Innovation Procurement in Health Systems: Exploring Practice and Lessons Learned.

As rising healthcare costs continue to challenge the sustainability of global health systems, there has been a strategic shift toward a focus on value, which considers the outcomes and value of healthcare delivery relative to the costs of care delivery. A unique feature of this focus on value has influenced a shift in procurement whereby health organizations are advancing the procurement of innovative solutions to achieve defined outcomes that overcome challenges such as the quality, safety and cost of care delivery. In this paper, we report on the implementation of three innovation procurement models in four Ontario healthcare organizations. These case studies provide evidence of the value and impact of innovation procurement approaches emerging from the four healthcare organizations. Three models of innovation procurement are described in the four cases, along with qualitative analysis of experiences and outcomes for both the organizations and the participating vendors. Evidence of the value and impact of procuring innovative solutions to address health organization challenges offers insights and new approaches to leveraging public procurement methodologies to achieve value and impact for health systems.

Case Study: Innovation Procurement for a Digital Services Platform.

This case describes a design contest strategy to procure a solution to coordination of care transitions across healthcare programs to strengthen patient outcomes. The fit of the vendors' approach with the organization and the potential for building a strong relationship with the vendor teams were evaluated. A consortium of small Canadian companies was selected to proceed to a proof-of-concept phase and full implementation of the digital solution across the region. This design contest approach resulted in a successful vendor partnership for the organization to co-design, develop, implement and scale an innovative solution to support care transitions across the region.

Case Study: Innovation Procurement for a Patient and Caregiver Support Solution in the Home.

This case describes an innovation partnership procurement strategy by a community care health organization to procure a digital solution able to support both caregivers and older adults receiving homecare services. Vendor submissions proposed both existing technologies and new solutions that were challenging to evaluate. An existing technology was procured and first pilot tested in a laboratory setting prior to a field trial with seniors and their caregivers in the home. Recruitment of seniors to participate was unsuccessful. The importance of early engagement of seniors and greater clarity in partnership expectations were key learning outcomes of this case.

Modeling improvements in booster seat use: a discrete choice conjoint experiment.

Automobile crashes are the leading cause of death in children aged 1-14 years. Many children, however, are not properly restrained in safety seats that reduce serious injury and death. This study used a discrete choice conjoint experiment to study factors influencing the decision to use booster seats. Parents of 1714 children aged 4-9 years from nine Canadian provinces completed choice tasks presenting experimentally varied combinations of 15 4-level booster seat promotion attributes. Latent class analysis yielded three segments of parents. The choices of the Benefit Sensitive segment (50%) were most sensitive to the injury prevention benefits of booster seats. The choices of parents in the Context Sensitive segment (33.5%) were more likely to be influenced by installation complexity, oppositional behavior, and the prospect that their child may be teased for riding in booster seats. Parents in the High Risk segment (16.5%) were younger, less educated, and less knowledgeable about vehicle safety legislation. They anticipated fewer benefits, expected more barriers and were less likely to use booster seats. Simulations suggest that consistent enforcement coupled with advertising focusing on injury prevention and the use of booster seats by other parents would increase adoption.

Methodology of estimating restraint use in children: roadside observation or parking lot interview survey.

OBJECTIVE: To compare the differences in Canadian national estimates of correct child restraint use obtained using the standard roadside observation method compared to a detailed parking lot interview. DESIGN: A multi-stage stratified survey design was used to conduct roadside observational and interview data collection at 182 randomly selected sites across Canada. For each site, a roadside intersection location and a parking lot location were used for the roadside observational survey and the interview respectively. Weighted estimates of correct restraint use from both locations were compared. RESULTS: Estimates of correct restraint use were significantly higher for all children under the age of 9 in the parking lot sample. The largest discrepancy between the two samples was in booster seat aged children (ages 4-8) where 29.1% versus 67.8% of children were observed to be correctly restrained using the roadside and the parking lot methodology respectively. There was a 67% participation refusal rate in the parking lot survey. CONCLUSIONS: There are specific advantages and limitations to both survey designs. The purpose of the data collection must be considered when selecting the methodology. Parking lot surveys provide richer data regarding restraint use/misuse. Estimates of correct restraint use must be approached with caution due to the effect of consent bias resulting in over inflation of estimates. Roadside observation is adequate and appropriate for providing national estimates of correct restraint use.

Continuing the journey to a culture of patient safety: from falls prevention to falls management.

This article documents the change management process undertaken in a small community hospital on one stage of the journey toward a patient safety culture. On this part of the journey, the patient care model founded on a philosophy of falls prevention was transformed to one based on a model of falls management. The change process culminated in a more elder-friendly environment complemented by a respect for patients' choices, even when those choices include personal risk. Our cultural transformation resulted in a patient safety culture characterized by (1) a restraints-free physical environment and (2) a rate of patient falls accompanied by serious harm that is lower than the industry average. The first step on our journey to a culture of patient safety was completed over a three-year period.

Are we there yet? Canada's progress towards achieving road safety vision 2010 for children travelling in vehicles.

This study examines safety seat use among Canadian children and evaluates child safety seat use relative to the national policy for child occupant safety, Road Safety Vision 2010. Using a probability sample, roadside observations of car safety seat use were collected from May to October of 2006 for 13,500 children aged from birth to 9 years in 10,084 vehicles at 182 sites in nine Canadian provinces and one territory. Observations revealed that 89.9% of Canadian children were restrained in some type of restraint. However, only 60.5% of these children were restrained in the correct safety seat. When comparing rates of correct use across provinces, results were not significantly different in provinces with booster seat legislation and those without this legislation. This data may be useful for healthcare practitioners and policy makers to develop interventions aimed at increasing appropriate car safety seat use for children in Canada.