Co-creation of social innovations and new professional institutions: diffusion of therapeutic patient education (TPE) for diabetes in Austria

Abstract

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.

The application of social innovation in healthcare: a scoping review

“…Kreitzer et al [ 76 ], for example, explored the Buurtzorg (Neighbourhood Care) Model in the Netherlands, designed to overcome vertical service delivery, low health worker satisfaction, and burdensome bureaucratic processes of care. De Freitas et al [ 73 ] presents a participatory process involving families of patients affected by congenital disorders in the design interventions in areas where health systems responsiveness is poor, and Windrum et al [ 77 ] presents the case of creating a standardised diabetes prevention and management programme based on patient-centred principles. This programme led to the reform of care provision across multiple countries.…”

“…These models may or may not have a digital component or a financial component. Innovation in care models involved the re-organisation of care processes, including how services were delivered, often moving facility-based services directly into the community, with the role and scope of providers modified to give more autonomy or allow for task-shifting to non-health professionals [ 63 , 70 , 76 , 77 , 80 , 86 ]. These care models reported positive outcomes on extending access to health services, enhancing affordability and improving effectiveness on disease or wellbeing indicators.…”

“…teachers) to network of primary care doctors Teachers act as main custodian of school children health ↑ Community ownership over health in line with collectivist cultural values ↓ In indirect costs of accessing care via in person doctor consultation ↑ Affordability of care ↑ Appropriateness of in-person consultations Merkel et al (2018), [ 70 ] Gesundes Kinzigtal (Healthy Kinzigtal) Germany Facility Overcoming fragmented and uncoordinated care through the HK integrated care programme A joint venture between a network of physicians and healthcare management company to extend health services Model supported by two sickness funds and a network 150 partners including allied health services, sports clubs, and self-support groups Outcome-oriented financial approach: profit only made if cost margins of population goes down ie. outcomes improve Provider training in supporting patient self-management and shared decision making Patient accountability through a patient advisory board, satisfaction surveys and patient ombudsman ↑ Patient outcomes ↓ In health expenditure Vijay et al (2018), [ 86 ] Kerala Community Palliative Care India Indian medical doctors & volunteers Community 230 community organizations (85 doctors, 270 nurses 15 000 volunteers, 26 000 social health activist providing care to 70 000 people across 143 villages (2012) Overcoming access to end of life services and the restrictions of a hospice-based approach: A hub-and spoke model linking community organizations to clinics Non-medical professionals, community volunteers, deliver palliative services Services delivered directly in people’s home ↑ Access to of care ↑ Affordability of care ↑ Awareness of palliative care Windrum et al (2018), [ 77 ] Therapeutic Patient Education Austria Facility Restructuring chronic disease diabetes care according to a patient-centred approach comprised of: Training diabetes educators (different health professionals) and specialist physicians’ postgraduate course Engaging professional associations to set standardised processes for diabetes care and ensuring compliances Including the services as core to the Social Health Insurance fund ↑ Patient knowledge & self-management ↑ Healthy lifestyle behaviour in diabetics Srini...…”

“…In addition to embedding social innovations directly into communities, institutionalised actor networks can work to ensure sustainability. One model which has successfully embedded an initiative across multiple institutional levels is the Therapeutic Patient Education Model for Diabetes [ 77 ] in Austria. This case demonstrates the importance of social innovations engaging in institutional and political work with existing professional bodies at local and international levels, while creating new professional bodies to support its translation from research, its diffusion and its sustainability.…”

“…health insurance funds), while they created new institutions (new professional bodies) to ensure that new norms, values and practices were embedded at a systems level. Windrum et al [ 77 ] recognised the potential of a model of patient centred care as having the potential of democratising medicine.…”