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WOMI Community - Workshops on Medical Innovation and Healthcare

WOMI is an international network of researchers who study innovation, entrepreneurship and the organisation of research and development in the context of healthcare organisations, medical devices and pharmaceutical industries and the broader field of medicine and life-sciences. Our WOMI network organizes an annual workshop, when the core group of researchers and other invited guests meet and discuss current issues within the field.

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News – 15 December 2023

WOMI 2023

Workshop focusing on challenges and opportunities of new technologies

Why do we meet?

The purpose of the annual WOMI workshops is to bring together a core group of researchers, to discuss current research through extensive debate and discussion. The core group of researchers comes back year to year, and we also slowly expand and change the topics and participants.

Our workshops give us the opportunity to discuss early stage work and scientific papers on a variety of themes, including but not limited to:

Specifying the dynamics of medical innovation and innovation systems
Explaining innovation in health care organisations
Explaining cross-organizational collaboration and networks in science and innovation
Facilitating entrepreneurial activities and companies in life sciences and medicine
Developing education and innovation in hospitals and medical faculties
Analyzing and engaging in debate with public policy

What happens before and after WOMI?

Our papers from WOMI are later presented at large conferences, both as individual authors and when we organize a series of special sessions at the key conferences. Our papers presented at a workshop are later published in a variety of prestigious scientific journals.

What is our focus area?

Our research is phenomena driven and we approach core topics in medicine and life-sciences from various academic traditions. We are also committed to novel empirical evidence and methods, as well as interesting theoretical explanations from various academic traditions. Important traditions include economics of innovation/evolutionary economics, industrial economics, innovation studies, innovation and science policy, and science and technology studies.

How are we organized as an international network?

The WOMI network grew from close ties among researchers into a stable annual network and platform for the sharing of knowledge on scientific activities, methods, conferences, education etc. of interest to all. We are informally and non- bureaucratic organized, with a low budget but with strong and weak network ties. We organize a conference in December every year, in different countries, with a local organizer.

Related publications in alphabetic order

Ali, A. & Gittelman, M. (2016). Research paradigms and useful inventions in medicine: Patents and licensing by teams of clinical and basic scientists in Academic Medical Centers. Research Policy, 45(8).

Abstract
In recent decades, teams that combine basic scientists with clinical researchers have become an important organizational mechanism to translate knowledge made in basic science (“the bench”) to tangible medical innovations (“the bedside”). Our study explores whether inventing teams that span basic and clinical research are more effective at licensing than teams comprised of inventors from only one domain. We propose that laboratory science and clinical research represent fundamentally different research paradigms that defy a simple arithmetic of combining the skills of individuals on teams. Clinical and basic researchers inhabit distinct cultures of work that yield different, and sometimes conflicting, beliefs and approaches to problem-solving. We claim that the complexity and variability of most human medical problems limits the role of basic science in medical innovation. Instead, we argue that clinical research remains an important engine of innovation, even in a period of rapid advances in molecular and genetics sciences, and advanced analytical techniques, because clinical researchers have unique opportunities for insights that emerge from the joint activities of research and close observations of living patients. Our empirical analysis focuses on patents and licenses from two prominent Academic Medical Centers (AMCs) over a 30 year period. In hazard models of licensing we find, controlling for a range of effects, that inventions by teams composed of clinical researchers (MDs) are more likely to be licensed than inventions by teams of basic scientists (PhDs), and that inventions that include both MDs and PhDs are not more likely to be licensed. This leads us to question the translational model of combining expertise to bridge different domains. We also find that the training of the team leader has an effect on licensing that is independent of team composition, lending support to our interpretation. Our results help inform policy about the relationship between research paradigms, team composition, and successful innovation in bio-medicine. Link to article.

Azagra-Caro, J., Llopis, O. (2018) "Who do you care about? scientists’ personality traits and beneficiary impact". R&D Management, In press.

Abstract
We investigate the roots of scientists' perceptions of the impact of their work by examining stable psychological characteristics such as personality traits. An analysis of personality traits highlights the effects of policies related to gender equality, allocation of research time and skills acquisition. It improves our understanding of the conflicts related to scientists’ perceptions of the impact of their research on beneficiaries. For example, conscientiousness increases the perceived impact on clinical beneficiaries, but reduces the perceived impact on industrial beneficiaries. Organizational scientific freedom increases the effects of personality traits on perceived impact on beneficiaries such that scientists affiliated to a university are less likely than colleagues working in other research settings to perceive the simultaneous impact of their work on both industrial and clinical beneficiaries. Link to article.

David Barberá-Tomás. (2017). Uncertainty in the Hybridization of New Medical Devices: The Artificial Disc Case In Medical Innovation: Science, Technology and Practice, Routledge
Link to article.

