The evaluation of a lean healthcare concept to improve the implementation of Digital Health innovations in secondary health care: a qualitative study within a Dutch hospital setting

doi:10.21203/rs.3.rs-3228673/v1

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Research Article

The evaluation of a lean healthcare concept to improve the implementation of Digital Health innovations in secondary health care: a qualitative study within a Dutch hospital setting

https://doi.org/10.21203/rs.3.rs-3228673/v1

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Background

Digital health innovations are considered a promising avenue in transforming the resourcing, organization and delivery of healthcare services and are often nurtured in organization based innovation labs. One of their biggest challenges is developing effective processes for sifting through ideas. To improve their existing work process, the Health Innovation Lab of the Maastricht University Medical Center + in The Netherlands took a lean approach. “Speed dating” was added to their innovation loop to optimize the contact between innovation owners and relevant experts. The aim of this research was to gain insight into the experiences and suggestions for improvement of this speed dating concept among the involved stakeholders.

Methods

A qualitative study was performed based on a focus group and semi-structured interviews. 36 stakeholders were selected by purposive sampling and approached to participate in this study. Data was collected from 11 respondents. The transcripts of the focus group and interviews were coded according to the open and axial coding phases of the methods of Grounded Theory.

Results

Five major themes emerged during the thematic analysis of the transcriptions: (1) Preparation before the Sign in, (2) Mapping out the process between Sign in and Sign out, (3) Defining the roles and deliverables of experts, (4) Guiding the idea owner, and (5) Supporting capacity of resources.

Conclusions

Since communication and collaboration to access external expertise and resources is so crucial to the success of the innovation lab’s process, it is perhaps not surprising that the most important improvements suggested by our results are associated with improving cooperation. We recommend large organizations, such as a secondary healthcare center, to examine the possibilities to introduce a similar process as the speed dating concept. Our results confirm the advantages of such an approach, but also highlight the necessity of continuous improvement. These improvements should focus on the coordination of joint efforts between stakeholders and the securing of resources. Therefore, we recommend focusing on clarifying the roles and deliverables of the experts, assisting the idea owner with project management and adding a sponsor who would be able to acquire specific resources.

Healthcare

Healthcare services

Digital transformation

Digital health

Innovation labs

Process improvement

Lean systems thinking

Implementation

Innovative ideas

Cooperation

Important demographic and epidemiological trends affect the demand for healthcare services. Noteworthy influences include a declining birth rate and higher life expectancy, a rise in the old-age dependency ratio, and an increase in mobility and urbanization.(1) Disease is increasingly characterized as non-communicable, chronic multimorbidity. The combined result is an ever-increasing demand placed on healthcare services. The current capacity and resources available for providing cure and care are already proving insufficient to maintain the levels of service society expects. Improving and expanding services under these conditions is even harder.(2) To illustrate, the World Health Organization estimates the current shortage of healthcare workers worldwide is already around 4.3 million. This number will grow to 10 million by 2030.(3, 4)

To address this widening gap between supply and demand, many organizations, researchers, governments and others have turned to the growing possibilities of digital health (DH) with the hope that they will contribute to transforming the resourcing, organization and delivery of healthcare services. The integration of technologies such as remote monitoring, data analytics, and artificial intelligence may help advance prevention, diagnostics and therapeutic options, without placing additional burden on the struggling workforce.(5)

Because DH innovations are considered such a promising avenue of innovation, their number has grown exponentially over the past years. This in turn has resulted in an increasing number of healthcare stakeholders (such as managers, healthcare professionals, and patients) to be led into an overwhelming and cluttered DH landscape of novel ideas.(6) As described by Bates et al.:

“Developing effective processes for sifting through ideas for innovation is one of the biggest challenges facing health care innovation centers. Only a few of the ideas that are presented are likely to have a major impact on clinical care or prove to be commercially successful, so it is essential to weed out most-yet it is extremely hard to predict which concepts will bear fruit.”(7)

This naturally leads to the question how this sifting should be performed. While Bates et al. recommend developing a number of ideas simultaneously, the authors also suggest assessing multiple dimensions of the innovations as to elicit their quality and value. This way only the most promising need to be nurtured. Though originally aimed at achieving commercial success, the method described by the authors for screening the innovations can be applied more generically. It consists of forming experienced multidisciplinary panels that include members with the relevant expertise to make the final decision to continue development or not.

