Opinion: How COVID-19 innovation is leading to better health services for Canadians

By Shannon MacDonald, FCPA, FCA, MHSc, ICD.D. Originally published on Linkedin, August 3rd, 2021

COVID-19 is a game changer for public sector health care innovation. Normally a risk-averse environment rewarding safe incremental change, our governments were catapulted into a series of innovative behaviours because the impact of inaction outweighed all else.

Many leaders demonstrated the resilience and courage needed to get us through the pandemic. Together these leaders have driven significant government innovation and new ways of thinking that could benefit citizens for generations.

We can now identify the best cases and use them to imagine the health systems we want for tomorrow. Many organizations fail to innovate because their business/operational models, organizational structures and leadership teams find it difficult to adjust to new ways of thinking and doing. Following a rigid path with top-down solutions may help reduce fear and uncertainty but can be counterproductive and limit an organization’s full innovative potential.

Governments also operate with limited resources, many competing priorities and significant public scrutiny. Governments are therefore designed to minimize risk and avoid situations where they may be seen as unreliable financial stewards. This can often be incompatible with the behaviours required to drive successful innovation such as failing fast, moving at scale, embracing partnerships, diversifying teams, and leading with resiliency.

Based on some observations, particularly framed from personal experiences in Ontario, here are some examples from our collective COVID-19 pandemic response where governments did get strong results with risks well managed and while using these innovation behaviours:

Innovation behaviour #1 – Fail fast (or learn fast): A manner of exploring innovation in which ideas are tried, tested and revisited resulting in new insights.

Pandemic Implementation: Initial implementation models of vaccine deployment needed to adapt as new waves exposed more vulnerable populations. The resulting evolution of vaccine distribution explored new, more efficient ways to deploy vaccines with stronger efficacy based on constant feedback in the system.

Outcome: With vaccine distributions, the Ministry of Health and Public Health Units were able to test several unique approaches through various iterations. In December 2020, Ontario quickly outfitted 20 clinics modelled after 2 pilots the week before. Within 24 hours and over a holiday period hundreds of people were trained and deployed to set up effective processes, leverage brand new enabling software and safely administer doses. There was no time lapse because of planning and approvals. Everyone was motivated and speed during exploration was experienced. People accepted uncertainty and solved issues, growing these clinic models to thousands that serve hundreds of thousands weekly. Later in the process, leveraging new data from the recently deployed systems, health leaders were then able to prioritize high-risk postal codes or high-risk locations like long-term care homes and there was more discovery with significant impact to decrease negative outcomes.

Innovation behaviour #2 – Embrace partnerships: Collaboration and ecosystems are an increasingly important part of successful innovation and where parties come together to the table often creating the most optimal solutions.

Pandemic Implementation: Leadership tables throughout the pandemic brought together the best minds in science, commercial corporations and governments to come forward with innovative and thoughtful ways of collaboration and integration.

Outcome: The ecosystem did not show silos in the pandemic. Governments, public health units, hospitals, pharmacies, and more all engaged for a common cause to combat the virus. These stakeholders worked side by side, knowing their own strengths, sharing insights and collaborating daily. When questions arose, all worked together to find the answer. Hierarchies or funding relationships were put aside. Pharmacies played an integral role in distributing vaccines, creating an accelerated deployment with their role as accessible community locations.  Researchers across universities quickened the pace to find innovative and efficient solutions to support decision-makers.

Innovation behaviour #3 – Diversity in teams: Different backgrounds and skillsets unlock innovation and improve decision making.  

Pandemic Implementation: New insights from different research sources created an enhanced platform for decision-making. We were able to improve health systems by creating an environment for increased collaboration to solve problems. Integrated teams benefitted from professionals in multiple disciplines, bringing a mixture of hard and soft skills.

Outcome: Support teams came from many disciplines. The variation in backgrounds meant that often people who had relevant insights from their background were able to problem solve beyond the job assigned to them. The concept of home room was no longer a restricting matter – if you had insight, lean in and help to solution. Through this approach, collaboration with different skillsets unlocked unique insights. For example, research around cause of death during the pandemic was accelerated through the validation of cremation data as a leading indicator to support the identification of cause of death earlier and highlight complex trends beyond COVID, speeding up insights from more traditional, yet not-time sensitive data sources.

