This latin expression refers to what is beginning to be, is in the process of accomplishment. It captures our research focus: Responsible Innovation in Health (RIH) is in motion, aspiring to come fully into existence.
High impact events
We regularly organize high-impact knowledge mobilization activities
Our team in action
In Fieri is a research program that focuses on Responsible Innovation in Health (RIH). It is led by Pascale Lehoux, full professor with the Department of Health Management, Evaluation and Policy at the University of Montreal. In Fieri conducts research in Canada (Quebec, Ontario) and in Brazil (state of São Paulo).
In Fieri’s knowledge transfer and exchange activities include the Hinnovic blog, where you may read about different types of health innovation and the policy issues they raise (French content). To keep in touch with our research activities, you may sign up to In Fieri’s newsletter and follow @Hinnovic and Pascale Lehoux on Twitter and LinkedIn.
The RIH Assessment Tool and User Guide
The In Fieri RIH Assessment Tool and User Guide are available online! The RIH Assessment Tool is the result of many years of research. It was developed and validated by In Fieri to assess responsibility in health innovation. A User Guide has been developed to facilitate the application of the Tool. Please do not hesitate to write to us if you have any questions about the Tool or would like to share your appreciation.
The International symposium on responsible innovation in digital health took place in January 2020 at the University of Montreal. You may watch the panels and conferences. Pascale Lehoux’s talk described the way responsible innovation in health can transform the design of digital health solutions.
Responsible Innovation in Health (RIH) builds on the field of Responsible Research and Innovation (RRI). RRI promotes the involvement of societal actors in scientific and technological development processes through inclusive participatory approaches. The aim is to develop “ethically acceptable, socially desirable and sustainable” solutions to major societal challenges (von Schomberg, 2013). Innovationstakeholders are numerous, operate in the private, public or non-governmental sectors and are involved at different stages of innovation: financing, design, production, regulation, diffusion, reimbursement, etc. These stakeholders possess complementary skills and pursue objectives that sometimes conflict with each other. Deliberation is therefore central to RIH.
The RIH conceptual framework is comprised of 9 attributes that should be considered when designing innovations, throughout their lifecycle and in the light of the context where users are located. These attributes highlight the processes by which an innovation is developed, its characteristics as well as the organisation that develops it and makes it available to users (Silva et al. 2018).
What RIH is not
RIH considers responsibility in the processes and decisions of organisations that develop and bring innovations to market, including their suppliers and distributors. These organisations must comply with environmental regulations, adopt proper governance frameworks and respect human and labor rights. Corporate Social Responsibility is necessary for RIH, but it is not sufficient. The 9 RIH attributes draw attention to the way health innovations foster equity and sustainability in health systems. Claiming to be responsible is therefore not enough: responsibility must be put into action.
Our research program
Under the leadership of Pascale Lehoux, In Fieri is a 7-year research program that obtained funding through the highly competitive Foundation Scheme of the Canadian Institutes of Health Research (CIHR). While the scholarship on Responsible Research & Innovation (RRI) is growing rapidly in Europe, In Fieri develops Responsible Innovation in Health (RIH). Our work examines how alternative business models, hybrid organizational forms such as social enterprises and social finance support the emergence, commercialization and institutionalization of RIH. The common thread across our 3 research streams is an emphasis on the creation of solutions that contribute to the common good healthcare systems embody.
A. The design of RIH
To clarify what RIH is and what it is not, considering system-level needs and challenges;
To elicit with clinical leaders, designers, engineers and technology developers the processes and products of RIH;
To analyse how patients, caregivers, clinicians and healthcare managers may participate to the co-design of RIH;
B. The emergence and contribution of RIH
To elicit the way alternative business models, social entrepreneurship and social finance support the design and commercialization of RIH;
To analyze the contribution of RIH to healthcare systems;
C. The institutionalization of RIH
To examine how the design, financing and commercialization of RIH interface with existing policy mechanisms in the innovation pathway, including regulatory approval, health technology assessment, reimbursement and procurement.
Our research team’s activities are supported by the University of Montreal’s Public Health Research Center (CReSP) and led by Pascale Lehoux who is known for her ability to engage into path-breaking research. In Fieri builds on her Canada Research Chair program (2005-2015), which clarified the impact of business models, capital investment and economic policy on technology design processes in academic spin-offs. In 2008, she created Hinnovic — a blog whose mission is to transform how innovation in health is envisaged— and has pioneered multimedia-based public engagement methods.