Increasingly, innovation labs play an important role within organizations “in supporting the enhancement of innovation capabilities and developing and testing innovative ideas and solutions”.(8) An example of this is the Health Innovation Lab (HIL) of the Maastricht University Medical Center+ (MUMC+) in The Netherlands. Here, assessment of innovations is performed by applying an Innovation Loop (Fig. 1). This framework was created to stimulate cooperation between healthcare workers so that eventually high-potential ideas and solutions devised by hospital employees (idea owners) can be better distinguished from less promising ones. Additionally, it offers a practical platform for executing and coordinating the hospital’s strategy concerning digital health.

In phase 1a (“Problem exploration”), idea owners and employees of the HIL sit down together to develop the idea into a presentable format. The steering committee for digital healthcare in the MUMC + then uses the Quintuple Aim model to identify which ideas hypothetically meet the criteria to realize real quality and value: improving patient experience, improving provider experience, reducing healthcare costs, enhancing population health, and advancing health equity.(9) Based on cooperation between employees of different departments of the hospital and the idea owner, only the most hypothetically successful ideas are allowed to continue to iterative prototyping, implementation and scaling up (the phases 1b “Pilot”, 2 “Implementation” and 3 “Managing”).

After the Innovation Loop was implemented in 2018, a qualitative research study among healthcare employees (n = 20) who worked in the hospital and used the framework, confirmed that there were still several organizational challenges in the use of the Innovation Loop. For the expert group, seven organizational problems were identified: an unstructured work process, lack of multidisciplinary communication, information asymmetry, insufficient resources, unclear division of roles, low quality of documentation, and an inefficient work approach. (A full description is given in Appendix A.) The study also showed that the idea owners experienced insufficient cooperation from other healthcare stakeholders their projects depended on. Not surprisingly, the employees of the HIL who coordinate the innovation process strongly felt that the existing Innovation Loop needed optimization.

The picture that all these results sketch might seem familiar to many people working in large organisations. All items are classic examples of waste. As Sloan et al. put it, specifically describing the situation in healthcare:

“People working in healthcare organisations become skilled in developing “workarounds” (Tucker et al., 2013) but the eight wastes categorized by [Lean Systems Thinking] (over -production, transportation, waiting, overprocessing, motion, inventory, defective products and latent talent) cause organizations and individuals pain, dissatisfaction and frustration.”(10)

To improve the situation, the HIL started making the Innovation Loop leaner: a management approach focused on identifying organizational challenges and eliminating waste. Lean is one of many methods that have been applied by healthcare organizations around the world to create a more standardized process for the identification and processing of innovations.(11) It enables the improvement of the organization of work processes, the collaboration of healthcare stakeholders of different departments and the efficient use of time and resources.(12) Since the biggest organizational challenges among the three groups was a feeling of insufficiency in the level of collaboration between healthcare stakeholders, the HIL added the concept of “speed dating” to the Innovation Loop in 2020 (Fig. 1). This allows the experts to meet the idea owners and work together in multidisciplinary panels, enabling more awareness of who is currently working on which step in the process from idea to innovation. The speed dating concept consists of the following parts:

Sign in: The idea owner pitches the innovation to the whole panel. This is followed by speed dating sessions between the idea owner and the experts. These sessions are used to determine which conditions need to be met for the pilot phase to be started. These conditions may include the availability of resources, budget, documentation and signed contracts with third parties.

Sign out: A follow-up meeting after the pilot phase between the idea owner and experts to evaluate whether the (usually more extensive) conditions have been met for implementation and/or scaling up to be started. This meeting results in a possible implementation plan.

