Low-cost innovation in healthcare: what you find depends on where you look

Professional groups such as clinicians are homophilus and so they tend to be drawn to the same knowledge sources. On the one hand, trusted knowledge networks are useful to ensure agreed-upon techniques and guidelines, but, on the other hand, these can become self-reinforcing, preventing the introduction of new ideas, technologies and solutions. There are some standout examples where remarkable healthcare innovations have arisen specifically from exploring very unusual knowledge sources. The success of the Aravind Eye Hospital in India arose from applying the principles of mass production to ophthalmic surgery. The impressive innovation to improve telemetric patient monitoring in intensive care services in Birmingham Children’s Hospital was the result of examining Formula One technology. Close examination of the airline industry and the exhaustive cockpit checks that are required before, during and after air travel led to the World Health Organization surgical safety checklist which has helped to prevent countless ‘Never Events’ (serious, preventable incidents) in preand postoperative care. Clearly, cross-fertilisation between industries is important to develop applications that reduce cost in healthcare. Looking to other countries is also important. Frequently, low-income countries develop frugal innovations, where the need for low-cost models of care is critical and necessary. Low-cost innovations, such as the use of mosquito net mesh to repair hernias (see Box 1), the use of sterilisable bags to replace the need for expensive, sterilisable surgical equipment, mobile phone platforms to integrate decision-making support systems for community health workers and community health workers’ models of primary care, offer exciting potential to improve the efficiency, equity and cost of health systems in both lowand high-income countries alike. To what extent do healthcare professionals and decision-makers look to other industries and other countries to find those innovative low-cost models of care that benefit the system without compromising on quality? Where do people on the frontline of healthcare look for innovative solutions to the clinical and organisational problems that they and their patients face? This is important, because what you find depends on where you look. The Global Diffusion of Healthcare Innovation study recently explored which are the dominant sources of ideas for Frontline Healthcare Workers in the health systems of six countries (USA, England, Brazil, Tanzania, Qatar and India). The study drew on quantitative surveys of more than 1350 Frontline Healthcare Workers and asked them where, in terms of industry, media and country, did their main idea to improve clinical practice in their health system in the last 12 months come from. The study found that the majority of Frontline Healthcare Workers (ranging from 91% in India to 82% in the US) stated that their ideas to improve healthcare practice or delivery were derived from their own clinical specialty. Only 5% of Frontline Healthcare Workers report that their idea was influenced by sectors unrelated to healthcare. Only 11% of Frontline Healthcare Workers reported that their ideas were influenced by practice in other countries, although higher proportions do so in Brazil (18%), Tanzania (12%) and, to a lesser extent, India (10%). Organisations that have the useful function of curating under-the-radar innovations from around the world (such as the Center for Health Market Innovations, the US Commonwealth Fund, in India the Centre for Innovations in Public Systems, in England the NHS Journal of the Royal Society of Medicine; 2018, Vol. 111(2) 47–50