The responsible innovation in health tool and the need to reconcile formative and summative ends in RRI tools for business

Figures & data

Table 1. An overview of the tools developed to support the implementation of RRI in innovators’ and entrepreneurs’ practices.

	Tool format and components	Dimensions covered	Target users
Formative approach
ORBIT Self-Assessment Tool (Stahl 2017)	2-page self-reflective tool relying on a set of questions and points to consider organized into a 4 × 4 Matrix: Process, Product, Purpose, People × Anticipate, Reflect, Engage, Act	Process- and product-dimensions	ICT developers
Responsibility Navigator (Kuhlmann et al. 2016)	44-page document with self-reflective questions and illustrative examples covering: (1) quality of interaction; (2) positioning & orchestration; and (3) developing supportive environments	Process-dimensions (governance principles)	High-level executives and innovation project managers
RMoI tool (Long et al. 2020)	Face-to-face reflective workshop using the visual frames of an existing tool to elicit socio-ethical issues: the Product Impact Tool (PIT)	Process- and product-dimensions (design for usability)	Entrepreneurs
Formative approach, including summative indicators
KARIM (Hin et al. 2014)	60-page document with self-diagnostic tool, 24-criteria analytical grid and good practices statements regarding innovation project management	Process- and product-dimensions (social, economic and environmental impacts)	High-level executives and innovation project managers
Responsible Innovation Compass (Tharani, Jarmai, and Nwafor 2020)	Online platform with surveys that offer a choice of answers reflecting RRI good practices covering the entrepreneurial pathway: (1) company management; (2) idea generation & research; (3) development & testing; and (4) market & impact	Process-, product- and organizational dimensions (company management)	Innovative SMEs and innovation project managers
PRISMA (Porcari et al. 2019)	98-page document describing a toolbox comprised of a self-assessment survey, a 5-criteria impact analysis, 10 KPIs and a roadmap template highlighting: (1) drivers & challenges to RRI practices; (2) risks & barriers that RRI may address; (3) the firm's RRI actions; and (4) key milestones in its innovation pathway	Process- and product-dimensions	Top level managers
ICT-based tool (Flipse 2018)	Online dashboard summarizing KPIs regarding socio-ethical issues using success of innovators’ previous projects as benchmarks, accompanied by weekly interviews with a critical outsider over a 12-week period	Process- and product-dimensions	Multidisciplinary teams of scientists and innovators

Figure 1. The value domains and attributes of the RIH framework. Source: Silva et al. (2018).

Figure 2. The RIH Tool scorecard.

Note: The RIH Tool itself can be found as a Supplementary file in Silva et al. (2020).

Table 2. Role of the interviewees (n = 23).

Region	Organization	Interviewee's role
Ontario	A-ON	Founder and Chief Medical Officer (CMO)
	E-ON	Founder and Chief Executive Officer (CEO)
		Vice-President (VP) operations
		Partnership & impact manager
	F-ON	Founder and CEO
	G-ON	CEO
		Chief Scientific Officer (CSO)
Quebec	B-QC	CEO
		Head, Sustainable development
	C-QC	Founder and CEO
		Chief Technology Officer (CTO)
	D-QC	Co-founder and CEO
	H-QC	Founder and CEO
São Paulo	J-SP	Co-founder and CEO
	K-SP	Founder and CEO
		Former manager
		Former manager
	L-SP	Founder and CEO
	M-SP	Co-founder and CTO
	N-SP	Founder and CEO
	P-SP	Operations manager
	Q-SP	Marketing director (volunteer)
	R-SP	Founder and CEO

Table 3. The legal structures and innovations of the 16 organizations.

