A management tool towards the development of healthcare innovation platforms

Marais, Annica (2018-03)

Thesis (MEng)--Stellenbosch University, 2018.

Thesis

ENGLISH ABSTRACT: The healthcare sector is constantly under pressure given rising patient demands, an increasing population and a lack of infrastructure and resources available in South Africa (SA). These trends result in mounting pressures and demands, which calls for renewed efforts in improving service delivery and access to basic healthcare. Healthcare systems are expected to deliver high quality services whilst simultaneously addressing complex challenges within resource constrained environments. The impetus of improved access to quality care, has seen healthcare organisations adopt diverse top-down approaches. These efforts have led to islands of success, but have had a disappointing impact on a larger scale. A key challenge that SA faces, pertains to the difficulty of achieving integration across healthcare value chains (VC). This study investigates innovation platforms (IP) as an approach towards addressing some of the shortcomings of previously implemented solutions. IPs are mechanisms that bring together different stakeholders to diagnose common problems, identify opportunities and find ways to better achieve their goals. IPs are a solution to addressing healthcare challenges in a sustainable manner and are theorised to assist in the integration of VC actors. The proposed value of IPs is its ability to introduce a gateway to all healthcare VC actors to contribute towards creating a better functioning healthcare system that serves to benefit the broader society and economy. The IP perspective creates an opportunity for the development of appropriate innovations that can efficiently be scaled across the sector. There is however a lack of evidence of appropriate methods regarding the development and operation of healthcare IPs in SA. This study proceeds to develop a framework and a tool that provides a guideline towards the formation and functioning of IPs that aim to solve challenges within healthcare VCs. This allows for the integration and consideration of opinions of all VC actors during decision-making and policy development. The research follows a constructivist perspective, which seeks to aid better understanding of phenomena. A systematic review is conducted to identify the core IP concepts from extant literature. The study identified 24 types of IPs and provides a brief overview of these platforms. This thesis identifies and investigates two major trends, seven IP dimensions and 39 core IP concepts. The prevalence of these concepts differs with respect to the type of IP that is investigated. Guided by the tenets of Jabareen’s Conceptual Framework Analysis, that consist of eight phases, the framework is iteratively developed through synthesising the IP concepts with the major trends in literature, validating the preliminary framework, and incorporating the validation findings in the final tool design. To address the lack of empirical research in this field, the framework and the identified areas of literature were tested. This was done by adopting a mixed methodology approach comprising of four progressive stages: (1) qualitative semi-structured interviews, (2) a quantitative framework-ranking exercise, (3) a qualitative case study and (4) qualitative case study supporting interviews. Finally, the validated framework and supporting typologies are assembled to create an IP management tool that enables: 1) building IPs; 2) facilitating improvement efforts of existing platforms; and 3) providing platforms with tools to address commonly experienced challenges. This tool’s main aim is to provide guidelines on how to interact in and with IPs. The tool adopts a VC approach and enables the development of IPs that align with the WHO’s health system building blocks. The unique contribution that this study introduces is the tool’s novelty. The developed conceptual framework guides the formation and functioning of healthcare IPs and is embedded within the management tool. The framework is validated as needed, reliable, relevant and useful within the healthcare domain. The efficiency, effectiveness and applicability of the framework is also confirmed prior to the development of the IP management tool. The systematic approach followed lends itself to future development and expansion. The validation results indicate a positive response, however, further study is required with implementation, tracking the tool through its implementation and the critical issues that arise from this.

