Newsletter # 1
We are excited to share with you the first newsletter of the ICU4Covid project. It presents the vision, the challenges, and the activities during the first year of the project.
Responsible Innovation in Health: Bridging the Gaps - Connecting Technological, Medical, and Social Language
Dr. Tal Soffer
(Anat Zuta, Idan Edut)
Tel Aviv University
The Covid-19 pandemic has led to the accelerated entry of technologies into everyday life. The social isolation imposed on citizens alongside the need to provide an immediate medical response to masses of citizens has led to the need of using innovative technologies in the field of health and especially in intensive care units. As such, the implementation and use of new technologies provide many opportunities and benefits, which are reflected in improving the quality of health services, providing effective, faster, and customized medical care, disease prevention and more. Alongside these benefits exist inherent challenges in issues related to values, privacy and ethics, equality, social inclusion and more. Many of these challenges are related to the differences in perspectives and motivation of different stakeholders (e.g., the general public, experts, policy makers), which stem from gaps in knowledge and common language in the same field. For that end, the ICU4Covid project has adopted the approach of Responsible Innovation in Health (RIH), which is based on the Responsible Research and Innovation (RRI) approach. The concept of RRI describes the relationship between science and society, stating "science with and for society".
#1 The challenges
According to the definition, “Responsible Research and Innovation” is a transparent, interactive process by which societal actors and innovators become mutually responsive to each other with a view to the (ethical) acceptability, sustainability and societal desirability of the innovation process and its marketable products.” (Schomberg, 2013).
Further elaboration of these ideas by the appointed European Commission (EC) expert group described six major dimensions of RRI that signify the importance of keeping to the norms of responsible research and innovation that considers different societal needs. Among them are public engagement, gender equality, science education, open access, ethics, governance. Two additional dimensions, sustainability and social justice, overlap with the previously named ones (European Commission 2015). All these dimensions require the involvement of SSH experts in the process of ICT development. The EC endorsed the SSH-RRI approach, which is defined as a continuous engagement of societal actors during the entire research and innovation process to better align both the research process and the results with the values, needs, and expectations of the “European Society” (Soffer et al, 2019).
As health has unique challenges to mitigate conflicts in clinical and policy issues, RRI implementation in health (RIH) has some unique characteristics. Among them are the tension between the need to save life and the patient's freedom of choice to get treatment, as well as the question concerning priorities, like avoiding diseases rather than treating them. As the use of technologies increases, so does the discourse on these issues among the public and decision-makers. In light of these challenges, it is essential to consider the equity and sustainability of health systems around the world, applied to the framework for RIH, to better align health and innovation policies and connect between different stakeholders in that field.
#2 Increasing engagement and mutual communication - Bridging the knowledge gap
Implementing the core ideas of RRI, the RIH offers a process that requires/demands all actors included in or affected by research and innovation activities to anticipate, monitor, and assess the social, economic, and environmental impact, taking into consideration purposes, motivations, assumptions, values, beliefs, uncertainties, risks, and dilemmas (Pacifico Silva et al., 2018). When discussing RIH, there is a need to consider the scope and specificity of addressing the challenges and needs of the healthcare systems in a sustainable manner. This require mutual collaborative of stakeholders who are committed to meet the ethical, economic, social, and environmental principles as well as values and specifically, it becomes even more essential when they design, fund, manufacture, distribute, use, and deploy socio-technical solutions.
ICU4Covid project adopts the RIH approach by making public involvement, ethics and governance an integral part of its activities. The public engagement is one of the methods to cover all the challenges and needs of users and end users. Moreover, research and innovation process in the medical field and specifically in ICU, may raise more challenges related to privacy and ethics (Timmers et al., 2019), mostly due to the patients’ condition which in most cases makes it impossible to ask them for informed consent prior to their hospitalisation.