David Barberá-Tomás; Jordi Molas-Gallart. (2014) Governance and technological change: the effects of regulation in medical devices. In The Governance of Socio-Technical Systems. Elgar.

Abstract
Any process of technical change carries with it an element of uncertainty: market responses are unpredictable, technologies may not work as expected and they may have unforeseen consequences. Such uncertainty occurs both when changes relate to a specific technology operating within a given innovation or socio-technical system, or when the changes are more profound and affect the whole system. Managing such uncertainty becomes one of the functions of a governance system, and in particular of the governance of processes of technological change. One of the instruments of such systems of governance is the development and implementation of regulatory frameworks. By focusing on regulatory frameworks, this paper addresses one of the three pillars of the analysis of the governance of change in innovation systems identified by Borrás and Edler (2014): the ‘instrumentation of the governance of change’. We see regulation as a form of governance instrument, shaping the ways in which actors involved in the innovation process develop, implement and use innovations. We understand regulatory frameworks as arrangements of ‘legally binding formal regulations which constrain and regulate interaction’ in innovation systems (Borrás and Edler, 2014). In other words, regulatory frameworks affect the way in which actors involved in innovation processes coordinate their activities: they ‘guide the search’ of innovation systems (Hekkert et al., 2007), and shape the direction of technological change and the evolution of innovation systems. Link to article.

Barberá-Tomás D., Consoli, D. (2013) Whatever works: Uncertainty and technological hybrids in medical innovation. Technology Forecasting and Social Change, Vol: 79 - pages 932 - 948

Abstract
The persistent uncertainty that looms over the search for solutions to health problems offers important conceptual insights for the study of technological change. This paper explores the notion of hybridization, namely the embodiment of multiple competing operational principles within a single medical device, as strategy to deal with the practical shortcomings due to said uncertainty. The history of the development of the hybrid artificial disc affords the elaboration of an alternative view of hybridization and, at the same time, the articulation of a dualism between medical science as area of basic research (e.g. what disease is) and as practical knowledge (e.g. how disease can be tackled).
Link to article.

Gittelman, M. (2016). The revolution re-visited: Clinical and genetics research paradigms and the productivity paradox in drug discovery. Research Policy, 45(8).

Abstract
Breakthroughs in genetics and molecular biology in the 1970s and 1980s were heralded as a major technological revolution in medicine that would yield a wave of new drug discoveries. However, some forty years later the expected benefits have not materialized. I question the narrative of biotechnology as a Schumpeterian revolution by comparing it to the academic research paradigm that preceded it, clinical research in hospitals. I analyze these as distinct research paradigms that involve different epistemologies, practices, and institutional loci. I develop the claim that the complexity of biological systems means that clinical research was well adapted to medical innovation, and that the genetics/molecular biology paradigm imposed a predictive logic to search that was less effective at finding new drugs. The paper describes how drug discovery unfolds in each paradigm: in clinical research, discovery originates with observations of human subjects and proceeds through feedback-based learning, whereas in the genetics model, discovery originates with a precisely-defined molecular target; feedback from patients enters late in the process. The paper reviews the post-War institutional history that witnessed the relative decline of clinical research and the rise of genetics and molecular science in the United States bio-medical research landscape. The history provides a contextual narrative to illustrate that, in contrast to the framing of biotechnology as a Schumpeterian revolution, the adoption of biotechnology as a core drug discovery platform was propelled by institutional changes that were largely disconnected from processes of scientific or technological selection. Implications for current medical policy initiatives and translational science are discussed. Link to article.

Gulbrandsen, M., Hopkins, M., Thune, T., & Valentin, F. (2016). Hospitals and innovation: Introduction to the special section. Research Policy, 45(8).
Link to article.

Hoekman, Jarno and Boon, Wouter (2019), Changing standards for drug approval: A longitudinal analysis of conditional marketing authorisation in the European Union. Social Science & Medicine, 222, pp 76-83

Abstract
Drug regulatory agencies around the world increasingly implement expedited regulatory pathways allowing for approval of medicines that intend to address unmet medical needs based on lower evidentiary standards than would be conventionally required. Few studies have investigated how companies and regulators utilise these pathways. We therefore conducted a longitudinal analysis of the emergence and implementation of the conditional marketing authorisation (CMA) instrument in the European Union. Drawing on archival documents, procedural data and interviews, we show that there was substantial ambiguity among regulators and companies about how to strike a new balance between evidentiary requirements and patient needs. As ambiguities were left unresolved, parties became reluctant to use CMA and in the majority of procedures did not use the pathway in a prospectively planned fashion. Rather, CMA became an option for regulators and companies to apply when submitted data were not strong enough to justify standard approval. Particularly, incumbent companies profited from this. The results stress the challenges of realising institutional change in drug regulation by showing how interest-driven actors can act upon ambiguities in attempts to shape regulatory outcomes and stretch rule interpretations. Link to article.

