Social franchising: Scale and spread of innovation in Canada

Highlights

• Fragmentation in Canadian healthcare deters the scale and spread of HIT innovation.

• Separation of microcosm and macrocosm is unique strength of social franchising.

• Separation of micro and macrocosm suits fragmented structure of Canadian healthcare.

• Evidence shows social franchising can spread programs without sacrificing quality.

• National BASE framework shows practical application of social franchising.

Abstract

Objectives

The Canadian healthcare system is caught in a perpetual cycle of pilot projects which precludes the spread of innovative projects. Social franchising is a governance and operating model used to support the scaling of certain types of social initiatives. This paper presents an overview of social franchising, discusses its applicability to HIT innovations, and proposes a framework based on this model for the Champlain BASE™ eConsultation program.

Methodology

A literature review on social franchising was performed to evaluate this model in non-healthcare and healthcare realms. A search was performed in electronic databases to identify peer-reviewed articles. Grey literature was also used to inform this review.

Results

Social franchising has been embraced internationally in healthcare and non-healthcare environments. Peer-reviewed articles related to social franchising and healthcare focused on patient outcomes in family planning and reproductive programs in low- and middle-income countries. Evidence related to developed and high-income countries was scarce, which may be attributed to the newness of this model. Evidence shows the model's ability to rapidly spread programs without sacrificing quality. A National BASE^TM model using social franchising is proposed for the Champlain BASE™ program, which represents a recently developed eConsultation project with potential to address the challenges related to access to specialists.

Conclusion

Social franchising is the fastest growing healthcare approach in low- and middle-income countries. High-income countries (e.g. UK, Germany) are beginning to experiment with the model. The Canadian healthcare system should consider the model as a viable framework to scale and spread innovative HIT programs.

Introduction

The Canadian healthcare system is falling behind its peers in relation to improving healthcare performance through innovation [1]. This is especially true for e-Health innovations, which have received significant attention in healthcare systems around the world [2]. While there is an impressive amount of innovation activity across the nation, these programs too often remain in the pilot stage and fail to expand or sustain themselves beyond an initial period [1]. A 2015 report identified the major barriers to healthcare innovation across Canada [1], including: old fashioned human resources models; system fragmentation; inadequate health data and information management capacity; lack of effective deployment of digital technology; barriers for entrepreneurs; a risk-averse culture; and inadequate focus on understanding and optimizing innovation. System fragmentation has been considered the most important barrier to innovation, with governance and leadership structure being a major contributor to this problem [1]. In recent years, Canada has seen more efforts towards health information technology (HIT) innovation. The Champlain BASE™ project in Ontario, which presents a model for access to specialists through eConsultation, is an example. The project allows primary care providers (PCPs) and specialists to communicate directly through a secure web-based application in order to improve access to specialist care in an innovative and inexpensive manner [3]. Benefits include cutting response time from months to two days, enhancing patient experience of care, and reducing the per capita cost of healthcare [3], [4], [5]. Despite these achievements, the absence of effective governance and operating models and policies that support and enable the sustainability of these innovations persists, which represents a significant threat to their sustainability.

Social franchising is a governance and operating model that has been widely used to support the successful rapid scaling of certain types of social initiatives. The model adapts the business strategy of franchising, where the owner of a service or product grants exclusive rights to an individual (franchisee) for location distribution and/or sale in return for payment or royalty [6]. This allows an organization to grow without necessitating expansion in its operations, all while allowing the franchisor to retain control over the spirit, quality, and strategy of the original brand [7]. According to Hurley [8], social franchising is “a way to enable successful social enterprise models to be reproduced in a local context in a way that combines social impact and financial sustainability”. Social franchising as a concept is still in its infancy, with the leading global social franchising organization formed in 2011 [9] and the world's first social franchising accelerator started in 2014 in Africa [10]. To date, limited information exists on the extent to which social franchising has been leveraged as a governance model in the context of healthcare innovations, especially in Canada. This paper addresses this area and provides an overview of social franchising and its relevance in healthcare. The first part of the paper provides an overview of social franchising and presents a literature review on social franchising in the context of healthcare. The second part discusses the applicability of this governance model in relation to HIT innovations in Canada by exploring its potential to supporting the scalability and sustainability of the Champlain BASE™ project as an example of these innovations [11].