The leader and her research team
The research team has a strong command of complex mixed method research and developed a unique set of KTE skills, which include organizing practice-oriented workshops and multimedia-based events.
Pascale Lehoux’s career has been shaped by industrial design, which fosters the creative envisioning and pragmatic appraisal of the way technologies fulfill user needs, and by a public health perspective: her work is motivated by the desire to improve our understanding and collective ability to govern technological change in health.
Lysanne holds a BA in Psychology (Univerty of Ottawa), an MA in Child Studies (Concordia University) and a PhD in Educational Studies (McGill University). Health, well-being, gender equality, and innovative practices that value and integrate participant's knowledge and priorities are at the heart of her research.
Hudson P. Silva
Hudson P. Silva is an economist and was Assistant Professor in Public Policy and Management at the State University of Campinas. His research activities are in public policy analysis, focusing on social protection, public health and health technology management. He holds practical experience as a technical advisor for the Brazilian Ministry of Health and the State Government of Sao Paulo.
After working as a journalist and filmmaker, Catherine looks to knowledge mobilization. She holds a master's degree in psychology from the Université de Montréal and is particularly interested in the role of images as a tool for knowledge transfer in public health.
Patrick Vachon (honorary member)
Interested in how objects work and invention, Patrick worked in mechanical engineering and later became a programmer, analyst and teacher of applied computer sciences in various cities in North America. After a few years in TV post-production, he joined the team in 2007 to combine two passions - science and communication - and contribute to a key societal issue: our health.
In Fieri’s graduate students and postdoctoral fellows
Hassane holds a Master's Degree in Public Health and Biomedical Informatics from the Faculty of Medicine of Rennes, a Master’s Degree in Administration of Public Health Policies from EHESP (Rennes) and a Ph.D. in Health Services Organization (Laval University). His research is on the challenges raised by the integration of innovative technologies into health systems, in particular AI and digital solutions.
After completing a bachelor’s degree in food sciences and a master’s degree in management in the State of São Paulo (Brazil), Renata is pursuing a PhD in public health at the University of Montreal. Her thesis focuses on transitions in food systems, looking at the emergence of responsible food production in different economic contexts.
Robson Rocha De Oliveira
Robson Rocha is an M.D. specialized in public health and health services management. He has practical experience in the Brazilian health system (public and private sector). He has been Assistant Professor of Public Health and Director of the Medicine Program at Anhembi Morumbi University. His research is related to the analysis of health innovation systems and the analysis of social networks.
Program experts and collaborators
Our research team benefits from the insights of academics from Canada, the United States, France and the United Kingdom, with a background in medicine, engineering, design, ethics, sociology, economics and public policy. We also benefit from the collaboration of the Canadian medical device industry association (MEDEC), the McConnell Foundation (Montreal) and MaRS (Toronto), which are instrumental to innovation and social entrepreneurship in Canada.
Catherine Beaudry (Polytechnique) is an economist and engineer and holds the Canada Research Chair on the Creation, Development and Commercialization of Innovation. Her research addresses innovation economics, the impact of innovation policies on scientific and technological performance, and the performance and survival of businesses. She brings expertise in partnerships and open innovation in high-tech industries.
Antoine Boivin (Univ. of Montreal) is a family physician and a CIHR clinician-scientist. His research focuses on patient involvement in primary care, chronic disease management, aging and end-of-life care. His policy-oriented research is geared at advancing the design of patient involvement interventions, evaluating its impact and supporting the implementation of sustainable partnerships in clinical settings. He is Co-Chair of the patient engagement strategy of the Quebec SUPPORT Unit.
Jean-Louis Denis (ENAP) is an anthropologist and holds the Canada Research Chair in Governance and Transformation of Health Organizations and Systems. He has over 20 years of experience in health services and policy research. His research examines healthcare reforms, medical leadership and the role of scientific evidence in the implementation of clinical and managerial innovation. He is a member of the Royal Society of Canada and Fellow of the Canadian Academy of Health Sciences.
Philippe Gauthier (Univ. of Montreal) is an industrial designer and sociologist who cofounded the Design and Society research group. His research addresses the normative and regulatory requirements of user centered and participatory design strategies in product, service and policy development and the role of expert judgments in modern democracies. He recently examined citizen involvement in the redesign of public institutions in Montreal.
Nicola Hagemeister (ETS) is a biomedical engineer with an affiliation at the Department of Surgery at University of Montreal. Her research at the Montreal University Teaching Hospital Research Center examines how a new technology (KneeKG™) may improve the surgical planning and care management of patients suffering from knee osteoarthritis. This research applies an early technology assessment framework to inform health policy.