Kukk, P., Moors, E. & Hekkert, M. (2016). Institutional power play in innovation systems: The case of Herceptin® Research Policy, 45(8).

Abstract
New technologies must be accompanied by institutional change. Innovative actors therefore need to do institutional work or take a role as an institutional entrepreneur in order to shape the institutions in the best interests of their technology. However, the literature on system building and on institutional entrepreneurship have little overlap. The goal of this paper is to bridge these two bodies of literature to gain additional insights into how institutional change evolves in a technological innovation system. We show how the pharmaceutical firm Roche acted as a powerful institutional entrepreneur by influencing the health-care system in England to create a market for the personalized cancer drug Herceptin®. We demonstrate that institutional change can be preceded by a range of innovation system-building activities that are not directly intended to bring about institutional change but are required in order for institutional change to take place. Through this case study, we show how the system-building and institutional change literature can complement each other. Link to article.

Lander, B. (2016). Boundary-spanning in academic healthcare organisations. Research Policy, 45(8).

Abstract
Policy makers view academic healthcare organisations as important to healthcare innovation because they act as boundary-spanning organisations that integrate science and care institutional logics. Institutional logics are implicit and socially shared rules of the game that prescribe behaviour within a social group. This paper explores how individuals affiliated with academic healthcare organisations negotiate science and care institutional logics within their day-to-day work through a qualitative case study of research and healthcare within academic healthcare organisations in Vancouver, Canada. It highlights that there is less hybridisation of institutional logics than policy makers might hope: some researchers hosted in academic healthcare organisations are not part of the care institutional logic, others are not well integrated with the research institutional logic. Clinician–scientists often struggle to integrate the science and care institutional logics in their day-to-day work; other workers do integrate science and care institutional logics through experiments of nature but their research may not be viewed as high quality science. Because of poor hybridisation, academic healthcare organisations may not be as effective in facilitating healthcare innovation as policy makers assume. Link to article.

Llopis, O. & D’Este. P. (2016) Beneficiary contact and innovation: The relation between contact with patients and medical innovation under different institutional logics. Research Policy, 45(8).

Abstract
The recent policy agenda to enhance translational research in biomedicine emphasizes the need to promote interactions among all the actors involved in the medical innovation process. While patients are generally acknowledged to be a critical source to facilitate medical innovation, there is little empirical evidence on the relation between direct contact with patients and medical innovation. Drawing on organizational psychology and institutional theory research, we propose that contact with beneficiaries is likely to enhance scientists’ propensity to engage in innovation activities, and that the intensity of this relation is contingent on the institutional setting in which actors are embedded. Our study is based on a large-scale survey of biomedical scientists in Spain. Our findings show an inverted U-shaped relationship between contact with patients and participation in medical innovation. We also observe that the effect of contact with patients varies depending on the institutional logic in which scientists are embedded: our results show that the positive relation between contact with patients and innovation is particularly pronounced for scientists who are embedded in a science logic compared to a care logic. Link to article.

McKelvey, M. & Saemundsson, R. J. (2020) The grey zones of technological innovation: negative unintended consequences as a counterbalance to novelty. Industry and Innovation

Abstract
The purpose of this article is to better understand the challenges of avoiding the dark side of technological innovation. Specifically, we analyse 10 public investigations started as a reaction to a major crisis in regenerative medicine at the Karolinska Institute, Sweden, associated with the clinician-scientist Paolo Macchiarini. We interpret the reaction as an attempt to restore the balance between the stimulation and regulation of technological innovation processes by clarifying ambiguities in the regulation at the interface between research and practice. We conceptualise these ambiguities as grey zones – situations when it is unclear if the benefits of experimentation outweigh its risks – and propose that grey zones are continually created and resolved as actors in innovation governance systems counterbalance the generation of novelty and the risk of negative unintended consequences. Link to article.

McKelvey, M. and Rake, B. (2020) Exploring scientific publications by firms: what are the roles of academic and corporate partners for publications in high reputation or high impact journals?, Scientometrics, 122, 1323–1360.

