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The Danone Case: How Social Innovation Can Help a Multinational Company Reinvent Itself

The ambition to change the world is at the heart of the most innovative entrepreneurial endeavors – be they those of Ford, yesterday, or, today, of Google. Nevertheless, an established company that nurtures such an ambition must also reinvent itself. Today, social business is the new frontier, in that it combines an ambition for development and the conquest of new markets. So, can environmental and social innovations become the levers of a transformation of big companies, not only improving their performance but also contributing to the invention of a new, more sustainable and more inclusive economy? The example of Danone provides a concrete framework to study the initiatives taken by multinational companies from first-world countries to address the low-income populations from emerging countries.

The environmental and social innovations that are emerging today are being met with both enthusiasm and skepticism. Prof. Muhammad Yunus’ “social business” and C.K. Pralahad’s “base of the pyramid”, in particular, are the subject of heated discussions. Some activists see them as the promise of a better tomorrow. Others see it as a cosmetic overlay – a “social green washing” of sorts – that will basically change nothing. But while this debate is far from settled, some answers are emerging already. And probably the best way to tackle the issue is to take a close look on the relevant companies themselves. Some of them have taken the lead on the subject and it is now possible to learn from their experience.

New models are being put to the test 

Let us briefly go over the two major reference models. The first one, “social business,” as defined by Pr. Muhammad Yunus (2010), is business whose “goal is to solve some of the social, economic, and environmental burdens that affect humanity: hunger, lack of housing, health, pollution, ignorance…” Organizations created for this purpose should in principle generate profits; however these profits, in Prof. Yunus’ strict definition, are to be invested back.

Now to the second reference model. The term “base of the pyramid” (sometimes referred to by its acronym BOP) comes from the findings of C. K. Prahalad and S. Hart. It is used to refer to low-income populations; it is also used to describe the economic models devised to give these people access to a number of products and services. The aim is to reconcile the fight against poverty with the profit motive: here, the societal goal converges with the economic objective.

Academic literature, to date, only has unsatisfactory answers to provide to the questions posed in this paper. In the field of Strategy and Corporate Social Responsibility (CSR), for example, a vast plethora of studies focuses on the why: why should companies adopt a more socially responsible behavior? Is it a mandatory quid pro quo for greater competitiveness?

Few are the studies, however, which focus on the how – that is to say, how the implementation procedures of CSR are actually being carried out. In addition, such finer studies cast new light on the very strategic innovations and overhauls that are giving companies newfound capability to meet the intense societal and environmental challenges faced by our economy.

The authors who have studied the societal models of access to goods and services that either fall in the social business category or in the “base of the pyramid” one have shown a keen interest in their implementation modalities, yet without hesitating to point their limits. However, very few studies have focused on the very stakes these approaches constitute for businesses, or on their transformational potential.

It turns out there is one simple reason for that: so far, very few large companies have really taken the subject seriously. And it is in this context that the Danone case stands out. Over a period of more than a decade (starting in the early 2000s), the company has been launching social business and base of the pyramid projects with the explicit intention of making them a lever of strategic renewal.

It is therefore possible to study this case not in terms of principles and values (i.e. “is Danone true to the values it fosters?”), but from a much more operational angle, relying on the analytical frameworks of strategy specialists (“Have Danone’s choices paved the way for its strategic renewal?”).

The approach developed by Crossan and Bedrow, two strategy researchers, provides an effective analysis framework to understand and evaluate the choices of the agri-food multinational company. Christened “the 4 I’s” (standing for Intuition, Interpretation, Integration, and Institutionalization), this approach makes it possible to analyze the organizational learning process behind the strategic renewal of a company.

Specifically, the goal is to carry out an analysis of the process, to understand how the insights of leaders and of “champions” at Danone (intuition process) have led to social projects (through processes of interpretation and integration), and were able to have more widespread impact on the company (institutionalization process).But this learning process is not limited to a “top down” dissemination of the leaders’ intuitions.

It is also about growing an interest in the skills developed by field managers and employees of Social Business or BOP initiatives, while wondering whether these skills are actually spreading through the organization and if so, along which modalities. Lastly, a basic question has to come to mind: do the skills thusly developed have a strategic character?

At Danone, the answer is yes. Social Business or BOP projects have played a significant role in the process of strategic renewal undertaken by the firm in the early 2000s. Far from being a simple matter of communication, these projects are levers for organizational transformation; provided a few conditions are met that we shall emphasize in this paper.