The Sign in and Sign out are anchored to the start and finish of the pilot phase: the phase in which an innovation idea is developed into a prototype.(13)

From February 2021 till May 2022, the processing of nine DH innovations was used to gain experience with the speed dating concept. An important question was what the experts, idea owners and employees of the HIL thought of the speed dating concept, in relation to their observations reported in the previous study. To find out, a qualitative follow-up study with the following research question was performed: How is the speed dating concept experienced by experts, idea owners and employees of the HIL and what are their suggestions for improvement? The results presented in this paper may inspire other hospitals in improving the implementation of DH innovations in the setting of secondary health care.

Study design

The study presented in this paper utilized a qualitative research design, primarily based on a focus group. This group provided insight into the experiences and possible improvements described by the experts, idea owners and employees of the HIL with regard to the speed dating concept. A focus group can be defined as a method in which a researcher gathers a group of people to discuss a particular subject, with the intention of drawing on personal experiences and perceptions.(14) As Sim and Waterfield put it, on the one hand, a focus group is considered a meeting (reflecting the planned and structured intent), while on the other hand it is considered a conversation (reflecting the spontaneous integrative approach).(15) In addition to the focus group, semi-structured interviews were organized as an alternative for the stakeholders who were unable to join the focus group.

Study selection

36 stakeholders were selected by purposive sampling and approached to participate in this study. To ensure the most relevant respondents, a number of inclusion and exclusion criteria were defined. The inclusion criteria were that participants were currently working at the MUMC + in an expert field, as employee of the HIL, or as another employee and idea owner of an innovation. They must have been present at a minimum of one Sign in session, and understand and speak Dutch. Participants who were unable to join the focus group or the semi-structured interviews were excluded. Finally, data was collected from 11 respondents.

Data collection

The focus group was organized in the MUMC + on May 13, 2022 and lasted one and a half hours. Experts, idea owners and employees of the HIL had the chance to discuss their experiences with the speed dating concept and suggest improvements. Discussion was prompted by the lead researcher by using a predetermined topic list (Appendix B). No validated questionnaires were used. A topic list was prepared in order to structure the discussion into general experience, positive experience, negative experience and future. The questions to prompt these topics were:

What is your experience with the speed dating concept?
What is your negative experience with the speed dating concept?
What is your positive experience with the speed dating concept?
If you look back at the positive and negative experiences, how can the speed dating concept be further improved?

Data processing and analysis

The audio recordings of the focus group and interviews were transcribed verbatim. Coding was performed in two phases by the principal author according to the methods of Grounded Theory.(16) During open coding, relevant text fragments which were associated with the research question were identified and separated from the transcripts into discrete components: the identified fragments were summarized into codes consisting of one to five words. During the subsequent axial coding phase, the relations between the codes were considered. In this phase, codes were organized by category. Each category was created by including a variety of codes. Afterwards, the resulting categories were cleaned and summarized, primarily bundling content-comparable codes and deleting duplicate codes.

A total of 11 people participated in the focus group and semi-structured interviews. Six participants (R5, R6, R8, R9, R10, and R11) were employed as experts. Their job titles were Information Manager, Chief Information Security Officer, Patient Communication Specialist, Medical Device Regulation Specialist, Technical Application Manager, and Functional Application Manager. Two participants (R4 and R7) were employees of the hospital and took part in the speed dating concept as idea owners. Finally, three participants (R1, R2 and R3) were employees of the HIL. Participant characteristics are summarized in Tables 1 and 2.

Table 1

Characteristics of participants in the focus group
	R1	R2	R3	R4	R5	R6
Gender	Male	Male	Female	Female	Male	Male
Background	HIL	HIL	HIL	Idea owner	Expert	Expert
Job title	Information Manager	Information Manager	Information Manager		Chief Information Security Officer	Information Manager

Table 2

Characteristics of participants in the semi-structured interviews
	R7	R8	R9	R10	R11
Gender	Female	Female	Male	Female	Female
Background	Idea owner	Expert	Expert	Expert	Expert
Job title		Patient Communication Specialist	Medical Device Regulation Specialist	Technical Application Manager	Functional Application Manager

Five major themes emerged during the thematic analysis of the transcriptions:

Preparation before the Sign in

Mapping out the process between Sign in and Sign out

Defining the roles and deliverables of experts

Guiding the idea owner

Supporting capacity of resources

Each theme will now be described in further detail. Additionally, Table 3 provides an overview of all the main points raised by respondents per theme.

