Innovation: what is it?

Innovation is the act of introducing something new. In high-performance sport, the description ‘change that creates a new dimension of performance’1 may help to focus the concept. ‘Performance’ may apply either to the athlete's performance or to the delivery of care. Innovation is critical to the advancement of all walks of life and has a strong foundation in business model literature, but is now recognised as a critical aspect in the development of healthcare systems and processes.2

There are many areas in HPSM where innovation may be rewarding—for example, developing novel working models (including structural and operational areas), treatments (pharmacological, modalities, rehabilitation techniques, surgery, other intervention), recovery models (nutrition, exercise, sleep, psychology, other) and business models (improving financial efficiency of service delivery) (table 1).

Why innovate?

High-performance sport lends itself to innovation because the stakes are high. Even a small change can make a difference between perceived success and failure. At the upper levels, science, medicine and technology merge to optimise performance. Targets for improvement include adaptations in equipment, clothing, training environments, nutrition, training systems, recovery strategies and medical care. Changes in any of the aforementioned areas have the potential to improve health status, reduce or prevent injury and ultimately enhance performance. Other improvements in diagnostics, therapeutics, working practices and communication strategies have the potential to speed care and recovery from injury. Currently we base much of our clinical practice in high-performance sport upon approaches that have evolved through clinical work and research on other populations—that is, the general population, or recreational athletes—but less commonly high-performance athletes. Conversely, the innovations tied to high-performance technology can also trickle down to the care of recreational athletes and everyday patients. The creative ideas and concepts generated through innovative thinking should help raise the standards and promote efficiency in this developing area, and can lead to research strategies based specifically on the high-performance athlete (figure 1). This will help to fill the gap that exists in evidence-based medicine in the field.

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Figure 1

Innovation pathways in Sport and Exercise Medicine.

How to innovate in high-performance sport

Innovation has fuelled many advances in medicine over the last century, although we as practitioners are not conventionally trained in this area. It is a step beyond standard medical training to understand the culture of innovation and the processes involved to be creative. While conventional thinking in medicine is essential to standardise care, it is healthy to challenge dogma, to identify unfounded assumptions and to think laterally—particularly in a novel area such as HPSM. Innovation may involve entirely new concepts but more often involves a recombination of pre-existing concepts, approaches and products. This is ‘creative collision,’ where pre-existing areas can be explored in new ways.3 It can range from simple small changes in a product or practice to radical changes or paradigm shifts (table 2).

Successful and repeated innovation does not happen by chance. It is hard work and often does not come naturally to many practitioners. It is also time-consuming, particularly in the initial stages. It relies on structure and methodology that starts by establishing an innovation culture within an organisation. While leadership is necessary to implement and prioritise this culture, the working environment must foster a non-hierarchical innovation democracy. Input from all individuals within the organisation is essential to the creative energy of the group. Key cooperative working relationships must also be established with professionals outside medicine, and different types of ‘thinkers’ should be included. Creativity requires whole-brain thinking; right-brain imagination, artistry and intuition, plus left-brain logic and planning. The more diverse the group, the more creative the group will become. For example, in a high-performance sport, all within the organisation—from the administration and management group through the coaches, the care providers and the athletes—are potential ‘internal’ innovators. The have their eye on the goal and a keen sense of the group mission. ‘External’ innovators include recreational athletes, medical providers outside the sport, other professionals (eg, product designers, IT experts) and the lay public. They all help to innovate ‘from the outside in.’4

Establishing and prioritising an innovation culture is a huge task. Once achieved, key target areas for innovation can be defined. This may be facilitated by identifying the unarticulated needs of the athlete through direct observation, experience mapping, and understanding their positive and negative experiences or outcomes. The goal is to refine the target areas for research and identify organisational strengths and weaknesses as perceived by the athlete.

Identifying the needs of the athlete helps to focus an innovation agenda for the Interdisciplinary Medicine And Science Team (IMAST5). The IMAST is the core service team, composed of those with the skill sets necessary to provide the structural aspects of medical care. The core competencies of the IMAST members should be identified, as they are often underutilised. What are the key attributes of the support team members? What additional competencies does the IMAST require to accomplish its goal? What are the performance questions that the IMAST must address?

Operational innovation describes how the medical/science team works on a daily basis. It includes approaches to team communication, skills integration and outsourcing to external experts. It also includes practice reflection, outcomes audits and continuing education to advance the field of HPSM as it applies to their athlete group. The day-to-day operation must support innovation to be successful: ‘The whole should be greater than the sum of its parts.’

Operational innovation can also include strategies and protocols for the prevention of injury and illness and optimisation of recovery. For example, simple changes in athlete and support staff behaviour may help athletes to cope better with travelling, training and competition. This can reduce stress, illness and injury, and improve the focus on the goal of optimising performance. The early detection of medical issues utilising enhanced recognition systems could speed the time to diagnosis. Changing athlete behaviour to report problems earlier in the injury or illness cycle may speed assessment and diagnosis, and result in an earlier return to training. Improved assessment techniques may minimise time away from conditioning and competition. Examples include functional analysis of movement patterns in relation to injury and recovery, monitoring of physiological loading and responses during training, and new protocols for musculoskeletal imaging.

Potential therapeutic innovations can range from aspects of pain management, promotion of tissue repair, management of sleep disturbance and jet lag, and interventions for other medical problems that can affect the athlete. Drugs and medical devices used in other areas of medicine may have a potential role in HPSM. Of course, it is vital to follow a rigid ethical pathway in the consideration of any new therapeutic approach, but creativity sparks the idea that fuels the research. Some innovative steps may be comparatively simple; seeking innovative ways of enhancing athlete compliance with medications, developing portability and user-friendliness of medications and topical agents or ensuring accessibility to rapid therapeutic interventions. Product design is important to standardise rehabilitation tools that are truly effective, easily transportable and easily used in the high-performance setting.

There is a great opportunity for ‘innovative extrapolation.’ If evidence for benefit from any form of therapeutic intervention has been established in general population studies, the next step is to address the question of application to the high-performance athlete. What are the effects, best regimes and best designs of such products for use in managing the high-performance athlete?

The innovation breakthrough can come from the simplest yet most obvious approaches. There is value in considering case studies, since greater individuality and depth of understanding can yield change. This involves further innovative thinking, which in turn drives further research—the subject of the final topic in this series.