Manager intuition & field experience

The insights of a few leaders and “champions” constitute the starting point. In the late 1990s, the company, which was then considered a model in termes of CSR, was faced with a challenge that took the leaders by surprise. They perceived there were social and strategic limits to the European “social” company model, which merely set out to treat its employees well. If a company wanted to continue to stand out from the crowd in this field, it had to go beyond its routines and reinvent its practices. The gradual opening of trade borders and access to foreign markets simultaneously led executives to consider major overhauls in the marketing of their products. They saw the need to broaden their target and to no longer confine themselves to the more affluent classes with premium and expensive products.

It is in this context that a few BOP initiatives were attempted at first, which turned out not to be convincing. At that point Danone’s management understood they probably must go beyond the simple adaptation of their products; and social business, which primarily targets the poorest classes, seemed likely to yield disruptive innovations in this direction, even if this meant they had to climb their way upwards inside the pyramid at a later point. Indeed, it induced very strong constraints (very low cost and ambitious poverty reduction goals) and the co-creation that it promoted with new stakeholders (NGOs, local communities) encouraged thinking outside the box.

These intuitions then became the subject of an interpretation endeavor. They were discussed in the steering committee and more widely within the firm, as well as with external stakeholders and experts such as Muhammad Yunus. This maturation stage was to be followed by an integration phase, with the launch of experiences as Grameen Danone in Bangladesh or Lemateki in Senegal.

Grameen Danone Food Limited (GFDL) is a joint venture between Danone and the Grameen Group and is based on the model of social business. GFDL ‘s first product was the shokti doi, a recipe developed to satisfy the taste and nutritional needs of children (one yogurt covers 30 % of their daily requirement of vitamin A, iron, zinc and iodine). The product was first distributed in rural areas, by the so-called shokti ladies, street vendors who received a fixed commission on each sale.

Lemateki is a social business whose goal is to improve the nutrition of Senegalese schoolchildren. It is primarily concerned with improving health and education, and therefore, with advancing equal opportunities for children living in suburban areas. The aim is also to encourage education regarding nutrition and hygiene in schools, in partnership with the Ministry of Education.

Both these projects were closely scrutinized, leading to new intuitions and interpretations following an iterative process. Leaders and champions notably realized that fresh dairy products – which are Danone’s core business – are not the most suitable products to target people with very low income, all the more in tropical countries. Both the Bangladeshi and Senegalese projects then inspired many other business units in emerging countries, such as Indonesia and India, but also in developed countries (Poland and France), thanks to dynamics of reverse innovation.

The institutionalization of these intuitions was also conducted by:

(1) Developing a strategy to now reach 1 billion consumers and thus to make products more accessible;

(2) Implementing a specific organization, promoting the decentralization of innovation in emerging countries through incubators that brought together local stakeholders and people from headquarters who were sufficiently open-minded to violate in-house standards. At the same time the involvement of leaders in the governance of social projects was institutionalized through the establishment of bodies such as the “Social Innovation Committee”: composed of several of the firm’s leaders, it was the body that made the decision to launch various social projects;

(3) The definition of processes, especially in the field of Human Resources, assessment procedures and knowledge management. Of particular note was an initiative called “For All Track”: it gave Danone managers the opportunity to spend two weeks, or one month, or six months, etc., in the field, for social business projects. Incentive systems were also of critical importance: for example, executive bonuses got to be calculated on the basis of one third (1/3 economic, 1/3 third managerial, 1/3 societal).

In terms of knowledge management, several leverage mechanisms were implemented. “Social innovation labs”, once a year, reunited the people involved in social business projects and the base of the pyramid, along with other stakeholders in the industry and NGO representatives. These reunions enabled the exchange of practices. Strategic thinking seminars were facilitated within subsidiary executive committees by a team from the headquarters. Lastly, a true social network, both internal and external, was built around Danone communities: 30% of French employees invested in shares of the Danone communities mutual fund, and thus the Annual General Meeting of Danone communities, which takes place the same day as the General Meeting of shareholders, regularly reunites over 1000 people.

Intertwined with this top-down dissemination of insights formulated at the highest level is a bottom-up approach, coming from the field and led in the mindset of an experiment: it consists in the emergence of new individual skills which proceed to become collective and eventually organizational. This is a pivotal point: the strategic vision and the top-down process explained above are a necessary but not sufficient condition for the transformation of the company, especially in a relatively decentralized company like Danone. It is in the field that profound changes in the representations, behaviors and practices are taking place and being experimented with. At individual level, the development of truly new skills can be observed in terms both of know-how and soft skills, especially among employees directly involved with the projects. At first, this translates into a true unlearning phase.

New know-how and new soft skills 

The models developed by Danone, such as Grameen Danone in Bangladesh or Lemateki in Senegal, are veritable disruptive innovation labs that radically challenge the entire value chain.

