Studies of innovation related to human health have emerged in great abundance, on topics ranging from advanced biotechnology to improvements in health services. Many of these studies argue that hospitals are central actors in this innovation, yet these organizations are rarely addressed direcdirect selection mechanisms, and users in investigations of industrial development and the commercialization of science. In this paper, we focus on the role of hospitals in the generation of medical innovations through a systematic review of the relevant social science literature.
Hospitals, in particular, university or research hospitals, are part of health innovation systems, which can be theorizesses and organizational innovations. Moreover, hospitals can be an integral part of the education system in which new practitioners are trained, so they can be loci of clinical experimentation and large R&D-performing institutions in their own right. Overall, they are key sites for the adoption, reproduction, and generation of medical knowledge.
The role of individual doctors as innovators has been covered extensively in the history of medical technologies but has to be understood within a complex institutional environment and in relation to long-term epistemic and cultural change (Blume, 1992, Pickstone, 2011). The role of hospitals in the consumption and implementation of innovations—both technical and clinical—has also been covered extensively in the health management, health economics, and health policy fields. However, despite notable exceptions (e.g., Djellal and Gallouj, 2005, Djellal and Gallouj, 2007, Salge, 2012, Salge and Vera, 2009), the organizational capacity of hospitals to generate medical innovations has been underemphasized. In this paper, we are interested in assessing the role of hospitals as generators of medical innovation, broadly defined as “new et al., 1994, Ramlogan et al., 2007). First, these organizations function as brokers among different domains and sources of knowledge, such as scientific, clinical, technical, and commercial knowledge. Second, they are bridges among different modes of learning, including learning through medical practice, through basic and applied research, through technical experimentation, and learning by adapting new technologies to local contexts (Morlacchi and Nelson, 2011, Rosenberg, 2009). Third, hospitals connect health-care systems across stages in the innovation process as they can be involved in idea generation, testing/verification, implementation, and diffusion.
Hospitals contribute to new idea generation through experiential learning in clinical practice and research (both basic and clinical) by identifying problems and potential solutions. They often do so in collaboration with universities and firms under a variety of institutional arrangements (Rosenberg, 2009, Schlich, 2002). The outcomes of these activities are research outputs, insights for new inventions, and candidates for new products and processes (Chatterji et al., 2008). Some of these ideas may be spun out to form the basis for new companies or are licensed to existing firms (French and Miller, 2012).
Hospitals can initiate some product development activities internally, particularly development of new procedures, new services and organizational arrangements, and new tools and methods. In the product development phase, however, hospitals mostly interact with established firms to transfer knowledge about the clinical context in which the new product candidates can be used. They are then involved in testing and documenting the effectiveness, safety, and efficiency of new product candidates, thus influencing technology selection (Windrum and Gae and medicine, which sets the parameters for the present study. Without implying strict linearity in these stages or dimensions, we propose that at any point in time a range of parallel and stepwise innovation activities occur in relation to the organizational context of a hospital.
The twin objective of the paper is to provide an overview of the state of the art on this interdisciplinary problem and to outline a conceptual framework that can be applied to the study of hospitals from an innovation system perspective. By highlighting the multiple roles hospitals play in distributed health innovation systems, we argue that the contribution of these institutions must be understood in relational and co-evolutionary terms: hospitals are sources of novel ideas as well as conduits for innovation generated elsewhere is the system. We argue that a more cplinary research literature on this topic. In the next section, we present our methods and data. Three thematic strands of contributions emerge that differ in their perspectives and levels of analysis, which are articulated in more detail in Section 3. In Section 4, we synthesize and discuss the key findings. Having identified contributions and knowledge gaps, Section 5 concludes by highlighting emerging issues for further research.
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