the application of social innovation in healthcare a scoping review CORD-Papers-2022-06-02 (Version 1)

Title: The application of social innovation in healthcare: a scoping review
Abstract: BACKGROUND: Social innovation has been applied increasingly to achieve social goals including improved healthcare delivery despite a lack of conceptual clarity and consensus on its definition. Beyond its tangible artefacts to address societal and structural needs social innovation can best be understood as innovation in social relations in power dynamics and in governance transformations and may include institutional and systems transformations. METHODS: A scoping review was conducted of empirical studies published in the past 10 years to identify how social innovation in healthcare has been applied the enablers and barriers affecting its operation and gaps in the current literature. A number of disciplinary databases were searched between April and June 2020 including Academic Source Complete CIHAHL Business Source Complete Psych INFO PubMed and Global Health. A 10-year publication time frame was selected and articles limited to English text. Studies for final inclusion was based on a pre-defined criteria. RESULTS: Of the 27 studies included in this review the majority adopted a case research methodology. Half of these were from authors outside the health sector working in high-income countries (HIC). Social innovation was seen to provide creative solutions to address barriers associated with access and cost of care in both low- and middle-income countries and HIC settings in a variety of disease focus areas. Compared to studies in other disciplines health researchers applied social innovation mainly from an instrumental and technocratic standpoint to foster greater patient and beneficiary participation in health programmes. No empirical evidence was presented on whether this process leads to empowerment and social innovation was not presented as transformative. The studies provided practical insights on how implementing social innovation in health systems and practice can be enhanced. CONCLUSIONS: Based on theoretical literature social innovation has the potential to mobilise institutional and systems change yet research in health has not yet fully explored this dimension. Thus far social innovation has been applied to extend population and financial coverage principles inherent in universal health coverage and central to SDG 3.8. However limitations exist in conceptualising social innovation and applying its theoretical and multidisciplinary underpinnings in health research. GRAPHIC ABSTRACT:
Published: 2021-03-08
Journal: Infect Dis Poverty
DOI: 10.1186/s40249-021-00794-8
DOI_URL: http://doi.org/10.1186/s40249-021-00794-8
Author Name: van Niekerk Lindi
Author link: https://covid19-data.nist.gov/pid/rest/local/author/van_niekerk_lindi
Author Name: Manderson Lenore
Author link: https://covid19-data.nist.gov/pid/rest/local/author/manderson_lenore
Author Name: Balabanova Dina
Author link: https://covid19-data.nist.gov/pid/rest/local/author/balabanova_dina
sha: 4943781074f37a3768f52fa1757a0cf5a9f51db7
license: cc-by
license_url: https://creativecommons.org/licenses/by/4.0/
source_x: Medline; PMC
source_x_url: https://www.medline.com/https://www.ncbi.nlm.nih.gov/pubmed/
pubmed_id: 33685487
pubmed_id_url: https://www.ncbi.nlm.nih.gov/pubmed/33685487
pmcid: PMC7938294
pmcid_url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7938294
url: https://www.ncbi.nlm.nih.gov/pubmed/33685487/ https://doi.org/10.1186/s40249-021-00794-8
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Keywords Extracted from Text Content: CIHAHL SDG HIC patient collectives people Buurtzog Neighbourhood Care Business-in-a-Box line HICs networks Ayob Bear Rainforest human nongovernmental bricoleurs' Edwards-Schachter patients Patient LMICs women iMOKO ... bodies Bank human institutions expert-driven root health-specific Nightingale's Guatemala coronavirus Fig. 1 niche/environment-a task-shifting Buurtzorg men 14/27 participants Windrum SDGs opportunity-when Timing/Leveraging first'-those patient her LvN LM
Extracted Text Content in Record: First 5000 Characters:Background: Social innovation has been applied increasingly to achieve social goals, including improved healthcare delivery, despite a lack of conceptual clarity and consensus on its definition. Beyond its tangible artefacts to address societal and structural needs, social innovation can best be understood as innovation in social relations, in power dynamics and in governance transformations, and may include institutional and systems transformations. A scoping review was conducted of empirical studies published in the past 10 years, to identify how social innovation in healthcare has been applied, the enablers and barriers affecting its operation, and gaps in the current literature. A number of disciplinary