At R&D level, radically new products were developed or industrialized, such as yogurt enriched with nutrients in Bangladesh, or the “pouch,” a kind of carton composed of local grain and a little milk, whose rare feat is that it can be stored at room temperature, in Senegal, thanks to the invention of an innovative and frugal method, which is extremely energy-efficient.

The supply chain also underwent a small revolution with the implementation of a local resource supply (in milk and cereal) and with the local distribution of products, notably through a network of rickshaws and the “shokti ladies” who sell products door-to-door.

At the industrial level, an equally revolutionary concept – the micro-factory, or even, the container factory – was introduced. It was associated with a model of efficient capital development. The use of renewable energies such as “bio-digesters” was also sought after.

Finally, innovative financing was implemented, such as solidarity-based employee savings and the Danone communities mutual fund, or new investing guarantee schemes created for the occasion by the French Development Agency which consisted in covering 50% of any impairment losses incurred by Social Business projects. These new skills, which concern both the firm’s organization as a whole and its individuals, were coupled with new soft skills based on equally new representations.

The stakeholders thus began by unlearning, by questioning their ways of thinking and acting. Coming from a behavior focused on products, in search of ever greater sophistication and somehow disconnected with reality and with consumers, they learned to observe, listen, and once more immerse themselves into actualities. They inverted the approach and gave it a fresh start – this time deriving from the needs, expectations, habits and constraints of individuals so as to design often simpler and better tailored offers.

They thus understood that they knew very little about the world of low-income consumers, and that it is also was important to co-create with them and with stakeholders close to them (NGOs, associations). At the origin of Social Business initiatives, the partnership with Grameen Bank was decisive: it is the one that put Danone employees in touch with poor consumers in Bangladesh and has been a major driver of disruptive innovation. Professor Yunus, founder of Grameen, was actually the one to suggest a relocated model to the leaders of Danone, based on small production units, with a double objective – to fight malnutrition, and to create jobs.

People at Danone went from simply carrying out orders to discovering they also could become entrepreneurs (or “intrapreneurs”), capable of acting creatively despite limited resources – in a much more frugal mode but with energy increased tenfold… because, in their new action, they found meaning that was hitherto missing. Lastly, a different relationship with time itself emerged as well: the rediscovery of lenghty time. For the law of “always faster” no longer works in such contexts. The hyper efficiency attitude gave way to a more patient and modest behavior.

Beyond the projects, a company that reinvents itself

These new individual skills could have been limited to a few of the projects’ personnel – those directly involved in the field – and at the end of the day, could have had but a minute impact on the organization as a whole. However, by observing the company for over a decade, one realizes these skills gradually transformed into collective skills (at group level) and organizational ones (at firm structure level).

Especially worthy of note was the renewed capacity of the company as a whole to focus on consumer needs, in a quest for accessibility and simplicity, rather than perpetually seeking to increase the sophistication of products. But also, a new skill in terms of supply and distribution, and in particular concerning last-mile delivery. Also notable were, first, the enabling of co-creation with external stakeholders, such as Grameen or the NGO Care, and secondly, the ability to develop disruptive business models, with low capital intensity.

In turn, emerging from these collective capabilities, two organizational skills appeared: the capacity to design disruptive products, henceforth able to reach all of the pyramid, and not just its wealthier classes; and the ability to handle a certain ambiguity between the societal and the strategic approach – and to turn this very ambiguity into a lever for competitiveness.

The transition from individual to collective and then organizational skills stems from a bottom-up process of sharing best practices, a pollination of sorts. Such pollination involves an element of spontaneity: employees have many natural opportunities to share their experience; and from this, they gradually get to form a social network.

In parallel, this pollination is also organized as a factor of the multiplication of experiments and other measures of Knowledge Management type, and then refers to more top-down processes described earlier in the institutionalization process. It also greatly depends on the strategic intent of the leaders.

Keys to success

A number of key factors can henceforth be identified to understand the success of this strategic renewal.

Firstly, a strong consensus, within the executive team, around strategic renewal and around what is at stake behind societal projects. Secondly, swiftly putting experiments into practice so as to materialize the initial intuitions; and then, the implementation of levers towards the institutionalization of such practices. Worthy of notice is a relatively decentralized organization, which promotes field innovation, data reporting and the dissemination of innovations. Among these levers, a human resources policy that actively contributes to strategic renewal by all the means at its disposal: through recruitment, career management, calculation of bonuses and training. This policy also includes the recognition of skills acquired in-house through social business and BOP projects, as well as processes to formalize and disseminate training.

Another key factor of success, which is pivotal for strategic renewal, is none other than the acceptance and acknowledgement of a long training time. This is a major challenge for a publicly traded multinational company, a priori subject to the law of short term and to the vagaries of markets, but all the more necessary given that these social business and BOP initiatives are precisely inducing true paradigm shifts and disruptions.