Abstract
Recent research suggests that firms, particularly in science-based industries, may publish scientific articles in order to achieve strategic goals. This paper explores whether the reputation seen as publications in journals with high impact factors and the impact seen as citations of such scientific publications originating in firms benefit from R&D alliances with different types of partners. Our empirical analysis is based on a unique dataset in pharmaceutical cancer research. We analyze publications originating in biotechnology and pharmaceutical firms, with a comparison of the results to publications that do not involve a firm-based author. Our results indicate that the returns to the number of partners are decreasing and are negative after a turning point. More surprisingly, our results suggest that biotechnology and pharmaceutical firms should focus on establishing R&D alliances with pharmaceutical firms in order to increase the probability of publishing in journals with a high reputation. However, in terms of scientific impact, i.e., forward citations, publications originating in firms do not benefit from having access to different types of alliance partners. Link to article.

McKelvey, Saemundsson, R., and Zaring, O. (2017) A Recent Crisis in Regenerative Medicine: Analyzing Governance in Order to Identify Public Policy Issues, Science and Public Policy.

Abstract
This article focuses upon issues that public policy makers need to address, when trying to stimulate world-leading research into new areas, which are potentially also valuable to solving societal challenges. Our analysis helps contribute to the theoretical discussions about governance of new knowledge. We focus upon the sequence of events surrounding the main actors of a recent crisis of regenerative medicine in Sweden. We define governance theoretically, and use a conceptual model in order to structure the empirical analysis. Regenerative medicine is an interesting setting to explore these topics, not least because both public and private actors are often involved, and because governments struggle with how to promote ‘translational research’, e.g. diffusing scientific research into clinical practice. Our case study helps understand the process that led up to a crisis in regenerative medicine and identifies and discusses four issues that need to be addressed by policy makers. Link to article.

McKelvey, M and Rake, B. (2016) Product Innovation Success Based on Cancer Research in the Pharmaceutical Industry: Co-publication Networks and the Effects of Partners. Industry & Innovation. 23:5, pp. 383-406.

Abstract
This paper builds upon the literature which provides conflicting theoretical insights and empirical results concerning the importance of companies’ collaborative relations, their position within a network of collaborative relations and the effects on their innovative performance. Taking the importance of collaborations and networks in the pharmaceutical industry into account, the paper untangles the influence of the firm’s co-publication relations with different types of partners and its network position on the company’s product innovation in a specific disease area—cancer. We find rather robust evidence that in particular, companies’ indirect connections within the co-publication network, including connections to academic institutions and biotechnology companies, support product innovation. In contrast to evidence in the strategic alliance literature, direct co-publication links to biotechnology companies do not support product innovation in terms of new cancer medications. Link to article.

Miller, F. & French, M. (2016). Organizing the entrepreneurial hospital: Hybridizing the logics of healthcare and innovation. Research Policy, 45(8).

Abstract
Contemporary research hospitals occupy a vexed position in the policy landscape. On the one hand, as healthcare providers, they must abide by the logic of healthcare policy, which expects health research to support improved health outcomes and high quality healthcare systems. On the other hand, as research facilities, they are beholden to the logic of innovation policy, which seeks to advance research-driven, science and technology-derived innovations, where industry is the key customer and client. At the intersection of these policy logics, the research hospital must orchestrate a range of interests that may not always coexist harmoniously. Through a detailed case study of a Canadian research hospital, we illustrate organizational efforts to hybridize healthcare and innovation logics. The need to be more ‘business like’ and the expected financial and reputational rewards encourage acceptance of a mandate for technology transfer and commercialization. As well, there is hope that the entrepreneurial turn can serve the hospital's own mission, by prioritizing the needs of patients and the organization itself as a user of its own innovations. Further, insofar as successful technology transfer and commercialization is a transformative force, it is expected to enable the research hospital to achieve its goal of translational and impactful health research. As we illustrate, there is much optimism that these hybridizing efforts will produce a successful cross. Yet the trajectory of change in the context of mixed logics is necessarily uncertain, and other hybrid futures cannot be foreclosed. More sterile or monstrous outcomes remain possible, with potentially significant implications for the intellectual, economic and health benefits that will arise as a result. Link to article.

Miozzo, M. and DiVito, L., (2020) ‘Productive opportunities, uncertainty, and science-based firm emergence’, Small Business Economics, 54, 539-560.

Abstract
We provide greater theoretical precision to the concept of productive opportunities of Penrose. We show firm emergence as a recursive cycle of changing productive opportunities. We show how those opportunities result from the technological base of the firm and are associated with the particular characteristics of the technology. We also show how productive opportunities require the assembly of different internal and external resources, and therefore partners. We address explicitly how the firm and its potential partners perceive uncertainty and single out the different mechanisms used by the firm to address uncertainty—envisioning, pooling, and staging—to secure resources from external partners and exploit the identified productive opportunities in a timely manner. Link to article.

Miozzo, M. and DiVito, L. (2016) ‘Growing fast or slow?: understanding the variety of paths and the speed of early growth of entrepreneurial science-based firms’, Research Policy, 45 (5), 964-986.

