That's not how the learning works - the paradox of Reverse Innovation: a qualitative study.

BACKGROUND: There are significant differences in the meaning and use of the term 'Reverse Innovation' between industry circles, where the term originated, and health policy circles where the term has gained traction. It is often conflated with other popularized terms such as Frugal Innovation, Co-development and Trickle-up Innovation. Compared to its use in the industrial sector, this conceptualization of Reverse Innovation describes a more complex, fragmented process, and one with no particular institution in charge. It follows that the way in which the term 'Reverse Innovation', specifically, is understood and used in the healthcare space is worthy of examination. METHODS: Between September and December 2014, we conducted eleven in-depth face-to-face or telephone interviews with key informants from innovation, health and social policy circles, experts in international comparative policy research and leaders in the Reverse Innovation space in the United States. Interviews were open-ended with guiding probes into the barriers and enablers to Reverse Innovation in the US context, specifically also informants' experience and understanding of the term Reverse Innovation. Interviews were recorded, transcribed and analyzed thematically using the process of constant comparison. RESULTS: We describe three main themes derived from the interviews. First, 'Reverse Innovation,' the term, has marketing currency to convince policy-makers that may be wary of learning from or adopting innovations from unexpected sources, in this case Low-Income Countries. Second, the term can have the opposite effect - by connoting frugality, or innovation arising from necessity as opposed to good leadership, the proposed innovation may be associated with poor quality, undermining potential translation into other contexts. Finally, the term 'Reverse Innovation' is a paradox - it breaks down preconceptions of the directionality of knowledge and learning, whilst simultaneously reinforcing it. CONCLUSIONS: We conclude that this term means different things to different people and should be used strategically, and with some caution, depending on the audience.

'They hear "Africa" and they think that there can't be any good services'--perceived context in cross-national learning: a qualitative study of the barriers to Reverse Innovation.

BACKGROUND: Country-of-origin of a product can negatively influence its rating, particularly if the product is from a low-income country. It follows that how non-traditional sources of innovation, such as low-income countries, are perceived is likely to be an important part of a diffusion process, particularly given the strong social and cognitive boundaries associated with the healthcare professions. METHODS: Between September and December 2014, we conducted eleven in-depth face-to-face or telephone interviews with key informants from innovation, health and social policy circles, experts in international comparative policy research and leaders in Reverse Innovation in the United States. Interviews were open-ended with guiding probes into the barriers and enablers to Reverse Innovation in the US context, specifically also to understand whether, in their experience translating or attempting to translate innovations from low-income contexts into the US, the source of the innovation matters in the adopter context. Interviews were recorded, transcribed and analyzed thematically using the process of constant comparison. RESULTS: Our findings show that innovations from low-income countries tend to be discounted early on because of prior assumptions about the potential for these contexts to offer solutions to healthcare problems in the US. Judgments are made about the similarity of low-income contexts with the US, even though this is based oftentimes on flimsy perceptions only. Mixing levels of analysis, local and national, leads to country-level stereotyping and missed opportunities to learn from low-income countries. CONCLUSIONS: Our research highlights that prior expectations, invoked by the Low-income country cue, are interfering with a transparent and objective learning process. There may be merit in adopting some techniques from the cognitive psychology and marketing literatures to understand better the relative importance of source in healthcare research and innovation diffusion. Counter-stereotyping techniques and decision-making tools may be useful to help decision-makers evaluate the generalizability of research findings objectively and transparently. We suggest that those interested in Reverse Innovation should reflect carefully on the value of disclosing the source of the innovation that is being proposed, if doing so is likely to invoke negative stereotypes.

Neoadjuvant chemotherapy first, followed by chemoradiation and then surgery, in the management of locally advanced rectal cancer.

Standard therapy for locally advanced rectal cancer (LARC) is preoperative chemoradiotherapy and postoperative chemotherapy. At Memorial Sloan-Kettering Cancer Center (MSKCC) the authors began offering FOLFOX (5-fluorouracil, leucovorin, and oxaliplatin) as initial treatment for patients with high-risk LARC to target micrometastases while treating the primary tumor. The purpose of this study is to report the safety and efficacy of initial FOLFOX given before chemoradiotherapy on tumor downsizing and pathologic complete response (pathCR) in LARC. The records of patients with stage II/III rectal cancer treated at MSKCC between 2007 and 2012 were reviewed. Of approximately 300 patients with LARC treated at MSKCC, 61 received FOLFOX as initial therapy. Of these 61 patients, 57 received induction FOLFOX (median 7 cycles) followed by chemoradiation, and 4 experienced an excellent response, declined chemoradiation, and underwent total mesorectal excision (TME). Twelve of the 61 patients did not undergo TME: 9 had a complete clinical response (CCR), 1 declined despite persistent tumor, 1 declined because of comorbidities, and 1 developed metastatic disease. Among the 61 patients receiving initial FOLFOX, 22 (36%) had either a pathCR (n=13) or a CCR (n=9). Of the 49 patients who underwent TME, all had R0 resections and 23 (47%) had tumor response greater than 90%, including 13 (27%) who experienced a pathCR. Of the 28 patients who received all 8 cycles of FOLFOX, 8 experienced a pathCR (29%) and 3 a CCR (11%). No serious adverse events occurred that required a delay in treatment during FOLFOX or chemoradiation. FOLFOX and chemoradiation before planned TME results in tumor regression, a high rate of delivery of planned therapy, and a substantial rate of pathCRs, and offers a good platform for nonoperative management in select patients.