Organization	Legal structure	Type of innovation	Innovation
A-ON	For-profit	Diagnostic & research tools, including digital components	Tablet-based solution that makes hearing tests more available and affordable, with a focus on hard-to-reach workplaces (e.g. offshore oil extraction) or low-resources countries
E-ON	For-profit	Nutritional supplement	Cooking tool made of cast iron that dissolves in boiling water to reduce iron deficiency around the world
F-ON	For-profit	Patient & caregiver tools, including digital components	Dementia-friendly illustrated paper and digital books and accompanying app that adapt and change with users as their dementia progresses
G-ON	Not-for-profit	Technical aids, including digital components	Cloud-based platform and 3D scanning, modeling and printing of assistive devices for children with a focus on resource-poor countries
B-QC	For-profit	Sustainable drug packaging	Set of eco-friendly drug packaging solutions for distributors and retailers of drugs
C-QC	For-profit	Patient & caregiver tools, including digital components	Online community to support informal caregivers that provides content and referrals
D-QC	For-profit	Diagnostic & research tools	Platform producing high-quality, low-cost eco-responsible antibodies (using chicken eggs) for life sciences research and development
H-QC	Not-for-profit	Patient & caregiver tools, including digital components	Web-based directory of buildings and accommodations accessible to people with reduced mobility or functional limitations
J-SP	Not-for-profit	Patient & caregiver tools, including digital components	Illustrated books clarifying complex terms and treatment approaches for children with cancer and their relatives
K-SP	Not-for-profit	Technical aids	Affordable hearing aids using rechargeable batteries and solar-powered charger
L-SP	Not-for-profit	Multidimensional intervention, including digital components	Multidimensional intervention to improve safety, self-esteem and economic conditions of waste pickers, including app to connect with those who have materials to recycle
M-SP	For-profit	Diagnostic & research tools, including digital components	Affordable portable device connected to a smartphone to support non-mydriatic eye fundus examinations and detect diseases that could cause irreversible blindness
N-SP	For-profit	Diagnostic & research tools, including digital components	High-quality affordable diagnostic test for indeterminate thyroid nodules that can prevent unnecessary surgical procedures
P-SP	Not-for-profit	Mobile care	Mobile care units for patients living in underserved areas
Q-SP	Not-for-profit	Multidimensional intervention	Sustainable lighting solutions made of plastic bottles, solar panels and LED lamps for communities lacking access to electricity
R-SP	For-profit	Technical aids, including digital components	Robotics, hardware and Artificial Intelligence-based components that can control a wheelchair by responding to the user's facial expressions

Table 4. Results of the availability and quality of the information sources used to apply the RIH Tool to the 16 innovations.

	Mean score for quality of the information sources
Number of attributes documented	<2: Compromised by sources of inferior quality	≥2: Based on sources of superior quality	Total
<7/9: Compromised by missing information	1 (6%)	–	1 (6%)
≥7/9: Covers key aspects of RIH	11(69%)	4 (25%)	15 (94%)
Total	12 (75%)	4 (25%)	16 (100%)

Note: The shaded cell indicates the number (%) of innovations for which the 2 conditions for interpreting the RIH overall score are met.

Table 5. Results of the assessment and rating steps for the 16 innovations.

Assessment step	A	B	C	D	N	Mean score	SD	Min	Max
Responsiveness	12 (86%)	0 (0%)	1 (7%)	1 (7%)	14	4.5	1.3	1	5
Health relevance	13 (81%)	0 (0%)	1 (6%)	2 (13%)	16	4.3	1.5	1	5
Frugality	8 (50%)	6 (38%)	2 (13%)	0 (0%)	15	4.3	1.0	2	5
Level & intensity of care	11 (73%)	0 (0%)	4 (27%)	0 (0%)	15	4.2	1.4	2	5
Health inequalities	7 (54%)	4 (31%)	2 (15%)	0 (0%)	13	4.2	1.1	2	5
Eco-responsibility	2 (40%)	1 (20%)	2 (40%)	0 (0%)	5	3.6	1.5	2	5
Business model	6 (38%)	3 (19%)	5 (31%)	2 (13%)	16	3.4	1.6	1	5
ELSIs	1 (7%)	3 (20%)	11 (73%)	0 (0%)	15	2.6	1.1	2	5
Inclusiveness	2 (14%)	2 (14%)	9 (64%)	1 (7%)	14	2.6	1.3	1	5
Rating step	4.1–5.0	3.1–4.0	2.1–3.0	1.0–2.0	N	Mean score	SD	Min	Max
Interval/Mean	5 (31%)	8 (50%)	3 (19%)	0 (0%)	16	3.8	1.4	2.6	4.8

Note: The shaded cells indicate the four-level scale score (from A to D) obtained by the majority of innovations. The attributes are sorted in descending order following the mean score (from 5 pts to 1 pt) obtained for each attribute.

Figure 3. Distribution of the 16 innovations according to their overall RIH score, region and legal structure.

Table 6. Comparison of the overall RIH mean score across regions and legal structures.

	N	Overall RIH score (mean)	Standard deviation
Region
Ontario	4	3.7	0.45
Quebec	4	3.5	0.59
São Paulo	8	3.8	0.76
Legal structure
For-profit	9	3.5	0.60
Not-for-profit	7	4.1	0.51

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