Innovation behaviour #4 – Patient voice/perspective: By bringing a patient-first approach to innovation, we’re able to provide a greater service to a demographic that is increasingly shaping how healthcare is provided, is more technologically savvy and is advocating for more access.

Pandemic Implementation: When focused on a patient, with a consumer approach to service, silos around patient service/interaction break down. Different disciplines are incentivized to collaborate through a universal health outlook. Everything from following the patient’s diet, exercise, recovery from surgery, physio and vaccines can be related.

Outcome: Personal health information has been highly fragmented, requiring people to repeat all aspects of their statistics and medical history with each medical encounter. Leveraging a Customer Relationship Management system, data collection was able to be designed in a user-friendly manner. The emergence of integrated data with these CRMs is enabling citizens to get test results, contact tracing and vaccine proof almost immediately. The integration of lab data with contact tracing information in the pandemic has been a significant time saver, freeing people from unnecessary quarantines. The focus on data collection also resulted in a rapid deployment/ frequent release approach to technology support. As a result, the timeframe from policy development to front line experience averaged 48 hours. The addition of thousands of volunteers at clinics to make sure people felt comfortable and oriented also created a strong citizen focused experience.

Innovation behaviour #5 – Be a resilient leader: Sustain energy levels while under pressure to cope with disruptive changes and simply adapt and bounce back from setbacks.

Pandemic Implementation: When innovating, it’s important to try new approaches that gain the best results and not simply copy existing approaches. By taking a trial-and-error approach, we are able to explore new territories and bring fresh ideas to the table.

Outcome: While Ontario built capacity for the millions that would require concurrent vaccine processing and recording, there were slow down periods created by vaccine delivery delays. However, these delays never resulted in pauses in the development, all hands were on deck to create micro-innovations within the long-range plan. Weathering criticisms on delays, work continued to analyze populations and design the future frameworks for hybrid models of mass clinics and pop up clinics that were flexibly deployed during the subsequent months. Resiliency was also seen in many jurisdictions as some prioritized 20-year-old’s because of their typical interactive social and work behaviour; others targeted long-term care homes due to outbreaks – while the approaches were different, we can appreciate the unique tactics and the learnings that came from each.

Innovation behaviour #6 – Move at scale: Achieving repeatable and sustainable success at new products, process, or concepts allows for broader application and more positive impact. 

Pandemic Implementation: The pandemic environment allowed us to move and innovate at scale. Cloud technology provided handling of volumes of data, Customer Relationship Management systems allowed for patient focus, and data security ensured data integration. With these proven tools quicker data insights and more rapid decision-making was enabled.

Outcome: The pandemic vaccine technology solution enabled real time data on individuals at all vaccination sites for trusted monitoring of vaccine distribution, including types, timing, and frequency. Early pilots were quickly replicated at various locations (hospitals, mass clinics, pharmacies, community centres, airports), bringing the vaccine to the population as quickly as supply was available.  Clinic spaces were designed in pockets and then teams were always running ahead to get clinics planned and implemented in communities across the province. The extended project team learned to work in nimble small teams that were able to communicate across teams and share success and innovations daily. End users were also involved in the process as their feedback was requested and listened to, resulting in improved experiences every time they interacted with the process.

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Health care is estimated to account for 11.5 % of Canada’s total GDP– and represents nearly 40% of provincial budgets. Over and above the better health outcomes and system efficiencies we can achieve, we must not lose sight of a government’s ability to drive change and innovation, not only in citizen services, but in our entire society.

With so many exciting technologies coming on stream the possibilities for innovation are endless. While innovation brings many unknowns, the right approach can reduce the risk, engage project partners and maximize outcomes.

Post-pandemic, governments can recognize lessons learned where innovation occurred and reflect on how to sustain it, allowing of course for the management of reasonable risk. Many government and health leaders have proven themselves to be resilient and transformational. Understanding and supporting their efforts is a key public policy priority as we forge a new modern post-pandemic citizen-government relationship.

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