Preparation before the Sign in

The HIL shares a short description of the innovation with the experts prior to the Sign in. This enables the experts to read up on the innovation and think ahead about questions to ask during the Sign in. Three respondents described being satisfied with this short description, while six respondents claimed that experts still missed important information about the innovation. They would have preferred to have this information available at an earlier stage:

“[…] when we are far into the process: ‘Isn’t it useful to check whether [the innovation] has a digital privacy impact analysis?’ Then I think: ‘Why didn’t we ask that question at the beginning?’.” (R5)

Besides the information intended for the experts, three respondents also described missing information for idea owners prior to the Sign in. This especially concerned the pitch, in which the idea owner presents the innovation to the experts. Several experts experienced that the pitches often differed in their levels of preparation and depth. Two respondents specifically mentioned the need to remind idea owners to present in regular Dutch, not using Latin or English medical terminology and abbreviations.

Two respondents from the HIL did not agree with this need for additional information prior to the Sign in, as presented by the experts and idea owners. They explained that the Sign in was initially intended to only pitch the idea. One respondent warned that over-preparing and informing experts and idea owners would make the speed dating concept feel akin a regular application process, which would be at the expense of the current interaction between experts and idea owners:

“[Otherwise] you will see that the idea owner says: Is that so? If I fill in ‘yes’ here [on a preparatory questionnaire], then: Oh, what a hassle that will be! I’ll fill in ‘no’!.” (R2)

However, three respondents suggested still letting the idea owner complete a “smart form” prior to the Sign in to provide additional information to the experts. This form could serve as a quick scan to analyse and assess DH ideas at an early stage. The group proposed designing a questionnaire to collect details about the innovation idea, such as the target population, motive for development, method of development, and whether certain requirements had already been met. An important question would be whether the innovation will be self-developed or purchased as an existing product. Second to this, it would be helpful to know if the innovation would be considered a medical device and would need to be CE marked:

“To quickly determine ‘he needs that or not’. [To] see what needs to be done […], what risks [there are], ‘does the idea meet certain elements?’ of which we can say: ‘Then can we take the next step?’.” (R5)

In addition to gaining a better understanding of the innovation, it was expected that this questionnaire would enable experts to provide more specific advice. This could also mean attaching a different expert to the innovation than usual, due to specific knowledge or experience. One respondent also expected the information to make it easier to determine whether a similar innovation already existed within the hospital. One respondent suggested designing the smart form as a web application.

Mapping out the process between Sign in and Sign out

All respondents described feeling involved with the innovation during the Sign in. For example, one respondent felt that the Sign in increased cooperation between experts and idea owners, due to the time spent together and getting to know each other at a personal level. Two respondents described that this made it easier to plan follow-up appointments.

Despite this general feeling of involvement (and the expectation that this would be the same during the Sign out), six respondents (mainly experts) indicated that the experts did not feel involved in the phase between the Sign in and the Sign out:

“We have had the Sign in and some follow-up sessions, but now it is quiet. […] I am not aware of the development.” (R10)

Additionally, two respondents (both idea owners) found it difficult to understand which steps needed to be taken between the Sign in and the Sign out:

“[…] then you do have those contacts [but] I don’t know yet […] in which order I should see those names. […] What are the steps I have to go through? And in what order? […] When do I have to deliver something? And which documents?” (R7)

To strengthen the involvement of experts with innovation, four respondents proposed digitally monitoring the progress of projects between the Sign in and Sign out. One respondent suggested doing so using a website, newsletter or Excel file. This would effectively force idea owners to provide updates and have the HIL employees share these with the experts. This would make it easier for experts to intervene when necessary:

“Maybe […] with a line with dots. That you see ‘[these expert fields are] connected… we’ll try this in a month’s time’. [That] you know: it is going well, stops for a while or the work is in progress. […] with colours you can indicate a kind of stage of progress.” (R8)

One respondent expected that it should be feasible for an idea owner to regularly write a summary of the progress. It was mentioned that the HIL could facilitate this by developing a standard reporting format. One respondent also expected that digital monitoring would make it possible for experts to perform a risk analysis of the innovation more efficiently:

“[That] certain expert fields already say [to] the rest of the experts: […] ‘I will get started with it, you take it easy for a while.” (R2)

To support idea owners in understanding which steps exist between the Sign in and Sign out, three respondents suggested creating a general roadmap, visualizing when an idea owner should contact a certain expert or when a certain deliverable becomes essential, such as a contract. It was noted, however, that this might be difficult to realize, because each new idea differs sufficiently from the previous ideas for the steps to be different as well.

Defining the roles and deliverables of experts

All respondents described that the speed dating concept successfully facilitated contact between idea owners and experts. This in turn led to a clearer understanding of which deliverables (such as documents, designs, risk assessments, and recommendations etc.) were needed per expert field in preparation of the Sign in and subsequent pilot phase. Four respondents remarked that this had made their work more efficient. Nevertheless, four other respondents still felt that it was unclear for idea owners what the division of roles and responsibilities between them and the experts was exactly. This example shows how a required document (in this case a digital privacy impact analysis) should have been drafted by a different expert in advance, but because this was not done, the question now lands with the idea owner, who is insufficiently equipped to complete this task:

“Then [an expert asked]: Has a digital privacy impact analysis been prepared already? [The idea owner responds:] Never heard of it. What do you need from me?” (R6)

Three respondents indicated an additional uncertainty. Some experts were unaware of who exactly the other experts were and what services they delivered during the innovation process. This sometimes resulted in confusion and was mainly explained by the freedom of the innovation process. Five respondents suggested that this was partly due to an overlap in the services provided by the various experts. One respondent did not agree though and suggested that it was due to the patient missing as an expert during the Sign in. The Communication expert effectively taking the place of the patient further contributed to the indistinct roles.

Various suggestions for improvement for the speed dating concept were mentioned, mainly focussing on combatting the lack of clarity. One idea owner suggested creating a list of names, job titles, and short descriptions of the deliverables per expert field:

“So that you have an idea why [for example] someone from Contract Management is present and what he wants to know about me [as an idea owner] and that I can take care of that.” (R7)

Two experts proposed organizing masterclasses about the expert fields, deliverables, and expected questions for the idea owner during the Sign in. This could be supplemented with information about the mission and vision of the speed dating concept. A document containing this information would make it easier for colleagues to familiarize themselves with it. This might benefit both idea owners as experts.

Three respondents from the HIL did not agree with the suggested forms of improvements to clarify the roles and deliverables of the experts, as presented by the experts and idea owners. They explained that the roles and deliverables of the experts can only be clarified by cooperation between experts and idea owners. One respondent noted that in this cooperation it is up to the experts themselves to clarify to the idea owners what their roles and deliverables are and therefore also when they are required to proceed:

“Experts are experts for a reason. […] They know better than anyone else when they are needed in the entire development process. […] but […] this [clarification] takes time.” (R2)

Guiding the idea owner

One respondent specifically pointed out being satisfied with the concept of idea owners itself, because this makes it clear who is responsible for the development process.

More practically speaking, two respondents described being satisfied with the guidance idea owners receive during the Sign in. An idea owner, for example, found it very helpful that notes are made containing all the names of the experts who ask questions and with whom follow-up appointments are to be made.

