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A new mode of innovation is emerging that blurs the lines between universities, industry, governments and communities. It exploits disruptive technologies - such as cloud computing, the Internet of Things and big data - to solve societal challenges sustainably and profitably, and more quickly and ably than before. It is called open innovation 2.0 (ref. 1).

Acclaimed entrepreneurship and innovation scholar Piero Formica, along with a strong and diverse cast of international contributors, explore the world of Open Innovation in this volume.

The discipline of Innovation is constantly evolving and we are now arguably at a strategic inflection point where a new paradigm of innovation is emerging. In the last century often it was a brilliant scientist at a Bell Lab or IBM lab which drove new inventions and subsequent innovations. Then along came Open Innovation which was neatly conceptualized by Henry Chesbrough (2003) and concerns a systematic process where ideas can pass to and from different organizations and travel on different exploitations vectors for value creation.  Open Innovation was based on the idea that not all of the smart people in the world can work for your company or organization and that you also have to look outside the organization for ideas. At this point Open Innovation was still seen a linear process which had an emphasis on licensing of technologies. (...)

Stay Left, Shift Left -10x (SL2-10X)  is a new Digital Health paradigm which seeks to introduce digital and technology innovations which deliver 10X benefits to healthcare in hospitals and move healthcare towards the Home. This case features the adoption of Trimedika Tritemp non contact infrared thermometer demonstrating 10X benefits in the hospital and home settings. There has been little innovation in Thermometry in years until the introduction of the TriTemp thermometer, development of which was stimulated by the need to avoid disturbing patients during sleep to have their temperature taken. Tritemp delivers 10X benefits across all four dimensions of the quadruple aim, reducing infection risk, improving nursing productivity, improving accuracy, eliminating plastic consumables whilst offering less disruption for the patient and delivering a case for system wide adoption. As an end-of-life-carer for her sister she experienced the  distress caused by contact thermometers and developed a hospital grade non-contact thermometer for critical patients especially in neonatal, paediatric, oncology, renal and surgical wards to minimise infection risk. This paper was prepared to assess the overall impact of implementing the TriTemp non-contact thermometer into hospitals on costs, healthcare professionals time, infection risk for patients, and sustainability. First challenge was how to introduce an improved new device into the daily workflow and  Tritemp delivered improvements in economic, environmental, and social sustainability. This challenge was overcome by building working partnerships with clinical engineering and medical teams with a shared goal of improving efficiencies and sustainability, enhancing clinical and patient experiences and delivering cost savings. Sustainability Consumable plastic waste costs are high for contact thermometers and  goes against HSE’s commitment to sustainability. (HSE Sustainable Development report 2018/19). A 900-bed hospital uses around 2-3 million plastic probe covers/year, equivalent to 6 commercial skips of plastic waste. Tritemp breakages were negligible (<0.5%) compared with 10 contact thermometers breakages/week.     Costs Each plastic probe cover cost 5c and a hospital taking 2 million readings per year saves €100,000 on plastic consumables. TriTemp was rolled out across 200 locations in Ireland with 10x cost savings to healthcare sites when costs doubled due to an international shortage of materials. Staff Time A nurse takes 6 minutes for temperature reading with contact thermometers compared to 1 minute (6 X improvement) with TriTemp, giving nurses back time to care. One hospital reported a saving of 500 Engineering hours for the first years use of TriTemp due to minimal maintenance and robustness of the device. Overall results showed a saving of 16 Nurse FTEs and 1.58 Engineer FTEs /yr for an 800 bed hospital. Patient Comfort Results indicated 80% of Nurses agreed that TriTemp was more comfortable for the patients and a Nurse user satisfaction score of  91%. Conclusions TRITEMP™ is a precision-engineered tool, designed to positively impact and better manage infection spread across healthcare. Future developments include a connected non-contact TriTemp enabling rapid transfer of data to the patient record via BLE. The results show 10x cost savings and can improve the lives of patients and nurses helping hospitals, healthcare systems and the planet.  