databases were searched between April and June 2020, including Academic Source Complete, CIHAHL, Business Source Complete Psych INFO, PubMed and Global Health. A 10-year publication time frame was selected and articles limited to English text. Studies for final inclusion was based on a pre-defined criteria. Of the 27 studies included in this review, the majority adopted a case research methodology. Half of these were from authors outside the health sector working in high-income countries (HIC). Social innovation was seen to provide creative solutions to address barriers associated with access and cost of care in both low-and middleincome countries and HIC settings in a variety of disease focus areas. Compared to studies in other disciplines, health researchers applied social innovation mainly from an instrumental and technocratic standpoint to foster greater patient and beneficiary participation in health programmes. No empirical evidence was presented on whether this process leads to empowerment, and social innovation was not presented as transformative. The studies provided practical insights on how implementing social innovation in health systems and practice can be enhanced. Based on theoretical literature, social innovation has the potential to mobilise institutional and systems change, yet research in health has not yet fully explored this dimension. Thus far, social innovation has been applied to extend population and financial coverage, principles inherent in universal health coverage and central to SDG 3.8. However, limitations exist in conceptualising social innovation and applying its theoretical and multidisciplinary underpinnings in health research. experienced by millions of people in high-, middle-and low-income countries [2] . While progress has been made to strengthen health systems, 2020 has been an unprecedented year in which both robust and fragile health systems have encountered significant additional pressures to provide care in the face of the novel coronavirus pandemic, climate-related changes and environmental disasters, economic recession, migration and civil unrest [3] [4] [5] [6] . Even prior to the SDGs and most recently the pandemic, social innovation had grown rapidly as an approach to address social challenges across all fields, including in healthcare. The enthusiastic interest in and application of this approach occurred despite a lack of conceptual clarity [7] [8] [9] [10] . The hindrance to its wider application, McGowan [11] argues, is that the term 'social innovation' has not been employed clearly or consistently. However, social innovation is regarded as a label for structural change and social reform [12] . From historical accounts, two examples in healthcare are cited as being social innovations: Florence Nightingale's work, supported by the Irish Sisters of Mercy, in pioneering reform of nursing care [13] ; and Cicely Saunders' creation of what became a global hospice movement for palliative care [14] . Contemporary challenges and the dominant technocratic culture, that often operates at a cost to the human and humane in healthcare systems, services or programme delivery, provide continued impetus for social innovation. In this article, we consider how social innovation has been applied conceptually in the past 10 years to support the achievement of global health goals, such as universal health coverage. We firstly provide conceptual clarity and framing of the multi-dimensional nature of social innovation, as underpinned by a variety of theories. Secondly, we synthesise the results of a scoping review of peerreviewed research literature, published in English from 2010 to 2020 on social innovation in health. We conclude by discussing limitations and gaps in the current literature and directions for future research. In 2017, Edwards-Schachter and Wallace [8] conducted a systematic review and identified 252 discrete definitions of social innovations. In this article, we provide a conceptual framing of characteristic aspects of social innovation based on various definitions (Table 1) . We seek to highlight the different theoretical applications and paradigms related to social innovation. In Fig. 1 , we draw on the work of Ayob et al. [7] , and supplement their propos
Keywords Extracted from PMC Text: Fig. 1 people women patient Business-in-a-Box first'—those health-specific Edwards-Schachter Buurtzorg human bricoleurs' people's women's participants N1 innovat* line Colombia " Psych INFO LMICs Sen's Bank iMOKO task-shifting N1 innovat coronavirus People Buurtzog Neighbourhood Care men 73–75 her Guatemala Patient low- bodies collectives root 14/27 patients Ayob ... Windrum 's SDGs Bear Rainforest