Réjean Hébert (Univ. of Montreal) is a geriatrician and epidemiologist with a long career in health services research for frail older people. He was the Director of PRISMA, which designed and validated a new integrated services model for frail elderly. PRISMA was successfully implemented in Quebec and in other countries and won a CIHR KT Award. Hébert was Dean of the Faculty of Medicine of Sherbrooke University, the 1st Scientific Director of the CIHR Institute of Aging and Quebec Health Minister. He is a member of the Canadian Academy of Health Sciences.
William Lazonick (Univ. of Massachusetts Lowell) is an economist and chairs the Center for Industrial Competitiveness. He is co-founder of the Academic-Industry Research Network and was Distinguished Researcher at INSEAD in France. His research focuses on the social conditions of innovation and economic development in advanced and emerging economies. He was awarded the 2010 Schumpeter Book Prize and the H. Larson Award from Harvard Business School for best paper in Business History Review. His research focuses on the role of financial institutions and capital in high-tech industries.
Marguerite Mendell (Concordia Univ.) is an economist who co-founded the Karl Polanyi Institute of Political Economy. Her research addresses impact investing, social enterprise, community economic development and economic democracy. She was a member of the Advisory Group of the Global Task Force on Impact Investing. She is a member of the Chantier de l’économie sociale Board, a founding member of CAP Finance and of the Scientific Advisory Group on Social Economy and Social Innovation of the Trento Center and of LEED-OECD-Paris. She received the Marie-Andrée Bertrand Prix du Québec and was appointed Officer of Ordre national du Québec.
Fiona Miller (Univ. of Toronto) is a historian, a member of the Joint Centre for Bioethics and the Director of the Division of Health Policy and Ethics at the Toronto Health Economics and Technology Assessment Collaborative (THETA). Her research centres on health technology policy, including the dynamics of technology development, assessment and adoption within systems of health research and healthcare. She brings expertise in health policy, science-based entrepreneurship and institutional theory.
Xavier Pavie (ESSEC Business School) is a philosopher and management scholar. He has spent 15 years as Marketing Director in leading organizations. He is the Director of the Institute for Strategic Innovation & Services and Chairs the Imagination Week seminar for ESSEC’s 600 Master students. He leads the responsible innovation definition efforts of an international network of academic institutions supported by the European Commission. He is President of the “Innovation-Regulation-Governance” commission of the French National Agency for Research as part of Horizon 2020.
Andrew Webster (York Univ., UK) is a sociologist and the Director of the Science and Technology Studies Unit and a Fellow of the Academy of Social Science. His research addresses funding models for regenerative medicine and responsible biobanking innovation. He serves on national policy committees including the UK Stem Cell Bank Steering Committee and the Regenerative Medicine Expert Group Sub-committee.
Former graduate students and postdoctoral fellows supervised by Pascale Lehoux
This 7-year research program has begun to bear fruits, like the publications below testify. Research on RIH is warranted when one considers the capital-intensive nature of R&D and how high-tech services make “choosing wisely” steadily more difficult. Our findings are of strategic importance to health and innovation policymakers, entrepreneurs and investors. It shows alternative ways of designing, financing and commercializing technologies.
Guided by Tronto’s (1993) ethic of care framework and Responsible Research and Innovation (RRI), the authors of this qualitative study focus on the ways in which health innovation designers reason around care and responsibility and translate these notions into their work. The exploratory findings provide a novel empirical basis for scholars to conceptualize health innovation designers as ‘care-makers’ and to integrate designers within the care relationship alongside caregivers and care-receivers.
The challenge of novel and high cost health technologies has encouraged the growth of regulatory agencies such as Health Technology Assessment (HTA) organizations and Group Procurement Organizations (GPO). Yet the existence of several agencies in the same polycentric regulatory regime raises questions about whether and how their work can be coordinated. Drawing on a case study of GPOs and HTA agencies across four provinces in Canada, we explore the separate evolution of these agencies, emerging connections between them for non-drug technologies, and the organizational processes and evaluative judgments that underpin coordination efforts.
In the field of Responsible Research and Innovation (RIR), tools have been developed to enable entrepreneurs to integrate RIR principles into their practices. While these tools may include measurable self-assessment indicators, external assessment approaches have so far received little attention. This study addresses this gap by applying the Responsible Innovation in Health (RIH) Tool, which adopts an external assessment approach, to 16 health innovations from Canada and Brazil.