AFRIKAANSE OPSOMMING: Die gesondheidsorg sektor is voortdurend onder druk gegewe toenemende pasiënt-eise, ‘n groeiende bevolking en die gebrek aan infrastruktuur en hulpbronbeskikbaarheid in Suid-Afrika (SA). Hierdie tendense lei tot toenemende druk en vereis hernieude pogings in die verbetering van dienslewering en toegang tot basiese gesondheidsorg. Daar word van ‘n gesondheidsorgstelsels verwag om hoë gehalte dienste te lewer en om gelyktydig komplekse uitdagings binne beperkte hulpbron-omgewings aan te spreek. Gesondheidsorg-organisasies het diverse benaderings tot voorsiening van gehalte gesonheidsorg aangeneem. Hierdie pogings het gelei tot eilande van sukses, maar het 'n teleurstellende impak op die wyer veld gehad. 'n Sleuteluitdaging wat SA in die gesig staar, is die ingewikkelde probleem om suksesvolle integrasie in die gesondheidsorg-waardeketting (VC) te behaal. Hierdie studie ondersoek innovasie-platforms (IP) as 'n benadering om sommige van die tekortkominge van voorheen-geïmplementeerde oplossings aan te spreek. IPs is meganismes wat verskillende rolspelers saam bring om algemene probleme te diagnoseer, geleenthede te identifiseer en maniere te vind om hulle doelwitte beter te bereik. Die voorgestelde waarde van IPs is die vermoë om 'n toegangspoort aan alle VC-rolspelers van gesondheidsorg te bied om by te dra tot die ontwikkeling van ‘n verbeterde gesondheidsorgstelsel wat die breër samelewing en ekonomie bevoordeel. Die IP-perspektief skep 'n geleentheid vir die ontwikkeling van toepaslike innovasies wat effektief oor die sektor geïmplimenteer kan word. Daar is egter gebrek aan bewyse van toepaslike metodes met betrekking tot die ontwikkeling en uitvoering van gesondheidsorg-IPs in SA. Hierdie studie gaan voort om 'n raamwerk en 'n instrument te ontwikkel wat 'n riglyn bied vir die ontwikkeling van IPs wat daarop gemik is om uitdagings binne gesondheidsorg-VCs op te los. Dit maak voorsiening vir die integrasie en oorweging van menings van alle VC-rolspelers tydens besluitneming en beleidsontwikkeling. Die navorsing is voltooi deur 'n konstruktivistiese perspektief wat daarop gemik is om die verskynsels beter te verstaan. 'n Sistematiese oorsig is voltooi om die kern-IP-konsepte uit bestaande literatuur te identifiseer. Die studie het 24 tipes IP geïdentifiseer en bied 'n kort oorsig van hierdie platforms.Hierdie tesis identifiseer en ondersoek twee hoof tendense, sewe IP-dimensies en 40 kern IP-konsepte. Die voorkoms van hierdie konsepte verskil met betrekking tot die tipe IP wat ondersoek word. Deur die beginsels van Jabareen se konseptuele raamwerk-analise te volg, wat bestaan uit agt fases, is die raamwerk iteratief ontwikkel deur die IP-konsepte te sintetiseer met die belangrikste tendense in die letterkunde, die voorlopige raamwerk te valideer en die validerings-bevindings in die finale instrument ontwerp in te sluit. Die raamwerk asook die geïdentifiseerde literatuurareas is getoets om die gebrek aan empiriese navorsing in hierdie veld aan te spreek. Dit is gedoen deur 'n gemengde metodologie-benadering wat uit vier vorderingsfases bestaan: (1) kwalitatiewe semi-gestruktureerde onderhoude, (2) 'n kwantitatiewe raamwerk-gradering oefening, (3) 'n kwalitatiewe gevallestudie en (4) kwalitatiewe gevallestudie ondersteunings-onderhoude. Ten slotte word die gevalideerde raamwerk en ondersteunende tipologieë saamgestel om 'n IP-bestuursinstrument te skep wat die volgende moontlik maak: 1) die bou van IPs; 2) die fasilitering van verbetering pogings van bestaande platforms; en 3) die verskaffing van instrumente om algemene platform-uitdagings aan te spreek. Dit is nie 'n padkaart om IPs suksesvol te ontwikkel nie, maar dit verskaf riglyne oor hoe om wisselwerking in en met IPs te bevorder. Die instrument neem 'n VC-benadering aan en stel die ontwikkeling van IPs in staat wat in lyn is met die WHO se boustene vir ‘n gesondheidstelsel. Die unieke bydrae wat hierdie studie bied, is die instrument se nuutheid. Die sistematiese benadering wat gevolg word, maak voorsiening vir toekomstige ontwikkeling en uitbreiding. Die resultate dui op 'n positiewe reaksie, maar verdere studie word benodig met die implementering daarvan, ʼn opvolgverslag van die vordering van die instrument tydens die implementering daarvan en die kritiese probleme wat hieruit voortspruit.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/103417
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