for pioneering responsible innovators, building organization capacity, economic drivers and possibly most importantly collective working practices precede a conclusion that summarizes one of the main take-aways from the book, that responsible innovation in health (but not only) is a practice, as well as a vector for transformational change.

Some Personal Thoughts

This is a very easy to read book, well researched and systematically laid out. Following the book means following a process, with each concept and practice point explanation accompanied by a practical example. It is written for practitioners and all importantly available open access through the link above.

The approach described and methodology followed is certainly not limited to the health sector however, with the structure described that is systematic and flexible enough to be used across a broad range of innovation fields. The book is already in use within the Society for All Ages. Longevity-Driven Design course currently running (2022) at the Milan Polytechnic (offered in association with the Bassetti Foundation) where it has been very well received.


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Links in this document:

  1. 1] /schedabiografica/Jonathan Hankins
  2. 2] https://link.springer.com/book/10.1007/978-981-19-3151-2
  3. 3] https://www.researchgate.net/publication/362731334_Responsible_Innovation_in_Health_Concepts_and_Tools_for_Sustainable_Impact
  4. 4] http://infieri.umontreal.ca/en/home/#section-knowledge-advancement
  5. 5] http://infieri.umontreal.ca/en/home/
  6. 6] https://www.tandfonline.com/doi/full/10.1080/23299460.2016.1256659
  7. 7] https://www.tandfonline.com/doi/full/10.1080/23299460.2019.1622952
  8. 8] https://www.tandfonline.com/doi/full/10.1080/23299460.2020.1844974
  9. 9] https://ocw.tudelft.nl/course-lectures/2-1-dilemma-moral-overload/
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Responsible Innovation in Health. A book review.
Articles by:  Jonathan Hankins
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