How can open innovation methods help improve healthcare outcomes in Brazil's most populous state?
Since early 2015, Brazil has been experiencing a major outbreak of the mosquito-borne Dengue fever, with 600 fatalities recorded in the first eight months of that year. Of these, 60% took place in the south-eastern state of São Paulo, the country’s most populous.
For São Paulo’s municipal government, a key weapon in the fight against Dengue has been the collective intelligence of its citizens, notably through the mobile app Sem Dengue (“Dengue-free”). The app enables users to send health authorities pictures of locations with stagnant water, which are potential breeding grounds for dengue-carrying mosquitos. The app represents a significant improvement on the intelligence provided by the three annual surveys of breeding sites carried out by official agencies, effectively enabling real-time updates. The app has now been adopted by 30 Brazilian cities, with more than 100,000 registered users.
What potential do new forms of collaboration like Sem Dengue have to improve healthcare outcomes more generally? This is what Nesta’s Open Innovation in Health project aims to find out. Following a fact-finding mission in August, Nesta and 100%Open recently travelled out to São Paulo to run a series of workshops on open innovation methods with local partners including the State Government of São Paulo, the State Secretariat of Health, health research institutes such as Instituto Adolfo Lutz, the Vanzolini Foundation and the FIA (Fundação Instituto de Administração).
We started by presenting a framework for open innovation in health, adapted from NHS England’s ‘Innovation Roadmap’. The framework is focused on the challenge of encouraging a more ‘porous’ health innovation system; or, in other a words, a system in which the development of new practices and products is informed by the insights, ideas and input of external actors, or actors who would not traditionally be involved in the same way – or at all.
For each stage of the innovation cycle - problem identification, invention, adoption, diffusion, and, finally, monitoring and evaluation - we presented examples of open innovation initiatives. For example, open innovation at the problem identification stage might involve a real-time social media and news monitoring platform like HealthMap to rapidly track the spread of a disease.
At the invention stage, it might involve a scheme like the Bright Ideas Fund, which supports the development of ideas of front-line staff at Guy’s and St Thomas’ Hospitals. At the diffusion stage, there might be a programme like the NHS Innovation Accelerator, which provides individual innovators with assistance with everything from business models to networking, to help them overcome the barriers to scaling up their proven innovations.
How did the diverse group of health researchers, policymakers and industry and civil society representatives present at the workshops respond to the idea of open innovation? Working in groups, participants experimented with various techniques and tools to develop distinctively ‘open’ innovations to respond to a wide range of ‘unmet needs’ – i.e. specific health issues, or health system issues, which they identified as particularly pressing.
One group, for example, came up with the idea of a preventative education programme to tackle the prevalent issue of teenage pregnancy and its attendant health risks. The group noted that while young people have been the target of a major campaign around sexual health and contraception use, their perspectives and experiences have often remained under-considered - and rates of teenage pregnancy among poorer Brazilians have remained relatively high. The group suggested that co-design workshops bringing together young people and health professionals might provide insights that could drive a more effective prevention programme.
Other groups tried applying open innovation techniques to health system challenges, for example the familiar problem of data integration. One group started with the observation that while clinicians in the primary care system communicate relatively well about individual cases, aided by co-location and regular meetings, clinicians working in different parts of the secondary and tertiary health system communicate much less well. One cause of this is the lack of an integrated patient record system across Brazil’s state health system. This was identified as a considerable barrier for patients in their communication with clinicians, as they were obliged to explain their problems again at each appointment with a new clinician, leading to misunderstandings.
The group suggested setting up Prontuario Digital (Digital Handbook) to tackle this problem, an integrated digital patient record system. Their open innovation methods included bringing together the numerous health agencies involved in data collection to identify the current barriers to integration. They also suggested building partnerships between hospitals that already integrate their data, and those which have not yet managed to achieve this, in order to facilitate the diffusion of effective techniques.
Another group worked on the issue of affordable collection, storage and transportation of virus samples from rural areas to often distant laboratories for analysis. This group proposed a number of possible innovations, including affordable diagnostic kits that can be used to test samples locally to improved refrigeration technology. The open innovation elements of their solution included using a challenge prize to draw on a wide pool of ideas and creativity, from engineering students to logistics companies.
The wide range of other issues which workshop participants tackled during the workshops were suggestive of the potential open innovation to improve a wide range of outcomes across the State’s health system. In the coming months, we will be working with our Brazilian partners to develop two pilot projects which will support the development and adoption of a number of health innovations, drawing on the methods and approaches explored in the workshops. The pilot will be particularly focused on the work of researchers based at Instituto Adolfo Lutz, one of Brazil’s leading public health-focused research centres.