Danone’s experience allows to measure the underlying transformative potential of societal projects of access to goods and services, of a confrontation with the reality of poverty and of the implementation of initiatives for and with people with low income.

The direct economic impact of the first projects undertaken by the Danone group, such as the social businesses in Bangladesh and Senegal is still limited, both in terms of social impact and of the profitability for the subsidiaries concerned: the learning time required to achieve breakeven results is longer than expected. The challenge, however, is broader. What is at stake is the very role of that transformational lever: to reconnect with the actual needs of low-income populations, and, with them, to devise a novel approach of co-creation, and more frugal and entrepreneurial action modes. All in all, to bring about a reality check.

The Danone case shows a number of disruptions in the representations and behavior of its stakeholders. In particular, among the committed individuals that work in the field of SB and BOP projects, a new relationship emerges at once towards economic activity, the fellow man or woman, oneself, and even time. And these developments can spread throughout a whole firm’s organization by a number of processes, be they bottom-up, top-down, or of a pollination type… provided that company leaders know how to stay the course, keeping their sights on strategic renewal, beyond the ebbs and flows of conjuncture and market pressures.

Bénédicte Faivre-Tavignot is Education Track Associate Professor of Strategy at HEC Paris. She is the Executive Director of the Society &...

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• corporate social responsibility

Corporate Social Innovation: The Convergence of Business Innovation and Social Good

by Luca Collina, Mostafa Sayyadi, and Michael Provitera

Image Credit | sorapop

What Is Corporate Social Innovation?

The operational definition proposed for corporate social innovation is as practices or efforts made by corporations that aim to find and offer innovative solutions to social problems using their organization ecosystem. 1, 2, 3

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More specifically, they define corporate social innovation as:

Expressing and realizing the desire to find creative solutions to social issues (primarily within the boundaries of the organizational environment);  

Initiating, shaping, and coordinating activities based on the innovative capacity and capability of organizations to identify social problems

Being supported by a culture that emphasizes social innovation and requires stakeholder involvement in problem identification and solution.

The relevance assigned to the stakeholders is related to their involvement in the problem statement and the solution. In this context, companies’ resources for innovation capabilities and capacities promote a culture emphasizing social innovation.

Corporate social innovation will be considered a subset of social innovation for the purpose of this article.

Defining the Boundaries of Corporate Social Innovation

Corporate social innovation has its own identity, distinguished from other forms of social support. 4, 5, 6 Corporate social responsibility represents the values declaration based on ethics overarching companies’ actions toward creating benefits for social aspects. 7, 8, 9 corporate social innovation works on specific innovational projects to deliver social value. It can be safely said that corporate social responsibility can be seen as the vision , while corporate social innovation is the strategy development and implementation. B-CORPS (B-Corporations) are businesses that balance purpose and profit. They are certified by a non-profit entity (B Lab) based on their social and environmental performance, transparency, and accountability. Social Entrepreneurship is a specific way to create social value by building an organization and business model to satisfy its mission. The last clarification relates to organizational innovation: it doesn’t include stakeholders or aim to generate effective societal change.

The Ingredients for an Impactful Corporate Social Innovation

Leaders play a pivotal role in setting their company’s social vision and embedding value-creation processes within the company culture while providing an atmosphere conducive to this activity. Their support is instrumental in allocating resources, mobilizing stakeholders, and accelerating social innovation initiatives.

Shared value creation, one of the key goals of corporate social innovation and business, involves the incorporation of social innovation into an organization, taking into account its business models, structures, systems and culture (especially corporate culture). Responsiveness to society should always take precedence as this fosters lasting social value creation.

Social empathy and awareness are integral parts of successful enterprise social innovation initiatives. 10, 11, 12 These abilities need to be developed over time and focused on specific social challenges to find bold, innovative solutions to overcome them. Recognizing this dimension highlights the necessity of industry-specific initiatives.

An organization’s ability to innovate in solving social problems has demonstrated its creativity by finding novel approaches to meet societal challenges using skills and technology while creating something of value to both society and business. Effective implementation must take account of structures and cultures as part of social innovation’s integration into an organization’s business model, structures, systems and culture. In other words, responsiveness must take precedence to ensure lasting social value creation.

As an important conclusive point consistent with what has been stated above, we draw particular attention to external stakeholders’ involvement, such as civil society organizations, public institutions and non-government organizations. They all play a crucial part in defining social problems and finding appropriate applications of corporate social innovation solutions. Nonetheless, employees constitute the first stakeholder group that drives social innovation by proposing and activating initiatives that foster an innovation-centric and social innovation culture.

