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Tatiana Iakovleva, Elin M. Oftedal and John Bessant

This introductory chapter starts with a description of the challenges of the healthcare sector. It further presents the importance of responsible innovation in digital health as an enabler for multiple stakeholder involvement – users, clinicians, businesses and policymakers – to create a system delivering better care and lower costs. This chapter then presents the major outline of the book and short illustrations of how cases from multiple countries explores dimensions of RI with a focus on user inclusion and the ways in which it can lead to better design and enhanced diffusion.

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Tatiana Iakovleva, Elin M. Oftedal and John Bessant

This chapter explores the concept of responsible innovation, examines its limitations and links it to the discussion of firm innovation process. In this chapter we first provide an overview of the field, followed by the discussion of purpose, process and outcome of innovation. Innovation is described as a complex process in the context of uncertainty where design space occupies an important role. We argue that with the high levels of uncertainty involved in radical or disruptive innovations, there is a need to keep design space open, allowing anticipation and reflexivity to happen to achieve a responsible solution.

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Elin M. Oftedal, Tatiana Iakovleva and John Bessant

In this chapter we provide an overview of the different healthcare contexts across countries in which the rest of our chapter’s cases are situated. We elaborate on the relationship between different stakeholders in healthcare and debate the role of patients in the healthcare sector from an innovation point of view. The chapter concludes with proposing a method for categorizing patients’ innovation behaviour in light of ongoing digitization of healthcare and society in general.

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Pedro Oliveira, Salomé Azevedo and Helena Canhão

Recent research shows that many patients and caregivers develop innovative solutions to cope with their health disorders. Nevertheless, this innovation presents low diffusion. We use a two-stage approach to discuss three research questions: Do these individuals play a role in health innovation? What are their motivations? Could an online, free-access platform promote patient-driven innovations diffusion? We discuss these questions through 11 case studies focusing on innovations by patients and caregivers. Consequently, we analyse data from www.patient-innovation.com, an online platform for innovation sharing. The concept of patient innovation is a good example of Responsible Research and Innovation (RRI). The European Union endorses it and would like to implement and generalize the concept. The objective is to assess implications and societal expectations with regard to research and innovation, and foster the design of inclusive and sustainable research and innovation. A discussion on how Patient Innovation can contribute to RRI in healthcare ends this chapter.

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Thomas Laudal and Tatiana Iakovleva

This chapter presents a preliminary review of the literature on institutional innovations linked to hospital patients, delineates the main concepts involved, and presents a research agenda. Patients’ knowledge of their health conditions has improved due to better education and information access. Trends towards peer-to-peer innovations and customer-driven innovations suggest there is a potential for patient-initiated innovations at a time where electronic health records (EHRs) are disseminated to patients. Based on the literature on how patients contribute to innovations and our interviews in a large Norwegian hospital region, we expect an increase in the number of patient-initiated innovations. Recommendations in the literature on ‘responsible innovations’ ensures that these innovations benefit patients and contribute to economic and/or non-economic performance indicators of hospitals. We identify three questions for future research: What kind of relationship is there between the release of EHRs and patient feedback? How do patient-initiated innovations influence hospital performance? And, what are the most important contextual factors?

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Bala Mulloth and Michael D. Williams

Can university health systems tap into benefits of health technologies in a responsible manner to better manage patients and improve their outcomes using patient-empowered tools? With the adoption of Epic as their only electronic health record system beginning in 2011, the University of Virginia (UVA) medical centre’s Epic integration process has undergone multiple evaluations with the purpose of optimizing their healthcare delivery system. This chapter focuses on how a patient engagement capability of Epic known as MyChart helped UVA support patient care and research. The methodology employed is qualitative in nature and draws on evidence based on interpretative interviews as well as direct and indirect observations. Utilizing the four core principles viz. anticipation, reflexivity, inclusivity and responsiveness of the RRI framework, we offer our analysis and lessons learned. We also present the challenges to realize the full potential of such an EHR platform along with our concluding thoughts.

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John Bessant, Allen Alexander, Danielle Wynne and Anna Trifilova

Innovation very often involves different stakeholder positions, regarding its design and ultimate downstream implementation. A challenge in responsible innovation is ensuring that sufficient ‘design space’ (the arena within which such differing stakeholder views can be articulated, explored and negotiated) is made available at an early enough stage to influence the outcome. Using the particular example of a detailed longitudinal case of the development and diffusion (with subsequent modification and ‘re-innovation’) of a digital health information platform we identify a number of key points at which the innovation concept ‘pivoted’ to reflect new information, some of which resulted from a wider level of inclusion (one of the core RI principles). The chapter explores the role played by structured frameworks (such as the ‘Business Model Canvas’) with which to work with the development of other digital healthcare innovations at an early stage.

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Raj Kumar Thapa and Tatiana Iakovleva

Based on an explorative case study of a privately owned Norwegian firm within the medical industry, this chapter addresses the question of how do business organizations pursue responsible innovation in business development and create positive social impact. Through analysis of purpose, process, and outcomes of the innovation process at the firm level from a responsibility point of view, we conclude that responsible perspectives and practices during the whole innovation process allow businesses to achieve a positive social impact and sustainable business growth. Based on these findings, we suggest a social impact assessment framework in the context of Responsible Research and Innovation (RRI).

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Dagfinn Wåge and Andrea Marie Stangeland

In this chapter the development of the welfare innovation called Blink is described through the lens of responsible innovation. Developed by a medium-sized multi utility and service company, the innovation project was designed for application of video communication channel in the homes of elderly people. Presented from a firm perspective, this story provides an example of challenges of new technology development in this particular setting and learnings gained while balancing new technology development with the needs of and feedback from users as well as market considerations.

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Elin M. Oftedal and Lene Foss

This chapter discusses how responsible start-ups are met in the health sector. Through following three companies, Voco, Cora and Medicus, we acquire insight into the world of challenges the entrepreneurs have when they introduce their technology/service to the healthcare sector. Using institutional theory, we look at the regulative, normative and cognitive dimension of the institutional framework. We use the term ‘institutional wall’ to denote a dense network of formal laws and regulation, informal norms and knowledge and beliefs that act as barriers for the entrepreneurs to access the market. We find that while there is a positive development in the regulative dimension: both the regulative and the normative dimension are set up to favour larger companies. The founders’ responses to the cognitive dimension indicate a lack of belief in Norwegian technology and thus tough access to finance.