Scaling innovation across hospitals and nations

Creating healthcare interventions and technological solutions that work is hard enough. But when the goal is sustainable system-wide improvement, it’s the easy part. Scaling a healthcare innovation is where the real challenge begins and, if scaling within a single health system is hard, scaling across healthcare regions and nations, and even across national borders, can seem downright impossible.

“Normally, when you hear scale, people think about scaling a solution, scaling a collaboration with one company, scaling a certain project in its entirety,” said Madeleine Thun, senior director at A.Catalyst, AstraZeneca’s health innovation network. “Instead, we want to coin the phrase ‘Love the problem, scale the outcome’.”

Because what works in one hospital, region, or country might not be appropriate in another, this focus on solving problems and scaling outcomes allows A.Catalyst to thread the needle between carrying over as much value as possible from one project to the next, while still staying flexible to those diverse needs.

“All the innovation work that we do – even if it’s really fantastic work, it’s novel, it’s solving a very deep, tricky problem – If we’re not able to scale it, it’s just going to be a nice thing,” Thun added. “It’s not going to change things for healthcare, it’s not going to impact society at large. So, while there’s been a lot of focus on the innovation process before, we wanted to move focus to what we call effective implementation at scale, because without scale we’re not going to benefit from it and neither is healthcare and neither are patients.”

Figuring out a model for effective implementation on a national scale is no easy feat. But by bringing together diverse stakeholders and addressing regulatory, reimbursement, and workflow challenges, A.Catalyst hopes to do just that.

Humble beginnings

Thun says A.Catalyst evolved organically from a variety of innovations hubs set up by AstraZeneca for different purposes and in different places.

“I think everyone who started these hubs and labs felt a little bit alone at times because […] we had a few brave souls trying something new,” Thun said. “So, they naturally congregated a little bit and started kind of forming a network. What we called ourselves from the beginning is literally a federation of tribes. No one governs each other. It’s the mutual benefit of learning from each other, collaborating together, driving innovation together. And, after a while, we then put a name to the network, the A.Catalyst network.”

Now, there are around 25 hubs in the network. Most are focused on particular local markets, but some work across borders on healthcare transformation, particular R&D problems or supporting biotech start-ups. Members of the network get together in person about once a year, but mostly connect with each other virtually to share ideas and approaches, collaborate on projects, or build up shared capabilities.

“If we can understand the problem really closely locally, and we can have that high-minded understanding of what's worked elsewhere and what can I piggyback on, there's a faster route to finding solutions to that problem that you've really understood,” Thun says. “And then you work through the local partners to implement it. We have to co-create based on the local healthcare infrastructure and the partners already procured and used by healthcare.”

In addition to the various hubs working together within the network, they’re also working with external partners to extend their reach. One such partner is EIT Health, an EU-backed network of health innovators. Another is the Swedish Association of Private Care Providers (SAPCP). Thun says these partnerships are helpful for overcoming systemic barriers to scaling innovation.

“The European perspective is interesting for us, since we do need to transfer health data across a national border to our neighbouring countries,” Daniel Forslund, SAPCP’s Head of Innovation, said. “So, that also makes it interesting to work together with EIT Health and A.Catalyst. The idea is that we can also find solutions from neighbouring countries, for example, or from our members […] So, we can also find ways of creating innovation hubs or test beds on a European level, not only a national level.”

Indeed, A.Catalyst’s mission doesn’t even stop at Europe’s borders, with just as many hubs in Asia and the Americas, one each in Africa and Oceania, and three “above market” hubs.

Challenges to scaling implementation

One of the primary challenges to scaling implementation of solutions from one country to another, or even between healthcare regions in the same country, is that technical infrastructures can be very different across borders – data structures, EHRs, and other more specialised systems.

“For example, in Sweden, most of the regions that are responsible for healthcare delivery have now procured remote patient monitoring solutions,” Thun said. “So, they're now going to implement those, and they are on contract for quite a while. Instead of approaching them with a completely new solution, we need to learn to work with them and their existing partners to implement new algorithms, modules, and content to drive the outcomes we all want to see.”

To scale a solution that relies on remote monitoring in a case like that, the solution might have to be re-imagined using the existing technology.

In addition, regulatory paradigms and reimbursement structures can make it very complicated to transplant a solution from one place to another. Forslund mentioned that, for example, some reimbursement frameworks require patients on a new drug to have a physical check-up, whereas elsewhere they could get away with a virtual one.

“Sometimes it's possible, sometimes it's not. And it makes healthcare providers uneasy to try new things because they don't know if it's actually in line with the agreements with the payers,” he said.

But beyond the technical and policy challenges, the biggest barriers to change are often around workflow.

“Often you have brilliant new things that you can propose for healthcare settings. But, simply, what [providers] don't have is the time to change the way they are working,” EIT Health’s Managing Director for Scandinavia Annika Szabo Portela said. “They don't have seven extra minutes a day. So, they don't want to think in a new way, they don't want to learn [to use] yet another app […] Technology is evolving really fast, but changing how we work is super slow.”

The only remedy, Portela says, is to accept that the pace of change will sometimes be slow, and to make sure to emphasise broad buy-in and clear communication at the start of a deployment process.

Envisioning healthcare’s future in Europe

At the heart of the work of A.Catalyst and its partners is collaboration – the notion that problems in healthcare won’t be solved without bringing together stakeholders, including pharma, healthcare providers, and payers.

“There are so many more challenges to health and healthcare out there than we as AstraZeneca can solve on our own,” Thun says. “And, for that reason, we really believe in external innovation, working with others to tackle those problems. And if we can enable and empower the entire health ecosystem, we're going to solve them much, much faster than if we only invest internally.”

But as stakeholders work together to solve individual problems, they can’t ignore the larger systemic challenges that underpin them. For example, accelerating the movement toward value-based care can help solve some of the reimbursement barriers innovators experience. Additionally, regulators can help streamline innovation by communicating and harmonising standards.

“We just need to repeat the message,” Portela said. “We need to make sure we are kind of respected as thought leaders, go to conferences, meet with the politicians, and so on.”

The scale of the problem may be intimidating, and the mission may be ambitious, but A.Catalyst and its partners are making progress creating a framework for efficiently sharing lessons learned from one hospital to hospitals across Europe.

One question remains though: Why is this the work of a pharma company?

“We are not looking to simply drive market share. What we're doing here is looking at the inefficiencies in the systems instead,” Thun said. “How we can get better at predicting disease, set early diagnosis and earlier interventions. That means that more patients are getting the right treatment and, as healthcare systems are hopefully treating these patients earlier, instead of waiting for them to deteriorate, this would save overall healthcare resources even if the total number of treated patients increases. “

Furthermore, Thun says, the health and effectiveness of the healthcare system as a whole is everyone’s business.

“If you think of it as a proper ecosystem and a big ocean, usually, when oceans become unhealthy, the big fish are affected first,” she said. “We're a big fish. We are dependent upon healthy ecosystems that are effective and efficient, that have increased capacity, that have high efficacy and accuracy, and that triage well and find patients early, and give them the right treatment at the right time.”