What Is the Ideal Leader for Corporate Social Innovation?

Transformational leaders are ideal for corporate social innovation as they encourage people to think creatively and challenge existing ways rather than blindly follow the rules. 13, 14, 15 Other leaders, like transactional ones, care more about rules and routines, basing reward and punishment to keep the status quo.

Transformational style works better for corporate social innovation than traditional types: leaders encourage individuals to create innovative new solutions for social problems to make a real, impactful difference. Transformational leaders get people excited about creating change and uniting all employees around a shared vision of positive changes for good that impacts internal culture and behaviors.

What Are the Best Cultural Elements for Corporate Social Innovation?

Studies have uncovered cultural factors which explain why some organizations exhibit more sustainable behaviors than others. One of the key cultural components required to make successful corporate social responsibility initiatives flourish is stakeholder-centric practices, which meet stakeholder needs directly; such cultural elements have also been validated through discussion and research on this matter.

People’s Elements for a Corporate Social Innovation’s Culture

One element of corporate social innovation’s culture focuses on humans’ self-realization and development embedded in organizational culture. This concept has also been highlighted when analyzing the factors that establish the elements needed by a company to put into action corporate social innovation: personal factors.

Several individual factors represent the critical elements of corporate social innovation that need to be considered: self-efficacy in personal innovation, prosocial behavior and mindset. Self-efficacy in personal innovation is seen as the expression of self-efficacy in innovation behavior, driving innovation and augmented capability of the decision-making process with higher performance in social innovation. Prosocial behavior is demonstrated when people in organizations take prosocial actions to help or protect each other, teams, and organizations through knowledge sharing, and team innovation results in being oriented towards identifying and solving social problems. Their view about practicing prosocial behavior positively impacts job satisfaction and retention. Mindset is similar to shaping and supporting people’s behaviors in an innovational culture. It is shifting away from old innovation paradigms and new values related to corporate social innovation.

These three crucial personal elements are part of the behaviors that activate corporate social innovation: support, call for ethics, and the need for consistency between ethical leadership and the perception of employees towards values related to the good in society, thus allowing the association with the company activities. 

Corporate Social Innovation’s Critical Successful Factors

Social innovation allows businesses to enter new markets or segments while exploiting previously unexploited resources. Achieving success through social innovation requires understanding its key success factors and drivers, including contextual factors, organizational elements and managerial considerations.

Policymaker support, community participation and demand for innovation, company structures and their leaders’ guidance (contextuality) combine to allow firms to successfully develop innovations that address social problems.

Organizational elements include the business model, partnerships, participative culture and intrapreneurship, creativity, and continuous learning. Managers should act as entrepreneurs/innovators by employing practices that encourage teamwork and participation.

How Challenging Will It be to Put These Changes into Practice?

Switching the focus on social innovation is hard for many companies. Leaders have got to put in tons of effort to get the whole organization on board. Employees can push back because they are used to doing things a certain way. They don’t want to change their routines for new, socially focused and integrated activities.

Also, leaders must balance regular business goals like making profits and the new social impact goals. They must determine what’s best for helping society versus what makes the most money. It’s tricky to pick priorities. Measuring whether the social projects are making a difference for people is challenging. You can’t always see how much it truly helps. So, it’s tough to know the value created, especially during the journey’s beginning.

When you get more people and groups involved, you get more ideas, which is good. But it also means more disagreements to work through since everyone has different views. More voices make things more complicated.

Leadership poses many obstacles - getting people onboard, balancing business goals with social ones, showing impactful results and dealing with different opinions - yet leaders can overcome such hurdles by remaining committed and applying transformational leadership effectively.

Two Real-World Examples of Corporate Social Innovation: GSK and VIRGIN MONEY

GSK , the pharmaceutical giant, supports corporate social innovation by providing funding, ingredients, testing, disease models, and expert advice. They let researchers collaborate with GSK teams to develop ideas for new medicines for developing nations. This allows innovation in medicine while tackling social needs.

Virgin Money’s Digital Bank for Social Enterprises has created a specialized digital banking service to help social enterprises manage their finances more effectively. They also provide mentorship and grants to these organizations (Financial innovation with a social dimension). Some companies do more than innovate to grow their business; they also innovate to solve societal problems.  

Getting Started with Corporate Social Innovation: A Road Map

An in-depth investigation of internal capabilities is required: organizational culture, collaboration methods and leadership approaches, employee perception and sentiment analysis about social innovation. Teams can generate highly innovative solutions that significantly benefit client groups and explore novel approaches to major complex issues that match identified social needs. Stakeholders’ needs must be determined thoroughly within and outside the business and then engaged to explore their needs. Match stakeholders’ requirements with employees’ diverse ideas for market solutions as well as manager proposals in an efficient fashion. Then pilots are the most efficient way to test both ideas, cultural adoption and business results and social impact:  lessons learned.