Experts, however, indicated that the guidance idea owners receive might still be lacking, because the pitches often differed greatly in the amount of information being presented. One respondent also experienced that idea owners were often insufficiently aware of the responsibilities of an idea owner. Additionally, the complexity of project leadership is regularly underestimated:

“[It] will depend on the project and idea owner, [but] often they are inexperienced people who have a nice idea, but don’t actually know about the process. […] We are not trained in that.” (R7)

Despite this desire among experts and one idea owner to expand the current guidance of idea owners, three respondents from the HIL warned about the risk of idea owners then simply transferring tasks to others, at the expense of the idea owner concept:

“I think the HIL is precisely intended to […] make use of the innovative power we have in this organization!” (R3)

Four respondents proposed introducing an innovation coach; someone who might assist the idea owner in the process of managing projects and making contacts. Three respondents suggested that the innovation coach should also regularly evaluate the progress of the innovation among the experts. It was expected that this would result in even stronger cooperation between experts and a clearer picture of what the speed dating concept entails, especially for experts that work outside the hospital walls:

“'(So) a person who collects what everyone has done and who contacts the other experts in the meantime: 'how are you doing?', 'have you already been in contact?' […] 'can I assume that you will take care of that? ' [And] also providing feedback to the Health Innovation Lab: 'these are the agreements made’’. (R11)

Two respondents suggested that the Sign in and the Sign out should be chaired by the innovation coach in the future to provide a clear overview of the involved stakeholders. The innovation coach could also manage time during the Sign in and take final responsibility for forwarding the pitch presentation afterwards. An additional suggestion was to let the innovation coach invite previous idea owners to the Sign in to remind experts of past successes and maintain their enthusiasm.

Supporting capacity of resources

Four respondents described being satisfied with the current workload and being able to handle it well with the available capacity of resources, such as finances, time, and employees. However, six respondents voiced concern that these resources will not be sufficient in the long term when two or three innovations per month will need to be processed. According to four respondents, this insufficiency was already becoming noticeable, since some experts are regularly absent from the Sign in, hurting the innovation process:

“If two or three expert fields are missing, the added value decreases enormously.” (R6)

For this reason, two respondents suggested organizing the speed dating concept at a higher organizational level within the hospital, with the aim of using the resources of different expert departments more efficiently. For example, one respondent suggested adding the Chief Information Officer or the Director of Patient Care as a sponsor to the speed dating concept to ensure approval of the resources requested. Alternatively, four respondents suggested letting the heads of the idea owner’s or experts’ departments act as sponsors in case of capacity issues. The reasoning being that this sponsor would be able to realize more specific resources, since C-level executives and directors are already responsible for a large number of projects and are generally less directly involved in the development process. In addition to adding a sponsor, it was suggested by one respondent to continue planning the Sign in for when as many experts as possible would be available.