Abstract
The paper explores the process of early growth of entrepreneurial science-based firms. Drawing on case studies of British and Dutch biopharmaceutical R&D firms, we conceptualize the speed of early growth of science-based firms as the time it takes for the assembly (or combined development) of three types of critical resources—a functionally-diverse management team, early fundraising and development of technology. The development of these resources is an unfolding and interrelated process, the causal direction of which is highly ambiguous. We show the variety of paths used by science-based firms to access and develop these critical resources. The picture that emerges is that the various combinations of what we call “assisted” and “unassisted” paths combine to influence the speed of firm growth. We show how a wide range of manifestations of technology development act as signaling devices to attract funding and management, affecting the speed of firm development. We also show how the variety of paths and the speed of development are influenced by the national institutional setting. Link to article.

Miozzo, M., DiVito, L. and Desyllas, P. (2016)‘When do acquirers invest in the R&D assets of acquired science-based firms in cross-border acquisitions? the role of technology and capabilities similarity and complementarity, Long Range Planning, 49 (2), 221-240.

Abstract
Drawing on a multiple case study of acquisitions of UK biopharmaceutical firms, we develop an analytical framework that elucidates how key determinants of the knowledge base of science-based firms and their combinations through M&As interact and affect post-acquisition investment in the target’s R&D projects. We show that two factors - the complementarity/similarity of the technology, and the complementarity/similarity of the discovery and development capabilities of the target and acquiring firm - interact to produce different outcomes in terms of investment in the acquired firm’s R&D assets and for the local science and technology system. Link to article. https://www.sciencedirect.com/science/article/pii/S0024630115000400

Molas-Gallart, J., D’Este, P., Llopis, O., & Rafols, I. (2016). Towards an alternative framework for the evaluation of translational research initiatives. Research Evaluation, 25 (3), 235-243.

Abstract
The perception that many promising results from basic biomedicine have not systematically contributed to medical treatments and, ultimately, health care improvements, has led to a wide range of publicly funded initiatives aiming at facilitating the ‘translation' of scientific discoveries into beneficial applications and practices. Many of these initiatives have been branded as ‘Translational Research' (TR), a term widely applied to large research programmes, research activities, and even academic journals. With the popularity of the term, a debate has emerged about the models of research that are to be considered ‘translational'. Consequently, the ways in which TR should be analysed and, more specifically, the approaches to the evaluation of TR programmes are also the subject of debate. Given the substantial investments in TR programmes, the definition of TR evaluation strategies and approaches has become an important element of the policy process. In a context of ambiguity about the type of activities to be considered as TR, evaluation approaches and practices can play an important role in determining what actions and outcomes are conceived, in practice, to be relevant and significant, and in doing so, shaping the future nature of TR initiatives. This article discusses the dominant approaches to TR evaluation and proposes an alternative evaluation framework, which would have implications both for TR evaluation processes and for the future shaping of TR programmes.
Link to article.

Molas-Gallart, J., D’Este, P., Llopis, O., & Rafols, I. (2016). Towards an alternative framework for the evaluation of translational research initiatives. Research Evaluation, 25 (3), 235-243.

Rake, B. and Häussler, C. (2019) Did relaxing clinical trial regulation enhance the stock of scientific knowledge in India? Not necessarily, PLoS ONE, 14(1), e0210163.

Abstract
The increasing amount of clinical research conducted outside the “traditional” countries raises questions about the benefits of hosting offshored clinical research. The extent to which trials contribute to the scientific knowledge base and, in particular, whether there are differences between different types of trials remain open questions. By examining a change in clinical trial regulations in India, a country often viewed as a first-choice offshoring location, we study how the relaxation of clinical trial regulations affects the number and the type of clinical trials as well as the domestic scientific knowledge base. Based on trial data from ClinicalTrials.gov and data on associated publication activities, our empirical analysis suggests that, despite an initial increase in the number of clinical trials, relaxing clinical trial regulations has a limited impact on the domestic scientific knowledge base. More specifically, the number of Indian researchers involved in the production of trial-related scientific knowledge remains modest. Furthermore, the potential to learn from the additional trials appears to be limited: the influx of phase 3 trials—mainly sponsored by Western-pharmaceutical firms—is accompanied by a lower likelihood that the trial results will be used in Indian researchers’ subsequent research activities when compared to phase 3 trials with preceding phase 2 trials, as was required before the regulatory change. Overall, our results contradict expectations that relaxing the regulatory requirements for conducting late-stage clinical trials is an appropriate means of supporting the development of the domestic scientific knowledge base. Link to article.

