Game changers: the outsiders driving new health policy

Game changers: the outsiders driving new health policy

Progress in the health promotion sector is often influenced by smaller, peripheral agencies that are agile, innovative and not afraid to try something new.


The world in which healthcare is delivered is rapidly changing and that poses something of a challenge to traditional health sector institutions according to Dr Vishaal Kishore, Professor of Innovation and Public Policy at RMIT University.

‘Governmental efforts to balance fiscal policy mean our supply institutions face new and structurally more constrained funding environments. Public trust in established institutions is arguably at an all-time low, and patients are demanding more than ever from the health system,’ he says.

But while this turbulence could be perceived as unsettling, Kishore points out that it also creates an enormous opportunity to expand the role played by the innovative and creative peripheral organisations which simultaneously sit both ‘inside and outside the great debate of public and policy ideas’.

Peripheral organisations have the most ability to influence what might be the innovation edge of practice

Bureaucrats and politicians have traditionally wielded the power in Australia’s health policy sphere, and while remarkable individuals and pockets of innovation exist within the established policy and political mainstream, Kishore argues that established institutions are often only able to focus on the ‘middle of the bell curve’.

‘If you’re running a large government department like a Department of Health, you’re keeping an entire health system running,’ says Kishore. ‘This makes dealing with anything on the edges – anything exceptional – much harder.  It’s the fringes that are routinely easier to overlook.’

Often the ends of a bell curve encompass groups of people who are extremely marginalised or vulnerable, with complex physical and mental health issues. ‘Basic ideas about health equity demand that we act to serve those at the fringes of our system,’ says Kishore. ‘If we can find creative and novel ways of addressing those at the edges of our system, there is a significant opportunity of generating very real gains for the system and the individual.’

Revolution from the periphery


While there is little doubt that the current health policy environment needs catalysts to help drive innovation for those on the edges of the system, it can struggle to generate the momentum. This is where the ‘peripheral organisations’ come in.


‘Peripheral organisations don’t hold any day-to-day responsibility for running major systems, but they still connect with different elements within the health sector, the economy and society,’ says Kishore.

The benefit of peripheral agencies is that they are on what Kishore calls the edge of practice.

‘These organisations have the most ability to influence what might be the innovation edge, the service edge, or the “vulnerability and drop-off” edge of practice,’ he says. ‘They are most likely unconstrained by the demands of keeping the bulk of the system running, and therefore have the chance to disrupt and revolutionise the conditions of health and wellbeing in Victoria.’


Freedom to experiment

There are several factors that enable peripheral agencies to disrupt the overall system and move towards change and improvement. The first is that these organisations have the freedom to experiment from the edges of the policy domain.

‘Players on the edge can often work on problems where there aren’t well-known or well-accepted answers, and they can experiment and gather evidence where there are knowledge gaps,’ says Kishore.

According to Kishore, some of these traditional gaps, such as increasing female participation in sport, are already being tackled by innovators like VicHealth. But the pathway to success, impact or influence isn’t always direct or clear-cut.

‘If you want to change political or policy direction it might mean community engagement and mobilisation,’ he says. ‘Changing doctor behaviour might mean engaging with technology companies. Addressing childhood obesity might be about supermarket partnerships. Agencies on the edge have to be brave and bold with their ideas, and also with their partnerships and collaborations.’

Having political autonomy is another factor that can encourage new ideas. ‘Peripheral organisations often don’t have a minister looking over their shoulder, so they’re given more space to have the courage to make creative leaps,’ says Kishore.

Without the main weight of the system on their shoulders, agencies on the edge tend to have more time, resources and headspace to dedicate to tackling issues in innovative ways.


Organisations leading from the edge 

It is possible for agencies to have a peripheral position but also lead from the edge. ‘It is not critiquing and rock-throwing from the sidelines any more than it is seeking to colonise the central position and leading through control,’ Kishore says. ‘It is a matter of experimentation, provocation, influence – with a larger vision of the system and its future.’

Kishore looks across sectors to find examples of those visionary players. He cites SITRA, the independent Finnish innovation agency with its mission to build sustainable wellbeing into the country’s systems and policies, and Israel’s Innovation Authority, formerly known as the Office of the Chief Scientist, that supports the country’s flourishing IT industry.

Another example, the Institute for Healthcare Improvement (IHI) in Cambridge, Massachusetts was initially an organisation dedicated to reshaping healthcare from the periphery by testing and implementing quality improvement practices. Now it has grown into a world-renowned ‘do-tank’ with global influence and impact.


The role of digital innovations

There is little doubt that new technology is rapidly changing how health is delivered, evaluated, coordinated and experienced.

‘Digital health technologies are recalibrating how we do health,’ says Kishore. ‘New devices are promising very different ways of dealing with everything from mental health and deafness to detection of diseases and cancer treatment.’

Digital health technologies are really recalibrating how we do health.

In this way, Kishore argues that it’s critical for services, public policy and ethical considerations to keep pace with rapidly advancing digital technologies.

‘We don’t want to be in a situation where digitisation just means doing the same thing we’ve done for the last hundred years, but on a screen rather than on paper,’ he says. ‘It would be a missed opportunity if we just digitised existing practice without exploring the edges of what’s possible.’

At the same time, Kishore senses that technology is not the silver bullet, and that agencies innovating on the edge may be the ones to think more laterally and more creatively about what it takes to embed sustainable wellbeing into our communities. 


‘We have advanced so far with our technologies, resources and policy settings, [but] we seem to be less mentally, physically and emotionally well,’ he says. ‘It seems to me that we have lost something in how we think about health and health promotion. We've become very metric-focused and perhaps unduly concentrated on the glitter of new technology but perhaps without thinking as clearly about the social, ethical, political – and the human – elements of how, where and why we use it  Again, agencies on the edge have a great opportunity to shift this trend.’


Facing the future

There is a great deal of uncertainty about what lies ahead for the community’s health. Kishore suggests that agencies on the edge have the ability to shape and shift how we think about the future.

‘We’re only ever really able to see to the next hilltop – what lies beyond that remains a bit of a mystery – and so there’s something of an iterative process of discovery when we think about the future,’ he says. ‘It’s not all or nothing. Experimentation and iteration are crucial to helping us to adapt in situations in which we can only see as far as we can see. Agencies on the periphery have the chance to expand our vision.’

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