Extracted PMC Text Content in Record: First 5000 Characters:People cannot operate in a new way unless they can see afresh their real cultural circumstance [1] The global community has made significant investments in realising health for all people. Yet, despite the ambitious Goal 3 of the Sustainable Development Goals (SDGs), universal health coverage has yet to be experienced by millions of people in high-, middle- and low-income countries [2]. While progress has been made to strengthen health systems, 2020 has been an unprecedented year in which both robust and fragile health systems have encountered significant additional pressures to provide care in the face of the novel coronavirus pandemic, climate-related changes and environmental disasters, economic recession, migration and civil unrest [3–6]. Even prior to the SDGs and most recently the pandemic, social innovation had grown rapidly as an approach to address social challenges across all fields, including in healthcare. The enthusiastic interest in and application of this approach occurred despite a lack of conceptual clarity [7–10]. The hindrance to its wider application, McGowan [11] argues, is that the term 'social innovation' has not been employed clearly or consistently. However, social innovation is regarded as a label for structural change and social reform [12]. From historical accounts, two examples in healthcare are cited as being social innovations: Florence Nightingale's work, supported by the Irish Sisters of Mercy, in pioneering reform of nursing care [13]; and Cicely Saunders' creation of what became a global hospice movement for palliative care [14]. Contemporary challenges and the dominant technocratic culture, that often operates at a cost to the human and humane in healthcare systems, services or programme delivery, provide continued impetus for social innovation. In this article, we consider how social innovation has been applied conceptually in the past 10 years to support the achievement of global health goals, such as universal health coverage. We firstly provide conceptual clarity and framing of the multi-dimensional nature of social innovation, as underpinned by a variety of theories. Secondly, we synthesise the results of a scoping review of peer-reviewed research literature, published in English from 2010 to 2020 on social innovation in health. We conclude by discussing limitations and gaps in the current literature and directions for future research. In 2017, Edwards-Schachter and Wallace [8] conducted a systematic review and identified 252 discrete definitions of social innovations. In this article, we provide a conceptual framing of characteristic aspects of social innovation based on various definitions (Table 1). We seek to highlight the different theoretical applications and paradigms related to social innovation. In Fig. 1, we draw on the work of Ayob et al. [7], and supplement their proposed framing with factors pertaining to understanding social innovation. In the follow text, we briefly discuss each aspect. The stimulus to social innovation, as for any innovation, is in response to a challenge. By the 1970s scholars had developed an awareness of the limitations of technological innovation and business approaches to effectively meet explicit social needs. Increasingly in the last decade, social innovation has emerged as an alternative to address complex and intransigent societal challenges such as climate change, poverty, the effects of globalisation and inequality, and as a way to produce lasting social change. Social innovation challenges transcend geographic, administrative and political boundaries [9, 25]. For this reason, van Wijk and colleagues argue, challenges best addressed by social innovation have been labelled as 'wicked problems' [26], 'metaproblems' [27], 'grand challenges' [28], or complex challenges with interdependencies across multiple systems and actors [24]. Mulgan [16] highlights the systemic nature of these challenges by noting that existing systems and structures often fail the very people they intend to serve. Others point to the existence of 'institutional voids'—absent or weak institutional arrangements—in the context of markets and governments that may hinder the participation of communities. The result is that social and economic inequalities emerge or are reinforced [29, 30]. However, Mair argues that these same institutional voids alternatively represent an opportunity for social innovation, allowing new forms of participation by a range of actors with complementary objectives [31]. A second distinguishing feature of social innovation, as compared to technological innovation, is its participatory process that promotes social inclusion—reforming existing and promoting inclusive social relationships among individuals, especially those previously neglected from political, cultural or economic engagement [19, 20, 32, 33]. This is often referred to as 'innovation in social relations' [15, 34]. It extends beyond the notion of participatory governance
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