Improvisation during a crisis: hidden innovation in healthcare systems

Abstract

BackgroundCrises, such as the COVID-19 pandemic, risk overwhelming health and social care systems. As part of their responses to a critical situation, healthcare professionals necessarily improvise. Some of these local improvisations have the potential to contribute to important innovations for health and social care systems with relevance beyond the particular service area and crisis in which they were developed.FindingsThis paper explores some key drivers of improvised innovation that may arise in response to a crisis. We highlight how services that are not considered immediate priorities may also emerge as especially fertile areas in this respect.ConclusionHealth managers and policymakers should monitor crisis-induced improvisations to counteract the potential deterioration of non-prioritised services and to identify and share useful innovations. This will be crucial as health and social care systems around the world recover from the COVID-19 pandemic and head into another potential crisis: a global economic recession.

Home palliative care professionals perception of challenges during the Covid-19 outbreak: A qualitative study

“…Flexibility should be fostered in healthcare organizations and stimulating improvisation and innovation in organizational culture may be a strategy for preparing healthcare workers in an emergency crisis. 54 The healthcare team played an essential role for home palliative care professionals, 37 both in terms of the clinical management of patients as well as their emotional support. It seems a good strategy to promote meetings and debriefing sessions among healthcare workers during an emergency situation.…”

‘Necessity is the mother of invention’: Specialist palliative care service innovation and practice change in response to COVID-19. Results from a multinational survey (CovPall)

“… 6 A more ubiquitous definition, also used in healthcare, 7 , 8 defines innovation more broadly as ‘an idea, practice or object that is perceived as new’ so a change in practice may be novel even if the same approach has been used elsewhere (p.12). 9 In crisis management, innovation can incorporate ‘improvisation’, 10 – 13 which involves organisations using, adjusting and recombining existing resources, structures and processes to manage the impact of a crisis. 14 In this paper, the term innovation is used as a broad umbrella term that includes ‘improvisation’ and practice change.…”

‘Necessity is the mother of invention’: Specialist palliative care service innovation and practice change in response to COVID-19. Results from a multi-national survey (CovPall)

“…The term improvisation rather than innovation has been used in crisis management 24-27 , as organisations are required to be creative by using, adjusting and recombining existing resources, structures and processes to manage the impact of a crisis 28 . In these circumstances, resistance to change is limited as there is an acceptance that ‘normal’ rules no longer apply and a collective identity develops, as seen in this study, with clinicians no longer working in professional silos and previously resisted technology being used 25 . Whilst used in a different context, such limited resistance to change resonates with Klein’s 29 concept of the ‘shock doctrine’ in which extreme crises (such as COVID-19) pertain the power to ‘shock’ systems and, in doing so, shake up socio-cultural norms to the extent that new changes – that may have been previously resisted - can be made quicker and easier than usual.…”

“…Changes seen do not reflect the standard literature on the diffusion of innovations 6, 9 . Standard forms of innovation require planning and funding, often impossible when responding to an unforeseen event like the COVID-19 pandemic 24, 25 . The term improvisation rather than innovation has been used in crisis management 24-27 , as organisations are required to be creative by using, adjusting and recombining existing resources, structures and processes to manage the impact of a crisis 28 .…”

“…A successful frugal innovation or improvisation may be retained but may not be useful unless there is a similar future crisis 27 . Changes in practice may lead to unethical practices and negative outcomes as resource scarcity may, in some instances, simply undermine the quality of care 25 . The challenge of implementing remote clinical consultations rapidly during the pandemic with limited resources, for example, has been raised 37 and how sustainable changes are beyond the pandemic without the necessary infrastructure being in place has been questioned 38 .…”