Thune, T., & Gulbrandsen, M. (2017). Combining knowledge to generate novelty: a study of disclosed ideas for life science inventions. European Journal of Innovation Management, 20(3), 446-462.

Abstract
Purpose: The purpose of this paper is to investigate how a combination of diverse sources of knowledge is important for generation of new ideas and address how institutional infrastructures and practices support integration of knowledge across organizations in medicine and life sciences. Design/methodology/approach: The paper investigates new product ideas that emerge from hospital and university employees, and looks at the extent of interaction between clinical and scientific environments in the idea generation process. The paper utilizes data about all new product ideas within life science that were reported in South-Eastern Norway in 2009-2011, as well as information about the individuals and teams that had been involved in disclosing these ideas. Interviews with inventors have also been carried out. Findings: Interaction and integration across scientific and clinical domains are common and important for generating new product ideas. More than half of the disclosed life science ideas in the database come from groups representing multiple institutions with both scientific and clinical units or from individuals with multiple institutional affiliations. The interviews indicate that the infrastructure for cross-domain interaction is well-developed, particularly for research activities, which has a positive effect on invention. Originality/value: The paper uses an original data set of invention disclosures and investigates the hospital-science interface, which is a novel setting for studies of inventive activities. Link to article.

Thune, T. & Mina, A. (2016). Hospitals as innovators in the health-care system: A literature review and research agenda. Research Policy, 45(8).

Abstract
This paper aims to improve the understanding of the role of hospitals in the generation of innovations. It presents a systematic and critical review of the interdisciplinary literature that addresses the links between the activities of hospitals and medical innovation. It identifies three major research streams: studies of the contribution of medical research and clinical staff to innovation, analyses of novel practices developed and diffused in hospitals, and evolutionary studies of technical change in the context of human health care. This is a highly heterogeneous body of literature, in which comprehensive theoretical frameworks are rare, and empirical studies have tended to focus on a narrow range of hospitals’ innovation activities. The paper introduces and discusses a framework integrating different perspectives that can be used to analyze the functions performed by hospitals at the intersection with different partners in the health innovation system and at different stages of innovation trajectories. On the basis of current gaps in the literature, a research agenda is discussed for a relational and co-evolutionary approach to the study of hospitals as innovators. Link to article.

Trust Saidi, Taran Mari Thune & Markus Bugge (2020), Making ‘hidden innovation’ visible? A case study of an innovation management system in health care. Technology Analysis & Strategic Management.

Abstract
Innovation activities in health care are difficult to monitor and manage as they are often tied to improvements of ongoing practices and services. Finding a way to make ‘hidden innovations’ visible is important if innovation is to be managed strategically within and across hospitals. This paper analyses the development of an innovation monitoring and management system in the Norwegian health care sector. The system, more precisely a technical infrastructure and development of practices to support its use, is analysed as an ‘inscription device’. The paper looks at whether the system has enabled an increased visibility of innovations, and whether this has improved the capability to manage innovation. The findings indicate that the system has to some extent contributed towards making hidden innovations more visible, and it has enabled sharing and learning not only among the hospitals, but also with external partners. However, there is still a limited use of the system, which relates to lacking abilities and incentives among staff to engage with the system, as well as the absence of common guidelines and joint understanding of the notion of innovation. This underscores the point that organisational practices need to be developed for innovation to be supported and managed. Link to article.

Windrum. P.; Schartinger, D.; Waring, J. (2017), "Co-creation of Social Innovations and New Professional Institutions: Diffusion of therapeutic patient education (TPE) for diabetes in Austria", Industry and Innovation, pp.1-24, Available online in journal March 2017.

Abstract
The paper examines the link between institutional change and the development and diffusion of social innovations. Patient-centred education in diabetes is a radical social innovation that alters the social and medical relationship between patients and medics. This paper discusses the ways in which institutional work conducted by national and international professional associations has shaped development and diffusion of this social innovation within the Austrian health system. The case study contributes to our understanding of social innovation and institutional change in two respects. First, it highlights the need for purposive institutional work in order to disrupt pre-existing institutions and, thereby, ensure the development and diffusion of a social innovation amongst a community of medical practitioners. Second, the case shows the overtly political work, policing and educating work that professional associations undertook with funding bodies and key policy-makers in order to develop a national programme for diabetes education. Link to article.

Windrum, P. (2014), "Third sector organizations and the co-production of health innovations", Management Decision, Vol.52 (6), pp. 1046-1056.

