How can ‘innovation’ be defined?
pharmafile | April 14, 2014 | Feature | Manufacturing and Production, Medical Communications, Research and Development, Sales and Marketing | Cancer, NHS, UK, eric low, innovation, myeloma
Innovation has been and continues to be an important topic of discussion for a number of different stakeholders and disciplines including the biotech and pharmaceutical industries, governments, commissioners, healthcare professionals and most importantly patients.
However, despite its importance and recent popularity, the term ‘innovation’ is often poorly understood and is often confused with related terms such as change, invention, design and creativity.
Several stakeholder groups have attempted to define innovation and to emphasise the importance of it for health, society and the economy.
Few people could argue with the case and need for innovation but, unless we can agree on a definition of what it is, we are in danger of spending more time debating it rather than actually doing it – as a consequence, patients won’t benefit from it.
In the context of developing new drugs, innovation can occur at many levels. It can be related to a drug itself – in the process by which it is designed, manufactured or administered.
It can occur in the processes by which it is approved for use, whether that be a health technology assessment or commissioning body. It can also emerge in the way it is used to benefit patients – i.e., a doctor choosing the right treatment at the right time for the right patient.
Innovation can therefore be thought of as a process with many steps and with lots of people involved, rather than one event, which transforms an idea into an output which has the ultimate aim of delivering value to patients, their families and beyond.
This process can be fed by both good and bad ideas. In the management of the innovation process, destroying poor ideas is as important as nurturing good ones. In this way, scarce resources can be allocated and good ideas spotted and pulled through the system effectively and efficiently.
If this is done properly, and the appropriate drivers and incentives are in place, then a new idea usually replaces an older, established one without too much fuss.
However, innovation doesn’t stop when a new drug is approved for use. It could and should continue by allowing doctors scope to use that drug in the best way possible to benefit patients. It should also enable patients to choose between available treatment options in a way that best fits their personal circumstances and preferences.
Seldom are two patients the same and therefore, the one-size-fits-all approach to treatment largely adopted by the NHS clearly has the potential to stifle innovation at the most critical stage.
The process of innovation needs to be managed carefully and, above all else, continuous and sustained. Ideas need to be managed and prioritised and goals clearly defined, communication and knowledge transfer should be enshrined at every stage and everybody involved needs to be aligned to delivering best possible value for patients.
All innovation has a life cycle and we know that many conditions – such as the majority of cancers, which are relapsing, remitting and evolving diseases – are always in need of the next effective treatment.
Therefore we have an almighty task on our hands. If we are to achieve our goals in cancer of adding best possible value to patients in the form of prevention, earlier diagnosis and improved survival and/or quality of life, we must continually innovate and replace existing products – or processes and services – with safer, more effective ones built around the specific needs of patients or sub-groups of patients.
Focussing on innovation not only in terms of adding best possible value to patients, but also as a continuous and sustainable process, acknowledges the effect that learning has on knowledge creation and knowledge transfer within the system of drug discovery and development.
Learning how to innovate effectively entails managing knowledge and being very clear on what type of added-value patients need most. The right treatment at the right time, for example, provides a clear road map that should identify good ideas that are most likely to add best possible value for patients.
Once identified, these ideas should be earmarked and pulled through the system as a high priority. This largely moves the idea of innovation in drug discovery and development from being driven solely by science to being driven by what added-value patients really, really need – adopting the patient perspective.
For innovation to work, the ability to store and use learning that is created by clearly understanding the future needs of its customer – in this case, patients – is critical to its success and sustainability. The consequences of not doing so are clear.
A system in which all the contributors can continuously learn and adapt their behaviour to external stimuli – i.e., austerity, value-based assessment, commissioning algorithms and especially the needs and wants of patients – does so by continuously adding to its collective knowledge store and wholly focussing on its customer.
The emerging perspective by specialists in the field of innovation is to define it in the broadest context possible. This may or may not be a good thing, depending on what your vested interest is, but one important reason for doing so is that, if the definition is too narrow, it may limit creativity by excluding certain avenues of investigation and practice.
Again, I come back to the need to think about the whole continuum of innovation and the need to allow doctors and patients to work together in the clinic to choose between available treatment options that are a best fit for the clinical situation at hand, as well as from the individual perspective of the patient. This is where innovation matters most.
In the NHS in England especially, we are at risk of dumbing down innovation by installing fairly benign treatment algorithms which in practice are designed to deliver equity and consistency by ensuring everybody prescribes the same way and patients, no matter where they live, should expect to get treated the same way.
This is an entirely sensible goal to a point, but unless a mechanism is added that allows clinical innovation to occur and then to be used to help modify and evolve the standard pathway, we will never add the best possible value to patients.
Innovation is inextricably linked to the concepts of novelty and originality and, although these terms are highly subjective, what may be a small change in the ability to prescribe any given treatment might result in significant innovation for an individual patient or sub-group of patients.
In reality, adopting and diffusing innovation is not easy and requires buy-in and alignment at almost every level of the process, but especially so at in the clinical setting – this is where we can truly maximise innovation to add best possible value to patients.
Innovation also needs to provide value for money – the ability to demonstrate this to payers has never been so important.
It is important that we focus on value for money and not affordability; just because a health system could afford to pay for innovation, it doesn’t mean to say it should unless the value of its potential benefits to patients is in line with the cost of delivering these benefits.
That said, failing to adequately defend the interests of patients in developing treatments that may directly or indirectly deliver value to them in the form of better health outcomes in the years ahead – for example, when treatments become generic but continue to have huge health benefits – could have costs that will far exceed those associated with paying premium prices for innovation in the short term.
At the end of the day, profitability that is regarded as excessive is something that, if necessary, can be recovered via a rebate or a similar mechanism as per the recently renegotiated PPRS in the UK.
By contrast, the opportunity to gain better health outcomes missed as consequence of not accessing innovation in clinical practice can never be regained.
Eric Low, chief executive of Myeloma UK
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