Policy as a strategy to innovate in health care? A content analysis of innovation policies in Germany, 1994-2017

Determining what innovation means for healthcare is becoming increasingly complex. Health policy addresses this challenge by designing initiatives to improve healthcare quality and efficiency, one example being the German Innovation Fund of 2015. We investigate the innovation concept underlying 25 years of German health policy to analyse which and why some innovations are sustainable in a healthcare system. Expanding a previous approach to identify changes in the semantic understanding of 'innovation', we identify the semantic understandings of innovation, variation in health innovation policy contingencies. We use Henry Mintzberg's approach to classify patterns in health innovation policy to uncover predominant planning, adaptive, and entrepreneurial strategy modes. Systematic analysis resulted in 44 decision-relevant policy documents. Content was classified based on a qualitative content structuring method according to seven main categories and 57 subcategories. Results reveal that the innovation concept is undergoing a transformation from a science-based concept, dominated by planning and adaptive modes, towards an exploration of process innovations, dominated by adaptive and entrepreneurial strategy modes. This change in strategy is an essential contingency of high-volume instruments, such as the Innovation Fund, and their capability to support the emergence of process innovations that lead to structural changes in the healthcare system.