Abstract
Purpose: The purpose of this paper is to examine the roles played by third sector organizations in forming and managing health innovation networks, and their contribution to the co-production of new health services. Design/methodology/approach: Using data collected in four case studies, the findings highlight the central role of third sector organizations in forming and organizing public-private health networks.
Findings: They are trusted organizations, commonly patient advocates, with perceived neutrality. Members of these organizations take leading roles in innovations networks, using their excellent network connections and their prominent positions within their organizations to leverage competences and funding. A key asset of key third sector individuals is their prior experience of public and private sector organizations and, hence, the ability to move across public-private boundaries. Practical implications: The research findings have important implications for practitioners. The author identifies a set of key drivers and barriers for the successful organization of innovation networks and the innovative services they develop. Prior knowledge and experience of partners, often linked to personal ties, in initial partner selection but are also important for trust and the effective organization of complementary competences during innovation projects. The absence of direct competitors – whether public, private or third sector organizations – is also highlighted. Non-rivalry and different partners’ interests in the outcomes of the innovation reduces moral hazard and the associated costs of setting up and monitoring formal contracts. Heterogeneity requires flexibility by actors; to understand partners’ different values, cultures, and organizational drivers. Finally, the research findings identify policy and practitioner enrolment as critical for the successful roll out and diffusion of service innovations. Originality/value: The paper examines an important, but under researched issue – the role of third-sector organizations in collaborative innovation projects. Link to article.

Windrum, P. (2013), "Role of third sector organizations in health innovation networks", in S. P. Osborne and L. Brown (ed) Handbook Of Innovation In Public Services, pp. 88-103, Cheltenham: Edward Elgar.

Extract
This chapter addresses the role played by third sector organizations in forming and managing health innovation networks, and their contribution to the co-production of new health services. The third sector has grown significantly, both in terms of the number of third sector organizations which exist and the range of sectors in which they operate. Research on the third sector is nascent but intensifying as national governments and the EU consider its social and economic role (Osborne 2009). Third sector organizations are found in a variety of sectors in Europe, and take a variety of organizational forms. Kendal and Knapp (1995) describe the third sector as a ‘loose and baggy monster’. Hasenfeld and Gidron (2005) highlight the complex organizational forms that are developing in not-for-profit organizations and link this to specialization and differentiation. Brandsen et al. (2005) and Evers (2005) propose that the traditional ideal-type characterization of voluntary organizations no longer applies because these hybrid organizational forms mix core values, cultures and organizational forms which were previously thought to be discrete and particular to the public and the private sector. Link to chapter.

Windrum, P. (2013), "The co-production of health innovations", in F. Gallouj, L. Rubalcaba, and P. Windrum (ed) Public-Private Sector Innovation Networks, (pp. 228-246), Cheltenham: Edward Elgar.

Extract
This chapter addresses the co-production of health service innovations, specifically focusing on the roles of end-users (that is, patients) and third sector organizations within the innovation process. Third sector organizations gave multifaceted roles that include patient advocate, knowledge-intensive service (KIS) provider, independent financier for innovation and the organization of the innovation networks that produce new health services. Third sector organizations are found in a variety of sectors, and take a variety of organizational forms. Kendal and Knapp (1995) describe the not-for-profit third sector as a ‘loose and baggy monster’ that includes unincorporated and voluntary associations, trusts, charities, cooperatives, foundations and not-for-profit business enterprises and social enterprises. The chapter has two aims. First, to critically examine the co-production of new health services. Second, to identify the specific contributions of third sector organizations to the organization and management of the innovation networks that co-produce new health services. The empirical research presented in this chapter is based on a cross-cutting meta analysis of ten case studies that were developed in the European Union (EU)-funded Public–Private Innovation Networks in Services (ServPPINs) project. Co-production has received much attention from scholars researching private sector services. Co-production was first discussed by Fuchs (1996), who observed that the knowledge, experience and motivation of users have a direct impact on the productivity of the provider. Fuchs took as his examples retail, banking, education and health services. Link to chapter.

Windrum, P.; Garica-Goni, M.; Fairhurst, E. (2010), "Innovation in public health care: Diabetes education in the UK", in Handbook of Innovation in Services, F. Gallouj, F. Djellal, and C. Gallouj. Cheltenham

Extract
Paul Windrum, Manuel García-Goñi and Eileen Fairhurst1 6.1 Introduction This chapter presents an application of the Windrum and García-Goñi (2008) model of public sector innovation. The case study that is being used to test the model is the provision of new education services for patients suffering Type 2 diabetes. The case study provides a useful introduction, and overview, of the particular issues that are raised by studies of public sector service innovations for innovation scholars. In particular, it is necessary to include explicitly the influence of public sector organisations and policymakers within the analysis. Also, one needs to consider the influence of heterogeneous user preferences and needs on the innovation process. Each has, by and large, been omitted in past theoretical and empirical studies of innovation in (private sector) services and manufacturing. Building on the work of Saviotti and Metcalfe (1984) on manufacturing innovation, and Gallouj and Weinstein (1997) on innovation in private sector services, the Windrum and García-Goñi model is a multi-agent model that explicitly considers the way in which interactions between service providers, patients and government policy-makers shape the development and diffusion of innovations within public sector healthcare. The Windrum and García-Goñi (2008) model is neo-Schumpeterian in two senses. First, one can use it to consider the five types of innovation discussed by Schumpeter (1934, 1943): product innovation, process innovation, organizational innovation, market innovation and material innovation. Second, it is neo-Schumpeterian in the sense that it is a generic model. Link to chapter.

