Q: What is GDHI?
Matthew Harris: GDHI stands for the Global Diffusion of Healthcare Innovation. It’s a research project sponsored by WISH that explores how innovation spreads between countries. It also explores how innovations could be adapted to align with the needs of frontline healthcare workers from around the world.
Q: This is the third phase of this body of research. What was explored in phase one and phase two? Where are you going to take the research in phase three?
Matthew Harris: In phase one, we examined the extent to which certain systems characteristics and frontline behaviors and enablers were considered to be important in eight different countries in terms of supporting the diffusion of innovation in each of those different country contexts.
The second GDHI project explored eight different case studies of innovations that had been successfully scaled in different countries and sought to identify the enablers to that process, again looking at some of the characteristics found in the first GDHI project.
This year, we’re exploring how innovation crosses national and international boundaries. We know that it’s sometimes difficult for innovations to cross boundaries. The often cited “not invented here” is a specific problem within healthcare systems. This research asks which contexts are considered to be most relevant to frontline health workers in terms of inspiration and sources of ideas.
Q: Why does this work matter? Why is it important to understand where innovation comes from and how it crosses countries’ borders? What’s the relevance to healthcare?
Matthew Harris: There are so many innovations out there. We already have solutions to many of our problems with healthcare delivery and patient care. The problem, however, is how to implement these solutions? One of the barriers, we think, is that these innovations aren’t directly addressing the needs of frontline healthcare workers, in terms of direct patient care. We’re concerned that a mismatch might exist between the needs of healthcare workers and the needs perceived by the executives of healthcare organizations.
We’d also like to understand the extent to which innovations developed in low income countries are adopted by higher-income countries. The learning process from the Global South to the Global North offers particularly complex challenges given that it is considered by some to be a nontraditional type of learning. So in this project, we’re interested in better understanding that process so that we can suggest policy recommendations to improve it.
Q: What are the some of the surprising findings you’ve discovered about GDHI? The research highlights?
Matthew Harris: One of the really important frontline characteristics and cultural behaviors we found from previous GDHI projects was the importance of what we call ‘delayering’. We want to avoid an accumulation of ideas and practices layering one on top of the other. Frontline workers are not particularly good at stopping an old practice that isn’t working. So what you have is a ‘paleontological’ effect of innovation; of layering one innovation on top of another which actually complicates processes rather than simplifies them. One of the problems is that healthcare workers don’t have necessarily the time and space to delayer.
Q: Tell us a little bit about some of the case studies that you have looked at in your research.
Matthew Harris: We’re examining innovations being developed in low income countries that we’d like to see adopted into a high income country context. The Brazilian Family Health Strategy is a prime example. It’s a community based primary health care model that’s had a significant impact on the reduction of infant mortality and cardiovascular disease mortality. It integrates good quality primary care with population health. That’s something that we don’t see happening very often in high income contexts particularly the UK and the USA where we see a much more fragmented model of primary care with multiple health professionals all working within the same context. So we are trying to understand what some of the barriers are to diffusing models of care like that.
Q: From a personal point of view, what draws you into this area of research?
Matthew Harris: The ideas are out there, and we’re spending a lot of money developing great technologies and great solutions. That’s great but the frustrating question is: How do we put this into practice? This is a common theme threading throughout most of the other WISH Forum Reports as well. There are significant opportunities to learn from many different countries about best practice but we’re not necessarily good yet at affecting change, partly because of the complexities of adapting innovations from elsewhere but partly also because of resistance to learning from other countries.
Q: How does WISH enable this kind of research and elevate it to the global stage?
Matthew Harris: WISH is a phenomenal opportunity. It brings together ministers, senior policymakers, clinicians, and allied health workers from all over the world representing nearly a third of the world’s population in one meeting. It doesn’t just end there. The forum’s reports generate significant discussions at the conference and also lead to high-quality publications moving forward. The influence of the WISH conference is significant. It’s a remarkable opportunity for the collective intellectual power of senior health policymakers to really come together and grapple with really tricky questions around systems delivery and design. The Global Diffusion of Healthcare Innovation really gets to the nub of how we affect change in healthcare which is an incredibly important issue of relevance to all WISH research.