Table 3

Structured overview main results
	Positive experience	Negative experience	Suggestions for improvement	Probable risks
Preparation before the Sign in	Satisfaction about the HIL sharing a short description of the innovation with the experts prior to the Sign in	Experts still missed important information about the innovation Missing information for idea owners prior to the Sign in	Let the idea owner complete a “smart form” prior to the Sign in to provide additional information to the experts. For example: questionnaire, web application	Over-preparing and informing experts and idea owners would make the speed dating concept feel akin a regular application process, which would be at the expense of the current interaction between experts and idea owners
Mapping out the process between Sign in and Sign out	Feeling of involvement with innovation during the Sign in (the Sign in increased cooperation between experts and idea owners and made it easier to plan follow-up appointments) and same expectation for the Sign out	Experts did not feel involved in the phase between the Sign in and the Sign out Idea owners found it difficult to understand which steps needed to be taken between the Sign in and the Sign out	Monitor the progress of projects between the Sign in and Sign out digitally Create a general roadmap, visualizing when an idea owner should contact a certain expert or when a certain deliverable becomes essential	A general roadmap might be difficult to realize, because each new idea differs sufficiently from the previous ideas for the steps to be different as well
Defining the roles and deliverables of experts	The speed dating concept successfully facilitated contact between idea owners and experts Clearer understanding of which deliverables were needed per expert field in preparation of the Sign in and pilot phase. This has made work more efficient	Feeling that it was unclear for idea owners what the division of roles and responsibilities between them and the experts was exactly Some experts were unaware of who exactly the other experts were and what services they delivered during the innovation process. This sometimes resulted in confusion	Create a list of names, job titles, and short descriptions of the deliverables per expert field Organize masterclasses about the expert fields, deliverables, and expected questions for the idea owner during the Sign in (supplement this with information about the mission and vision of the speed dating concept) Create a document containing the information of the masterclasses	It is up to the experts themselves to resolve the lack of clarity about the roles and deliverables of experts. They know better than anyone else when they are needed in the entire development process
Guiding the idea-owner	Satisfaction with the concept of idea owners Satisfaction with the guidance idea owners receive during the Sign in	Experts indicated that the guidance idea owners receive might still be lacking Idea owners were often insufficiently aware of the responsibilities of an idea owner The complexity of project leadership is regularly underestimated	Introduce an innovation coach who might assist the idea owner in the process of managing projects, making contacts, regularly evaluate the progress of the innovation among the experts, chair the Sign in and Sign out, manage time during the Sign in, take final responsibility for forwarding the pitch presentation afterwards and invite previous idea owners to the Sign in	When idea owners can simply transfer tasks to others, this would be at the expense of the idea owner concept and might diminish the innovative power of the organization
Supporting capacity of resources	Satisfaction with the current workload and being able to handle it well with the available capacity of resources	Concern that the resources will not be sufficient in the long term	Organize the speed dating concept at a higher organizational level within the hospital: add a high-level sponsor Continue planning the Sign in for when as many experts as possible would be available	Since C-level executives and directors are already responsible for a large number of projects and are generally less directly involved in the development process, the heads of the idea owner’s or experts’ departments might be more suitable to act as sponsors in case of capacity issues

Creativity, innovative thinking, and the acceptance of controlled risk associated with entrepreneurship is only possible within an environment where these values are not only tolerated but stimulated. Besides being a phenomenon in an organization’s culture, it has distinct advantages to offer a physical location too where various stakeholders can meet to develop their skills and ideas. Innovation labs are intended to provide such a space, generally offering more freedom to employees to explore new solutions and opportunities than the organization at large.(17)

To allow this freedom in a fairly hierarchical organizational structure - such as typically seen in professional organizations like hospitals - an innovation lab is often positioned relatively separate from the rest of the organization. This might fit the independent culture intended for the lab to have, but also creates certain risks. Primarily, innovation labs do not directly control resources located elsewhere within the organization, such as manpower and available funds. This can have an impact on how effectively an innovation lab can realize its goals, especially considering the typically low budgets and small teams allocated to innovation. Consequently, most labs must rely heavily on convincing others within or outside the organization to collaborate and provide the required resources. This limits their ability to independently achieve widespread change through a sector, such as regional or national healthcare.(18)

However, in the setting of secondary health care, innovation labs are still expected to play an important role in the development and introduction of DH innovations. It can be very informative to study what other organizations have created to attempt this. One such early example is the Digital DesignLab at NYU Langone Health.(19) The larger hospital organization felt they did not have a suitable channel for the strategic deployment and support of digital innovations. In response, the Digital DesignLab initiated multidisciplinary, digital development teams that help innovators with navigating the stages of intake, problem discovery, prototyping and development. At the same time, they formed connections with the research community at their center, which enabled embedding research findings into their innovative process, researching the outcomes of innovations, and sourcing research grants as an additional opportunity for funding. Offering such a structured and streamlined pipeline for collaboration has strongly benefited Langone’s ability to explore and implement DH innovations.

Since the collaboration between parties and streamlining of their process is so crucial to the success of the innovation lab, it is perhaps not surprising that the most important improvements suggested by our results are also associated with improving cooperation. These include developing smart forms for idea owners to enhance information collection prior to the first meeting with the experts, digital monitoring of an innovation’s progress, clarifying the roles and deliverables of the expert fields by various media (documents, master classes), introducing an innovation coach role to assist the idea owner with project management and introduce him/her to relevant contacts, and adding a sponsor to establish and solidify the lab’s position within the organization.