This presentation begins by outlining and briefly discussing seven critical problems and gaps in global integrated healthcare. These are the productivity gap, the resource gap, the equity gap, the adoption gap, the sustainability gap,  the digital gap and the overarching gap, the management gap. This presentation then describes a grand coalition approach to tackle the overarching problem, the management gap based on key management insights from leading management thinkers such as  Drucker, Crosby and Deming. Deming  estimated that 85% of all systems problems are management problems. Perhaps there is no greater challenge and indeed opportunity for management than improving the global healthcare industry and systems. Drucker famously said “Every organization, whether a business or not, needs a theory of the business. Indeed, a valid theory that is clear, consistent, and focused is extraordinarily powerful”. While we have such remarkable progress in global health over two centuries, with average life expectancy more than doubling, it is now clear that there is a significant crisis in Healthcare and I believe that Healthcare’s theory of the Business is broken. Driven by the ‘rule of rescue’ too often care is delivered in the most expensive place, i.e. an acute hospital and at the last possible moment, often in an ED department. Michael Porter of Harvard University has said in Healthcare, “too many people get paid more to pay the wrong thing” which is additional evidence that the theory of the business and associated business model for health is broken. A gigantic opportunity exists to radically transform health by simultaneously using digital technology and a next management initiative. We are working to build a Digital Health and Wellness Capability Maturity Framework (CMF), collectively developed which when applied can help drive a structural change in the global health industry and radically improve health outcomes.  Capability Maturity Frameworks (CMFs) are breakthrough management tools which originated from Philip Crosby’s seminal work “Quality is Free” and subsequently evolved by leaders such as Watt Humphrey into capability maturity models (CMM) at the Software Engineering Institute. Subsequently the author evolved the concept into a broader Capability Maturity Framework which also focussed on outcome maturity and not just process maturity to create the IT Capability Maturity Framework which has been used by many healthcare organizations to assess and improve IT capability.  Peter Drucker said The most important contribution that management needs to make in the 21st century is to increase the productivity of knowledge work and knowledge workers. We can be encouraged by the productivity improvements achieved in manual labour with Drucker saying “The most important contribution of management in the 20th century was the fifty fold (50X) increase in the productivity of the manual worker in manufacturing”. With a new focus and use of  breakthrough management tools such as capability maturity frameworks we can be hopeful that we can invent and innovate a new better and more sustainable healthcare system, accelerating the adoption of the Stay Left, Shift Left-10X paradigm and the IFIC nine pillars of integrated care.    

Introduction: Cardiovascular disease (CVD) accounted for almost 33% of global deaths in 2019 and remains a leading cause of acute emergency department (ED) attendance (1). Ischaemic heart disease represented more than 40% of these deaths, 80% of which are preventable (1) emphasizing the need for early identification, intervention, and education on risk factor prevention. This case study explores the effectiveness of a proactive cardiovascular screening service, incorporating AI-enabled technology and point of care (POC) blood testing, for timely and accurate predicting cardiovascular issues.  The methodology involved data collection through questionnaires, established screening protocols, digital tools with advanced AI algorithms, and adherence to ethical considerations. Case Study: An active 60 year old male, history of hypertension and pre-diabetes, no history of chest pain or palpitations, received a proactive cardiovascular risk assessment incorporating: POC HBA1C/NTproBNP (LumiraDX), a non-fasting lipid profile, Heartscience  MyoVista wavECG and cardiorespiratory auscultation. Findings: Elevated HBA1C, LDL and NON-HDL levels. Conventional ECG Glasgow Analysis suggested borderline prolonged QT and left ventricular hypertrophy. Positive MyoVista report for Left Ventricular (LV) repolarisation abnormality, indicative of diastolic dysfunction. Interventions: 24 hour blood pressure monitor revealed sub-optimal control: average 140/90mmHg with 4% nocturnal dipping. 3 day Holter monitor identified a supraventricular ectopic run at 149bpm, associated with a future risk of Atrial Fibrillation (afib). Lifestyle modification education provided. Advised the individual to attend his GP regarding blood pressure control and statin therapy, and referral to Cardiology for echo examination. Before the echo was planned, an episode of chest pain led to an emergency department (ED) presentation which identified paroxysmal afib and an acute coronary syndrome requiring emergency coronary angiogram. The angiogram revealed triple vessel disease potentially requiring Coronary Artery Bypass Grafting (CABG). However, a strong case was presented by the patient, for Percutaneous Coronary Intervention (PCI) over CABG, and a staged PCI strategy was decided. The first PCI stage was successful, however, numerous delays lead to an inpatient stay of 13 days and a transfer to another hospital for PCI intervention.  Conclusion: If proactive screening were undertaken, this ED attendance and extended hospital admission could likely have been avoided. Elevated blood pressure, lipids and HBA1C would be identified earlier and treatment started sooner, thus reducing risk factors. The HeartSciences wavECG indicated a repolarisation abnormality and an abnormal ECG, confirming a cardiology referral was required for an ECHO examination and which likely would lead to a CT Angio/Angio or cardiac MRI and if required PCI interventions managed electively as 1-3 days in hospital. Combining clinician skill, POC testing, patient education and AI analysis help predict cardiovascular risks, leading to opportunities for early intervention, and subsequently reducing the number of acute emergency admissions. The implications/benefits of incorporating this proactive screening service include potential reductions in healthcare costs, improved patient outcomes, and enhanced awareness of cardiovascular health. While limitations, such as potential biases and technological constraints, were acknowledged, the case study ultimately emphasizes the crucial role of integrating AI-enabled technology into proactive cardiovascular screening services to predict and prevent acute emergency admissions effectively.

