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Innovating at university hospitals

How do you build a university hospital which is capable of innovating solutions which make a real difference to patient outcomes and that have commercial applications? We interview Dr Daniel Moreno-Martinez, who has spent the last three years building an innovation unit at Germans Trias i Pujol Hospital, one of the largest university hospitals in the Barcelona region managed by the Catalan Health Institute (Institut Català de la Salut).

ICS delivers the majority of the publicly funded healthcare in Catalonia through an integrated system which includes everything from a primary care network to eight university hospitals spread around the region. It is, in fact, the largest public healthcare provider in Spain’s 17 autonomous healthcare regions.
Catalonia and particularly Barcelona has emerged as the leading healthcare innovation hub in southern Europe and has placed big bets on digital health care over the last decade. Yet he says that Spain is generally bad at turning research into solutions. “We are tenth in the world in research outputs, yet only 30th in transforming those outputs in commercial offerings.”

As in most European countries, apart from the Netherlands, university hospitals in Spain are siloed. On the one hand, you have universities or research institutes with their own budgets, payors and employees. On the other, you have their partners, the big hospitals where patients with complex needs are treated and which provide the data for the university/research institute.

The big challenge for Dr Moreno-Martinez is twofold. Firstly how to actually apply the research created in the research institute to patient care in a meaningful way. “Catalonia looked at this 5-6 years back and we found that this was not happening as much as it should. That research was not being used by the doctors in the hospitals. It wasn’t being integrated into care pathways and it was certainly not being developed into something of commercial value!”

Secondly he wants the doctors in the hospital to become ideas generators and innovators in their own right.

The problem is that in most university hospitals the specialist doctors in the hospital delivering the care typically do not see innovation as part of their job or duties and instead focus on more academic research. “Innovation is something that happens around the doctor but not something they typically perceive as part of their job role. Yet they are at the coalface. They are the ones best able to identify applications.”

Moreno-Martinez, who himself has a PhD in research, adds: “For me a doctor’s role should always be about improving care and advancing medicine, and not just individual patient care. Without this involvement, he says clinical needs that could be met through innovation are not being identified and so not being met.

The solution at Germans Trias i Pujol Hospital, as it was in other large university hospitals in the Catalan Health Institute, was to set up an innovation unit embedded in the general management structure of the university hospital. Dr Moreno-Martinez says: “Just as a hospital needs an oncology or cardiology department, so it needs an innovation department and that is what we have built.” This innovation department mirrors and works closely with a similar innovation unit within the twinned research arm, the Institute for Health Science Research Germans Trias i Pujol.

Counter-intuitively perhaps, Dr Moreno-Martinez sees the role of his department inside the university hospital to be primarily the identification of ideas that can then be developed into concepts that the research institute can turn into applications. In other words his work is upstream from his partners in the research institute. The way he sees it, ideas need to come from doctors treating patients that can then be modified and patented downstream by the research institute.

So how does Dr Moreno-Martinez identify all the ideas that could be turned into applications within the hospital? The short answer is he doesn’t.

“We have 4,000-5,000 staff here and there is no way that I personally can identify the ideas which might work.” Instead, he is engaged in a process of cultural change with the doctors and nurses within the hospital to empower them to see all this as part of their routine. He says the first step is to persuade staff that the new approach is for real, that this isn’t some passing fad. “It is only then that people will come forward with ideas.”

“We started by identifying the enthusiasts, those doctors and nurses who almost automatically do think about how things could be done better.” Some of these are then given the title of innovation ambassadors as a reward and to show public recognition. “So I may not know everyone in the hospital but if I go to one of our ambassadors they will know the 2-3 doctors or nurses who can help me.

Events and discussions have been added to the programme. “We run a series of seminars through the year, some with outside speakers. So we got in Microsoft to talk about artificial intelligence or some start up to discuss an app. Doctors and nurses find this fascinating. It is extraordinary the degree to which they often have not been included in conversations around these technologies.”

Employees are also encouraged to attend external innovation fairs and technology events, however Dr Moreno-Martinez claims that “If the our healthcare staff does not approach technology, we do our best to bring the technology to them.”

In fact, he has found that “activating” an employee is not that difficult. “Doctors and nurses are highly educated people that care passionately about patients, so you don’t need to put much petrol in their tanks to get them involved, motivated and thinking about innovation.”

The innovation unit also has a big external role. “We show the outside world that our door is open and that we are ready to partner.”

Dr Moreno-Martinez uses the term “tech scouting”. “We spend a lot of time looking at who is doing what and identifying start-ups we could work with.” There is a lot of publicity and networking involved here. The innovation department attends a wide range of international conferences. Whilst a lot of these partnerships are local to Barcelona, he casts his net widely. “We reach out to Latin America, the UK and elsewhere in Europe, and we get interest from start-ups from all around the world that are looking for help to validate their solutions and business models.”

The hospital has worked on projects with two UK start ups. All this reflects his personal background which includes 8 years in Manchester (United Kingdom), where he worked as an academic and co-founded the Innovation Forum, a grassroots network for scientists entrepreneurs that supports local innovation ecosystems throughout the world through a number of activities, including an accelerator for healthcare ventures.

He says that very few Spanish and British hospitals adopt this open door approach. “We get start ups from Madrid who say that none of the hospitals in the city are interested in working with them.” He also advises start ups to commit to hospitals who open their doors. “Sometimes we see start ups who engage with several hospitals without informing them that they have multiple partners. This doesn’t work well for us.”
All of this activity is carefully monitored by a CRM system. “We log staff who attend an event or help us out so gradually we can build up an involvement score.” This enables the innovation department to set measurable KPIs. Dr Moreno-Martinez can show that the number of doctors and nurses involved in innovation has risen 500%, for instance. Other measurements include the number of pilot projects deployed, income from competitive funding projects, how many start-ups have been engaged with or how many of the hospital departments are engaged (around 80% today).

The system also highlights challenges. A big one is engaging nurses. “It is easy to ignore nurses and their somewhat regimented working makes it harder to reach them than doctors. But when a nurse comes up with an idea it tends to be more practical and often easier and more impactful to implement: this is where the concept of “entreprenursing” starts to make full sense!” he says.

We would welcome your thoughts on this story. Email your views to Max Hotopf or call 0207 183 3779.