Our study had several limitations. Firstly, the study population was limited to employees of our own hospital and only included 11 of the 36 invited participants. Although we are convinced many of our results are applicable to innovation labs and hospitals in general, having our study include participants from other labs might have resulted in a higher external validity. Additionally, not all stakeholders that emerged in the results were included in the initial study population. For example, C-level executives, directors and patients were not interviewed. Secondly, the experiences shared by the participants in the focus group may differ from reality as a result of peer pressure. There is always a chance participants had a motivation to describe their experiences untruthfully or incompletely. Thirdly, not all participants were interviewed during the focus group because they were not able to attend. Although every attempt was made to provide as much context during the individual interviews as was discussed during the focus group, the different setting may have resulted in a misinterpretation of the reactions.

Innovation labs are crucial in fostering an environment that stimulates experimentation and scaling of (digital) healthcare innovations. Considering that they strongly depend on communication and collaboration to access external expertise and resources, the results of this study may be interpreted as a number of suggestions for making optimal use of an innovation lab within a large organization, such as a secondary health care center wanting to improve its portfolio of digital innovations.

For these organizations, we recommend examining the possibilities to introduce a similar process as the MUMC+’s speed dating concept. Our study results confirm the advantages of such an approach, but also highlight the necessity of continuous improvement. These improvements should focus on the coordination of joint efforts between stakeholders and the securing of resources. For example, clarifying the roles and deliverables of the experts and assisting the idea owner with project management are forms of improvement which are expected to increase the innovation lab’s efficacy. Additionally, adding a sponsor who would be able to acquire specific resources might give innovation labs more stability and independence.

These results may inspire other hospitals in improving the implementation of DH innovations in the setting of secondary health care.

DH Digital Health

HIL Health Innovation Lab

MUMC + Maastricht University Medical Center+

AMC Academic medical center

Ethics approval and consent to participate

Prior to the focus group and interviews, participants were emailed a letter explaining the purpose of the study. Information included the expected duration of the interview, and that the resulting discussion would be recorded for transcription and analysis afterwards. The privacy of participants was ensured by processing the data anonymously. Personal data and confidential information were not shared with third parties. All data was used solely for this study. The letter also explained that participation was voluntary and that respondents may terminate their participation at any time. Respondents were not obliged to answer questions that they preferred not to answer.

The audio recordings were destroyed after the thematic analysis. The transcriptions were stored in accordance with the ethical guidelines of Maastricht University.

Signed informed consent was provided by all participants, declaring their approval of the study design, privacy conditions, and audio recording. The study was conducted according to the ethical protocol of Maastricht University and approved by the research and Ethics Committee of the Faculty of Health, Medicine & Life Sciences of the University of Maastricht. Signed informed consent was provided by all participants, declaring their approval for publication.

Consent for publication

Not Applicable

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Competing interests

The authors declare that they have no competing interests.

Funding

Not applicable

Authors' contributions

H.K. collected, analysed, and interpreted the data. H.K. wrote the manuscript with support from E.E. and M.S. and E.E. was a major contributor in improving the structure and writing quality. N.E. and M.S. supervised the project. N.E., P.H. and M.S. devised the original idea. All authors read the manuscript and provided critical feedback.

Acknowledgements

Hanna A. Kellner^a*, Eric R. Edelman^b, Nicole van Eldik^b, Perry Hunen^b, Marieke Spreeuwenberg^a

* Corresponding author

^a Maastricht University

Faculty of Health, Medicine & Life Sciences

Minderbroedersberg 4-6

6211 LK Maastricht

The Netherlands

^b Maastricht University Medical Center+

P. Debyelaan 25

6229 HX Maastricht

The Netherlands

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Editorial decision: Major revision
18 Sep, 2023
Submission checks completed at journal
14 Sep, 2023
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First submitted to journal
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The evaluation of a lean healthcare concept to improve the implementation of Digital Health innovations in secondary health care: a qualitative study within a Dutch hospital setting

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