Figure 1 - A Road Map for Corporate Social Innovation

In Conclusion

Businesses can create innovative solutions to social problems through corporate social innovation. It benefits both communities and companies: companies gain insight into people’s needs while rallying support among employees to address those needs collectively. Leaders should foster innovative thought. Their company cultures should welcome any fresh approaches that aim to better society. Employees should feel they can make a change and seek ways to do good work for the community. Leaders should integrate caring about the community into their values, actions, environments, learning processes, and responsibilities. This means caring about society, making it part of every employee’s goal, environment, learning process or responsibility structure.

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Social innovation: a systematic literature review and future agenda research

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• Volume 17 , pages 23–40, ( 2020 )

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• Francisco do Adro 1 &
• Cristina I. Fernandes   ORCID: orcid.org/0000-0001-8560-0758 2 , 3  

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The concept of Social Innovation (SI) emerged 70 years after the work of pioneering researchers such as Schumpeter. Starting from the linear model of innovation, a systemic and expanded concept of innovation was reached, in which several social agents can be innovative and not only companies. This research proposes to review and synthesize the evolution of innovation until reaching the focus on the analysis in the SI (origins, definition, agents, differences with other forms of creativity, contemporaneity of the concept, evolutionary perspective and political rhetoric). Through the methodology of the systematic review of the literature, an analysis by citations, content analysis and research by the references of the found articles was carried out. The results show a recent and somewhat marginal interest in the notion of SI, but with a contemporary intensification of studies, largely motivated by global socioeconomic and environmental changes. We intend to contribute to the systematization of the scientific knowledge of this field of study.

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do Adro, F., Fernandes, C.I. Social innovation: a systematic literature review and future agenda research. Int Rev Public Nonprofit Mark 17 , 23–40 (2020). https://doi.org/10.1007/s12208-019-00241-3

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Applying social innovation theory to examine how community co-designed health services develop: using a case study approach and mixed methods

• Jane Farmer   ORCID: orcid.org/0000-0003-1730-2622 1 ,
• Karen Carlisle 2 ,
• Virginia Dickson-Swift 3 ,
• Simon Teasdale 4 ,
• Amanda Kenny 5 ,
• Judy Taylor 6 ,
• Felicity Croker 7 ,
• Karen Marini 8 &
• Mark Gussy 9  

BMC Health Services Research volume  18 , Article number:  68 ( 2018 ) Cite this article

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Citizen participation in health service co-production is increasingly enacted. A reason for engaging community members is to co-design services that are locally-appropriate and harness local assets. To date, much literature examines processes of involving participants, with little consideration of innovative services are designed, how innovations emerge, develop and whether they sustain or diffuse. This paper addresses this gap by examining co-designed initiatives through the lens of social innovation – a conceptualisation more attuned to analysing grassroots innovation than common health services research approaches considering top-down, technical innovations. This paper considers whether social innovation is a useful frame for examining co-designed services.

Eighty-eight volunteer community-based participants from six rural Australian communities were engaged using the same, tested co-design framework for a 12-month design and then 12-month implementation phase, in 24 workshops (2014–16). Mixed, qualitative data were collected and used to formulate five case studies of community co-designed innovations. A social innovation theory, derived from literature, was applied as an analytical frame to examine co-design cases at 3 stages: innovation growth, development and sustainability/diffusion.

Social innovation theory was found relevant in examining and understanding what occurred at each stage of innovation development. Innovations themselves were all adaptations of existing ideas. They emerged due to local participants combining knowledge from local context, own experiences and exemplars. External facilitation brought resources together. The project provided a protective niche in which pilot innovations developed, but they needed support from managers and/or policymakers to be implemented; and to be compatible with existing health system practices. For innovations to move to sustainability/diffusion required political relationships. Challenging existing practice without these was problematical.

Conclusions

Social innovation provides a useful lens to understand the grassroots innovation process implied in community participation in service co-design. It helps to show problems in co-design processes and highlights the need for strong partnerships and advocacy beyond the immediate community for new ideas to thrive. Regional commissioning organisations are intended to diffuse useful, co-designed service innovations. Efforts are required to develop an innovation system to realise the potential of community involvement in co-design.

Peer Review reports

This paper considers how co-designed health services emerge and develop, and their potential for longer-term sustainability and diffusion. It considers the potential for social innovation theory as a frame for understanding what happens. For policy and practice, it highlights that understanding initiatives co-designed with communities as social innovation could help to identify useful strategies in co-design processes so that community co-design may fulfil on its potential to support healthcare change.