Windrum, P.; García-Goñi, M. (2008), "A neo-Schumpeterian model of health services innovation", Research Policy, Vol.37(4), pp.649-672.

Abstract
The paper presents and empirically applies a neo-Schumpeterian model of innovation capable of studying interactions between service providers, patients and policy makers, and how these complex interactions determine the timing, direction, and success of innovations in the public sector. The model is tested using a case study that traces the introduction and development of ambulatory surgery in a Spanish hospital. The multi-agent model applies the ideas of Schumpeter to services, encompassing Schumpeter's five types of innovation, and re-introducing the policy-maker as a key agent in the innovation process. The model has a number of advantages over previous, reduced form models. First, it can analyse the interactions between the economic, social and political spheres that make up the complex selection environment of innovations. Second, it captures the recursive impact of radical innovations on agents’ competences and preferences, and their relative power. This brings politics, power, and rhetorical persuasion to the fore. Third, it provides an improved set of definitions for radical and incremental innovation. These are not only important for understanding the sources and drivers of innovation, but also for the accurate measurement of innovation. Link to article.

Yaqub, Ohid. (2018) Variation in the dynamics and performance of industrial innovation: what can we learn from vaccines and HIV vaccines? Industrial and Corporate Change, 27 (1). pp. 173-187. ISSN 0960-6491

Abstract
This article examines contingencies and constraints in problem-solving processes underlying technological change and industry evolution. It shows how learning through practice can help drive technical change but, when this is impeded, the ability to make use of models and engage in experimental learning becomes even more pertinent for explaining variation in the rate and direction of technical change. The article explores HIV as an example of vaccine innovation, and vaccines as an example of medical innovation. I find the absence of these two variables (ability to learn directly in humans, and ability to learn vicariously through animal models) not only make up a large part of how I would characterize “difficulty” in the HIV R&D process, but they also seem to go a long way toward explaining why 33 other diseases have—or have not—had vaccines developed for them. Implications for theory and policy are discussed. Link to article.

Yaqub, Ohid (2017),Testing regimes in clinical trials: evidence from four polio vaccine trajectories. Research Policy, 46 (2). pp. 475-484. ISSN 0048-7333

Abstract
This paper highlights distinctive features of a neglected class of economic activity in the domain of medical innovation, namely the creation of testing regimes in clinical trials, asking how their nature might be expected to affect innovation of medical technology. It argues firstly that clinical trials are not simply about passively validating an already well-known technology and verifying its safety. Rather, clinical trials are part of a more active process of learning that allows pharmaceutical innovations to be useful outside the laboratory. It argues secondly that product development can proceed along a number of long and costly paths before a product’s behaviour in actual practice becomes clear, which can make selecting between alternative courses of action difficult. Thus, product choice and product development need to go hand-in-hand. To consider these arguments, the paper maps out four trajectories of polio vaccine development, tracing their paths through clinical trials since the 1950s, and describes some of the defining features of testing regimes for medical innovation. These include institutions that integrate knowledge and co-ordinate skills in testing processes, and capabilities for allocating testing resources, managing testability constraints, sharing knowledge and improving commensurability between testing communities. Link to article.

Yaqub, Ohid and Nightingale, Paul (2012), Vaccine innovation, translational research and the management of knowledge accumulation. Social Science and Medicine, 75 (12). pp. 2143-2150. ISSN 0277-9536

Abstract
What does it take to translate research into socially beneficial technologies like vaccines? Current policy that focuses on expanding research or strengthening incentives overlooks how the supply and demand of innovation is mediated by problem-solving processes that generate knowledge, which is often fragmented and only locally valid. This paper details some of the conditions that allow fragmented, local knowledge to accumulate through a series of structured steps from the artificial simplicity of the laboratory to the complexity of real world application. Poliomyelitis is used as an illustrative case to highlight the importance of experimental animal models and the extent of co-ordination that can be required if they are missing. Implications for the governance and management of current attempts to produce vaccines for HIV, TB and Malaria are discussed. Link to article.