Over the past two hundred years mankind has made remarkable progress in health with life expectancy more than doubling and global population growing ten fold or 10X. The epidemiological transition from communicable to chronic disease, originally described by Omron in 1971, coupled with clinical workforce shortage and attrition will force healthcare systems to evolve to a new paradigm.  This new paradigm I call Stay Left, Shift Left-10X (SL2-10X) which I introduced as CIO of Ireland’s Health Service Executive and is supported by the UNGA Digital Health symposia community proposes a new paradigm, policy, prescription and platform for coordinating collaborative digital health innovation towards a new kind of Health System which also proactively promotes and delivers wellness. The SL2-10X paradigm is about first keeping people well and enabling self care, shared care in the home as the location of choice for healthcare. Shift Left is about keeping well people well or if you have a chronic condition or need rehab a person can be best managed from home. Shift Left is about moving patients as quickly as possible from Acute to a community to a home setting. 10X is the notion that Digital and Data Technology when applied to healthcare which is essentially an information management disciple and an information intensive industry leads to 10X or Ten fold outcomes (10X faster, 10X cheaper, 10X better, 10X higher Volume etc). Coherent, consistent and cohesive digital health innovation in the common direction of Sl2-10X can lead to shifting the entire industry ‘left’ resulting in a radical transformation of individual health, population health, health systems and the entire health industry. Nobel prize winner, Ilya Prigogine wrote “In a system that is far from equilibrium, smalls island of coherence have the ability to totally transform the entire system”. A metamorphism of our health system and associated values is entirely possible where “the rule of wellness” is equally prioritized with the “rule of rescue”, Digital and Data provide the opportunity to proactively manage wellness and the use of internet of medical things devices such as continuous glucose monitoring devices will enable advanced and early detection and indeed reversal of chronic disease. The use of artificial intelligence or perhaps better augmented intelligence will give clinicians and indeed patients an extra pair of eyes helping detect disease and proactively recommending solutions. To accelerate the phase transition from a presence, physician and disease centred health system to a person, wellness and more virtual health system will require concerted  aligned efforts which be required to overcome the resistance that the medicine discipline is renowned for. To structure and align transition efforts SL2-10X is presented as a new paradigm, policy, prescription and platform for Digital Health Transformation. The presentation include multiple Living Lab examples of digital health solutions which enable patients and clinicians to Stay Left, Shift Left and deliver 10X benefits.  

Across the world there is a growing demand for health services driven by an ageing, less healthy population suffering from increasing levels of multi-morbidity. Alongside, patients are now mature and experienced consumers with increasing levels of expectation of service delivery. As a result of all these factors, health systems are having to find ways to serve increasing numbers of \"Unhealthy Consumers\". However, the global shortage of healthcare staff means that we need to find other ways to help to satisfy the growing demand. The concept of remote care to enable people to manage as close to home as possible (“Stay Left, Shift Left”) can: improve the quality of care; improve quality of life; and reduce demand and costs, especially when digital health tools are used to significantly increase the impact and reach. This paper explores the approaches that are needed to enable Stay Left, Shift Left to succeed with a specific focus on engaging, educating and empowering patients. In this paper we propose that there are two particular interrelated themes that need pursuing; firstly, changing the role of the patient in the care pathway and secondly, using local health care systems and health care professionals to bring about the required change in patients. We propose that to achieve and deliver the potential of Stay Left, Shift Left,  patients who use digital tools in most other aspects of their daily life, have to be activated to achieve increasing levels of maturity of self-management and independence. We identify a Model of Patient Self Care Capability Maturity Framework that will help patients improve their health and health care professionals and health systems to better understand and bring about increasing maturity in their patients. Patients will not do this on their own initiative, and they need to be encouraged, enabled and facilitated. For that to happen, health systems need to set the context and build the necessary capabilities and we propose a Person/Patient  Capability Maturity Framework which codifies the evolutionary path and journey of patients moving from early stages of engagement through five levels of maturity including education to ultimately patients excelling. The paper concludes by showing how this CMF has been used to inform a significant patient enabled living lab at Dublin's Mater hospital.