Stevens N, Cambon L, Alla F
Bordeaux Population Health Research Center. UMR 1219 CIC-EC 1401, Université de Bordeaux, Bordeaux, France.
Bordeaux Population Health Research Center. UMR 1219 CIC-EC 1401, Université de Bordeaux, Bordeaux, France; Chaire de prévention, ISPED, Université de Bordeaux, Bordeaux, France.
Rev Epidemiol Sante Publique. 2021 Aug;69(4):235-240. doi: 10.1016/j.respe.2021.04.138. Epub 2021 May 28.
Given today's evolution of the healthcare system, organizational transformations, technological developments and major challenges, innovation has taken on primordial importance. In this context and with considerable support, many experimentations have taken place. Unfortunately, few have managed to scale up. What results is a congeries of innovations without a future, possibly avoidable squandering of resources, a number of missed opportunities, and the grim prospect of inventor burnout. As regards prevention, innovation is at the heart of an anticipated "preventive transition" of the health system that has yet to achieve operational status. In this article we attempt to redesign the contours of innovation in health, considering it first and foremost in regard to its social utility. We will go on to explore the limitations of innovative practices that delay the arrival of advances in health. Four types of obstacles appear: faulty evaluation; insufficient dialogue between researchers, stakeholders and decision-makers; lack of visibility and, finally, conceptions and perceptions of innovation characterized by tunnel vision. In the concluding section of this paper, we will present several tracks through which the innovation process could be impelled to drive health system transformation. They consist in: (i) incorporating an evaluative and comprehensive research into innovation processes, (ii) elaborating "bottom-up" approaches giving special consideration to innovations instigated by stakeholders and brought to fruition under real-life conditions, (iii) breaking from standardization by thinking from the outset of the adaptability of innovations and, finally, (iv) tying in the experimental approach with a decision-making process.
鉴于当今医疗保健系统的演变、组织变革、技术发展以及重大挑战，创新已变得至关重要。在此背景下并在大量支持下，进行了许多试验。不幸的是，很少有试验能够扩大规模。结果是一系列没有前途的创新、可能避免的资源浪费、许多错失的机会，以及发明者倦怠的严峻前景。至于预防，创新是卫生系统预期的“预防转型”的核心，但该转型尚未实现运作状态。在本文中，我们试图重新设计卫生领域创新的轮廓，首先从其社会效用方面进行考虑。我们将接着探讨那些延误卫生进步到来的创新实践的局限性。出现了四类障碍：评估有误；研究人员、利益相关者和决策者之间缺乏充分对话；缺乏能见度，最后，以狭隘视角为特征的创新观念和认知。在本文的结论部分，我们将提出几条可推动创新进程以促进卫生系统转型的途径。它们包括：（i）将评估性和综合性研究纳入创新过程；（ii）制定“自下而上”的方法，特别考虑利益相关者发起并在实际条件下实现的创新；（iii）从一开始就通过思考创新的适应性来打破标准化；最后，（iv）将实验方法与决策过程相结合。