Furthermore, the co-creation approach is one of the foundations of the project, reflecting the importance of the local context in which health technologies should be applied. Therefore, the involvement of the various stakeholders (hospitals, medical staff, decision makers) from the very beginning of the project is vital to address the project's objectives. Hence, a variety of activities have been adopted to boost communication and engagement between the various stakeholders:
(a) Increasing engagement –continuous meetings, interviews and dialogues, conducted by the project team with the medical staff at the hospitals, in order to explore the work environments of each hospital with an emphasis on ICU, the infrastructure, the arrangements of health services and the resources available to implement the CPS4TIC system. In addition, there’s a need to identify the challenges and barriers in the process of implementing the system in hospitals, all while maintaining the principles of privacy and ethics as required by the GDPR.
(b) Mutual communication – our ability to communicate and deliver our message with consistency, while still having the ability to speak with different target groups, is another aspect of public engagement and policy. To that end, dedicated workshops have been conducted, to create uniform and clear communication between all stakeholders. The main goal is to bring together medical professionals and technologists, to bridge the knowledge gaps in technology to medical staff on one hand and present the user experience and medical needs to R&D staff on the other one. The workshop’s participants expressed very high satisfaction. In addition, to reach diverse audiences, we produced special documents and videos that were distributed through the media channels and the website to spread the project's activities and create mutual communication.
(c) Joint cooperation - another good example of our collaborative effort is our installation teams that work together: once in two weeks there is a joint meeting, aiming to share the latest updates. In addition, all parties work with one cloud system, so everyone can deliver their needs and outputs. In this way we ensure the i nvolvement of as many partners as possible in the implementation processes and that everyone works with the most relevant and up-to-date information.
#3 Bridging "language" gaps - Connecting different professional communities
As ICU4COVID aims to be a bridge through which technological, medical, and social language connect, it all has a great influence on each other and the ability to successfully weave them together depends on patience, understanding, and willingness to learn, and to know more about what connects us than about what separates us.
Professionals from various fields perceive the meaning of terms and ideas in the context in which the discourse takes place - they all know the linguistic shortcuts and the special codes used in every language. Therefore, when people from the same field use the same language, either verbally or in writing, the margin of error in understanding is smaller. However, discourses that combine different areas of practice, can lead to problems of inaccuracy, ambiguity, and confusion, which can be very problematic when trying to save lives.
One of the most significant lessons we have learned in this project is how to succeed in bridging the gaps in language - between the technological, medical, and social language. The difference between them is not only in their character, but also in the way they explain reality.
The technological language - is designed to enable us to operate technological systems. It is a sharp and unambiguous language that requires a great deal of knowledge and that most people are unfamiliar with. It has clear and precise lines and connections that even those who know how to operate technology at the basic level may not understand.
The medical language is also a very professional one. It allows quick access to complex information and connects many important factors together. This is a language that only professionals are proficient in, and misunderstandings can be costly.
The social language is a very flexible one, it varies easily from place to place, full of metaphors and influences from different cultures. It includes verbal gestures as opposed to physical and non-verbal ones. It is more emotional and loaded with a lot of political weight - things that are acceptable and unacceptable to say.
As part of the project, one of our solutions for bridging language gaps was a development of a joint communication strategy framework that set up the main project's outputs in terms of technological and clinical dimensions in addition to timing and budget aspects. Specifically, it clarifies how the overall system would work at the hospitals and highlights its added value to the stakeholders (the hospitals). A short illustration video, helped to bridge perception gaps. It presents the project in various events and appears on the project website. This process, of creating joint language, required us first to look at the similarities that bind all together. One of the most interesting things to discover is that they all rely on traditions, norms, beliefs, and values that make them what they are.
Being able to operate and move forward safely in a project that connects these three aspects requires great care and emphasis on explanations and collaborations. We have learned that sometimes we need "translators", professionals who know how to speak the three different languages. For example, social sciences researchers who have an affinity for medical technology. We know today that mutual understanding is the key. We are constantly thinking of new connections and new ways of listening to nuances that can allow us to better understand each other. We are constantly looking for our linguistic blind spots and seeking solutions to problems that may arise in the communication that takes place between us