The participation of ‘lay’ people (consumers, the public and communities) in aspects of health service production is recommended in policy internationally (Australian Commission on Safety & Quality in Health Care [ 1 , 2 ]), and increasingly enacted. Lay participation can be in designing and planning services, evaluating, strategizing and governance [ 3 ]. One area of health services where lay participation is accepted as significant is in the work of regional commissioning organisations. These exist in countries including England, Canada, New Zealand and Australia [ 4 ]. Such organisations bring together service providers, clinicians and local citizens to consider population health data and evidence about what works, to design models of healthcare for local settings [ 5 ]. A key driver of community participation – defined as involvement of diverse people that live and/or work locally [ 6 ] - is to design and then provide services that align with local context and harness local resources [ 7 , 8 ]. Regional commissioning organisations aim to identify innovative, efficient, contextually appropriate service models that will improve population health [ 5 ]; these might be disseminated across regions, perhaps with adaptation. Here, we investigate the community participation efforts of two Australian regional commissioning organisations – Primary Health Networks (PHNs) – to design and implement locally appropriate service models to improve public oral health.

There is a substantial literature about lay participation in health services, but few studies include multiple cases that allow for comparison. Thinking about the role of communities in producing service innovation, Greenhalgh et al. [ 9 ] highlight a gap; published research evidence “focuses on innovations that arise centrally and are disseminated through official channels at the expense of those that arise peripherally and spread informally”. Despite significant interest in lay participation in design, there is a dearth of evidence considering the innovations that community participation might lead to, how these innovations emerge and what happens to them. With an interest in studying community-designed ‘grassroots’ health innovations, we turned to the relatively new notion of social innovation, considering its potential to provide an analytical frame for studying community co-design.

Social innovation as an idea has risen to prominence in relation to movements for citizen involvement in service delivery and novel approaches to welfare. Original usage was sociological, stemming from Gabriel Tarde’s theory that new forms of social relations lead to innovation [ 10 ]. Social innovation became widely discussed in the 1990s, with one branch of literature considering innovations developed by civil society actors aimed at creating socio-political change [ 11 ]. Within contemporary European policy, social innovations are those that are ‘social in their means and social in their ends’ ([ 12 ]; p.35). Brandsen et al. [ 13 ] depict social innovation as involving collaborations to co-design and implement solutions to social problems, particularly at local level. According to social innovation theory, co-produced solutions are assumed to have positive societal effects, either through increasing aggregate utilitarian value, or by empowering citizens in innovation processes [ 14 ].

Here, our interest lies in the potential of using social innovation ideas and research findings to develop a frame for considering the design, implementation, sustainability and diffusion of co-designed initiatives for providing local health services that come from the ‘grassroots’ of communities. We are interested in how instrumental ‘top-down’ community participation processes (driven by regional commissioners) enable diverse grassroots participants to gather, learn from each other, share knowledge and adapt ideas to new contexts [ 13 , 15 ]; and then what happens to innovations once they are planned and enacted.

We use data from the Rural ECOH (Engaging Communities in Oral Health) research project that involved community participation in co-design in six rural communities in two Australian states, funded by the Australian National Health and Medical Research Council (2014–16). Discussing our findings as social innovations, we raise questions in this paper, about the development, sustainability and potential for diffusion of initiatives created and consider how this might relate to aspects of process.

Overall project design

The Rural ECOH project aimed to support Primary Health Networks, local service providers and community members to co-design and implement new initiatives intended to improve local oral health; and to study what occurred. At each of six community settings, an evaluated community participation for co-design framework – Remote Service Futures (RSF) [ 16 , 17 ] - was used to implement a co-design process. RSF centres on four facilitated public workshops covering discussion of: 1) local health and health challenges including using objective health data; 2) evidence-based approaches to local health challenges; 3) exemplar initiatives of services to address health challenges trialled at other communities; 4) and then, co-designing a plan for local health initiatives. Following the co-design process, PHN staff worked with groups of community members and local service providers to implement co-designed ideas. The co-design and implementation processes were facilitated by a university-employed facilitator. Regional commissioning organisations were key drivers/sponsors. In 2014, these organisations were Medicare Locals, but following reconfiguration in 2015, changed to become Primary Health Networks (PHNs) [ 18 ]. Mixed-methods data were collected to document what happened during co-design and implementation phases over 24 months. The project had ethical approval from Human Ethics Committees of La Trobe (13–052) and James Cook (H5540) Universities and Queensland Health (13/QTDD/73).

Community settings included

Six communities were included, with population size ranging from 1150 to 10,400 people and a median of 8670. Community locations were 30–270 min-drive from a large regional hospital (median 150 min-drive). At three settings there were public and private dental practices, while two settings had private dental practices and one township had only visiting dentists. All settings were selected based on health services data showing high incidence of poor dental/oral health compared with state and national averages.

