Disruptive versus incremental innovation in healthcare…

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Andy Goldberg MD FRCS(Tr&Orth)Consultant Orthopaedic Surgeon

Royal National Orthopaedic Hospital NHS Trust

Deputy Director R&DUCL Institute of Orthopaedics & Musculoskeletal Science

Andy Goldberg MD FRCS(Tr&Orth)www.medicalfutures.co.uk

Andy Goldberg MD FRCS(Tr&Orth)www.medicalfutures.co.uk

Andy Goldberg MD FRCS(Tr&Orth)www.medicalfutures.co.uk

Andy Goldberg MD FRCS(Tr&Orth)www.medicalfutures.co.uk

Andy Goldberg MD FRCS(Tr&Orth)www.medicalfutures.co.uk

?Better?

Andy Goldberg MD FRCS(Tr&Orth)www.medicalfutures.co.uk

Andy Goldberg MD FRCS(Tr&Orth)www.medicalfutures.co.uk

Market cap $340BnLargest company in the world

T/o - $65Bn, $14Bn Profits Making it 111th company in size

Andy Goldberg MD FRCS(Tr&Orth)www.medicalfutures.co.uk

Market cap $340BnLargest company in the world

T/o - $65Bn, $14Bn Profits Making it 111th company in size

T/o $350Bn with $30Bn Profits

Disruptive Technology

Andy Goldberg MD FRCS(Tr&Orth)www.medicalfutures.co.uk

Andy Goldberg MD FRCS(Tr&Orth)www.medicalfutures.co.uk

Andy Goldberg MD FRCS(Tr&Orth)www.medicalfutures.co.uk

Andy Goldberg MD FRCS(Tr&Orth)www.medicalfutures.co.uk

Andy Goldberg MD FRCS(Tr&Orth)www.medicalfutures.co.uk

Andy Goldberg MD FRCS(Tr&Orth)www.medicalfutures.co.uk

Andy Goldberg MD FRCS(Tr&Orth)www.medicalfutures.co.uk

Everett Rogers, Professor of Rural Sociology, Iowa (Rogers, Everett M. (1962) Diffusion of Innovations)

Adoption of Innovation

Andy Goldberg MD FRCS(Tr&Orth)www.medicalfutures.co.uk

Everett Rogers, Professor of Rural Sociology, Iowa (Rogers, Everett M. (1962) Diffusion of Innovations)

Adoption of Innovation

Andy Goldberg MD FRCS(Tr&Orth)www.medicalfutures.co.uk

Everett Rogers, Professor of Rural Sociology, Iowa (Rogers, Everett M. (1962) Diffusion of Innovations)

JVC VHS

Sony’s BetaCam

Adoption of Innovation

Adopter’s willingness to

participate

AwarenessInterestEvaluation (evidence base)Tendency to risk

Andy Goldberg MD FRCS(Tr&Orth)www.medicalfutures.co.uk

Adopter’s willingness to

participate

AwarenessInterestEvaluation (evidence base)Tendency to risk

Andy Goldberg MD FRCS(Tr&Orth)www.medicalfutures.co.uk

Uncemented Hips

MeyerBurutaranL.S Barouk

Andy Goldberg MD FRCS(Tr&Orth)www.medicalfutures.co.uk

Andy Goldberg MD FRCS(Tr&Orth)www.medicalfutures.co.uk

Uncemented Hips

Andy Goldberg MD FRCS(Tr&Orth)www.medicalfutures.co.uk

Uncemented Hips

Andy Goldberg MD FRCS(Tr&Orth)www.medicalfutures.co.uk

Uncemented Hips

Stepwise Introduction

of Technology*Preclinical TestingFirst In ManClinical TrialsPost Market Surveillance

Andy Goldberg MD FRCS(Tr&Orth)www.medicalfutures.co.uk

* Malchau 1995 (modified)

Stepwise Introduction

of Technology*Preclinical TestingFirst In ManClinical TrialsPost Market Surveillance

Andy Goldberg MD FRCS(Tr&Orth)www.medicalfutures.co.uk

* Malchau 1995 (modified)

– FDA & MHRA

Are we joined up?

FDA/MHRAClinical GroupsNICEInsurers/CommissionersIndustry

Andy Goldberg MD FRCS(Tr&Orth)www.medicalfutures.co.uk

* Malchau 1995 (modified)

New Proposal

Industry has commercial pressuresNHS funds research (circa £1Bn)Quid Pro Quo

Andy Goldberg MD FRCS(Tr&Orth)www.medicalfutures.co.uk

* Malchau 1995 (modified)

New ProposalNew Technology Panel (composed of stakeholders (ie regulators, clinicians, commissioners, industry and patients)

Identify what evidence could be developed at the outset

Joint funding of research (NHS & Industry)

Limited marketing authorisation granted to industry (to trial centres who pay for product)

Full marketing authorisation granted after agreed time period

Andy Goldberg MD FRCS(Tr&Orth)www.medicalfutures.co.uk

Q&A Session

andy@medicalfutures.co.uk