Although Do-It-Yourself and open access health innovations can offer interesting solutions for patients with needs that are currently not met by the medical industry, they pose new dilemmas in terms of quality and safety. In this study, the authors seek to better understand the dilemmas raised by two examples of popular innovations. To do so, they gathered the views of health care innovators who are familiar with medical device standards and regulations in order to identify practical issues and develop recommendations for public policy.
Seen as professional intermediaries, procurement offices affect innovation: they shape the valuation of goods and the markets through which they are exchanged. Yet procurement offices seem largely incidental to the innovation efforts of others. In this article, the authors argue that enhancing the capacities of procurement offices can support responsive innovation.
COVID-19. The speed with which solutions have been developed and made available to the population in Latin America raises an important set of ethical, legal, social, economic, and environmental questions. In this paper we discuss how the perspective of Responsible Innovation in Health (RIH) provides important elements for answering these questions.
The In Fieri team, in collaboration with OBVIA, developed a policy brief on AI and digital solutions. Using examples, it describes the four responsible innovation principles and clarifies pre-existing socioeconomic dynamics that condition the current development of these solutions as well as future trajectories. We offer guidance for public decision-makers and developers to help them shift towards a more responsible development of these innovations.
International Journal of Health Policy and Management
By confirming key aspects of the RIH Tool’s reliability and applicability, our study brings its development to completion. It can be jointly put into action by innovation stakeholders who want to foster innovations with greater social, economic and environmental value.
This article examines how improving the quality of work and well-being of health care providers could help rethinking the implementation of EHRs and also other information technology-based tools and systems, while creating more value for patients, organizations and health systems.
This article generate methodological insights into the way prospective public deliberative processes can stimulate the public’s moral imagination regarding what may (or may not) happen in the future and what should (or should not) happen in the future.
This paper examines how two complementary perspectives —as a public representative or a health services user— entail different yet mutually challenging ways of appraising health innovations. Policymakers should foster the expression of both personal and collective perspectives.
By analyzing the practical insights of health innovators on what is and is not responsible innovation in health, this paper demonstrates how they consider both the desirability and feasibility of responsibility features when contemplating their operationalization.
International Journal of Technology Assessment in Health Care
This article analyzes how procurement organizations assess the value of medical technologies: how products are solic- ited and evaluated, who is buying, and how buying practices structure opportunities for suppliers.
To generate an empirically-grounded model of why and how responsible innovations are produced, this paper provides a synthesis of 17 qualitative studies describing the development of responsible innovations that have an incidence on the determinants of health.
International Journal of Health Policy and Management
To identify the challenges that responsible innovation in health should seek to address, this papers presents the findings of a synthesis of 254 articles that examined the challenges of health systems in 99 countries.
This article introduces an integrative RIH framework drawing on the RRI literature, the international literature on health systems as well as specific bodies of knowledge that shed light on key dimensions of health innovations.
Drawing on a prospective public deliberation study, this article offers sociological insights into the ways in which members of the public reason around assistive actions, be they performed by humans, machines or both.
International Journal of Health Policy and Management
Response to three comments on the article « Providing value to new health technology: the early contribution of entrepreneurs, investors, and regulatory agencies» (Lehoux P., Miller F., Daudelin G, Denis J., 2017).
This article looks at what kind of research was conducted on Health System challenges, where it was performed, in which health sectors and on which populations. It also identifies the types of challenge that were most present and how they varied across countries
This article examines the rules that characterize economic policy, capital investment, and regulatory approval as well as the way these institutions enable and constrain the development of ventures at an early stage.
This study uses structuring theory to explore how members of the public anticipate the potential and limitations of prevention in the context of predictive medicine and to clarify the underlying reasoning processes.
Building on insights from sociology of expectations and institutions, this paper elicits how specific institutional requirements provide potency to the expectations that pave the health technology development pathway.
This study explored interactions with device industry representatives among physicians who use implantable cardiovascular and orthopedic devices to identify whether conflict of interest (COI) is a concern and how it is managed.
This article seeks to deepen our understanding of the responsible research and innovation (RRI) approach as it relates to health care systems, where the notion of responsibility is already deeply embedded.
This paper clarifies why technology developers are pushed to prioritize design features that expedite sales, often to the detriment of design features that would increase the clinical value of their technology.
This book explains how health technology is embedded in broader social and political practices that can be reshaped through appropriate policy initiatives. It was short-listed along 3 others for the 2007 Best Book Award of the British Sociology Association and Sociology of Health & Illness.