Co-design process

Community members – defined as people living and working locally - were invited to participate in co-design through: letters sent to local organisations and community groups; advertisements in community newsletters, websites, noticeboards and social media sites; and letterbox drops. Given that, in Rural ECOH, participation was to co-design oral health initiatives, Workshop 1 involved engaging with data about oral health status, while Workshop 2 presented evidence about effectively addressing poor oral health at community level. From this stage, participants identified priority themes for local service innovations. The facilitators brought information about evidence-based projects and initiatives previously undertaken elsewhere, to Workshop 3. This included, e.g. a video about Scottish Government ChildSmile project [ http://www.child-smile.org.uk/professionals/about-childsmile.aspx ]. Plans featuring the new initiatives wanted by communities, for all settings, were created at Workshop 4. This co-design phase occurred over 12 months.

Eighty-eight community members volunteered to participate across the six settings, through their attendance at one or more of 24 co-design workshops (four at each setting). Numbers attending individual workshops ranged from 3 to 14. At all settings, community members that worked in public services (e.g. health, education and council) participated, and there was also participation of people employed in other sectors, and retirees. Following the design phase, implementation groups were established. Meeting four times over 12 months, their role was to drive the planned changes at each setting to ensure as much action as possible within 12 months, occurred. Implementation group participants included PHN staff, representatives of local service providers and some community members that had also participated in co-design. The lay community members included were those that were interested to stay involved after the co-design process. University-employed facilitators organised the group meetings, took notes and ensured communication between meetings. At two stages, following planning (12 months) and implementation (24 months), cross-community meetings were held in each State, where representatives from all communities met together to discuss their experiences. This was intended to give the participants the experience of being part of a larger research project, to learn from each other and transfer knowledge from one rural community to another. This sharing acted as a motivator and a mechanism for knowledge dissemination between communities across the regions.

Data collected about co-design and implementation

Formal data collected included: a) typed notes of 24 co-design workshops and 24 implementation group meetings; b) co-designed plans for each setting (six); c) transcripts of audio-recordings of four cross-community meetings (with participants from all settings). In addition, the two facilitators maintained reflective journals covering 2014–16. Informal data were also gathered including notes from informal community conversations and newspaper articles and public social media site postings. Formal written consent was obtained for all recorded outputs. All qualitative data were entered into NVivo for management and analysis.

Initial data analysis

Following completion of the 12-month implementation phase, Rural ECOH project partners including from universities, PHNs, the Royal Flying Doctors Service and state dental health agencies met for two days to discuss the community co-designed plans, their implementation, project outputs and impacts. It was observed that a set of innovative co-design ideas had been generated - and in several cases actually implemented. We identified cases of innovative initiatives and considered these to be impactful outputs. We decided to examine and explain them.

We took an abductive qualitative approach to data analysis, involving iterations of researcher discussion and working with primary data - and ultimately, comparing with theory [ 19 ]. For coding, we followed Richards’ [ 20 ] method of descriptive, topic and analytical coding. Three researchers were involved in data analysis, to allow for verification. Eight of the author team were active in various ways in the co-design and implementation processes, so we were able to test and verify our coding and interpretations, through team discussions, with ‘lived experiences’ of the community processes. Exposing our overall data analysis and interpretation to the wider project partner team of health services providers allowed us to further test our interpretations, against their lived experiences of working in and with the communities. Specific steps in this initial analysis are detailed below.

The project researcher and partner group observed cases of new activities (innovations) at a workshop in April 2016. It was observed that each participating community had developed innovations. There was no community in which there were no innovations.

Data were initially analysed to identify ‘cases’ of innovations and a set of five were selected for in-depth description and analysis. These were selected from the overall set of innovations designed by communities based on the criteria that they were: a) relatively complex ideas (defined as involving multiple stakeholders and actions) that had arisen from co-design; and b) were seen through to implementation during the 24 months of the Rural ECOH project. Other innovations occurred in each of the six communities during the project, but we judged them as less complex including: information leaflets, provision of free toothbrushes and toothpaste to community members, providing information on oral health in ‘walk-to-school’ programs and an oral health needs assessment. Some ideas were complex, but not delivered during the timespan of the project. These included wanting: fluoridated public water supply; change to a state-provided oral health triage telephone line; and fluoride varnishing for vulnerable children’s teeth.

Author 1 worked with the two Rural ECOH facilitators to formulate the case study ‘stories’ of innovations, drawing on analysed data.

Case study drafts were sent to all project researchers and partners for validation or revision.

Case studies were revised in light of comments (mostly factual corrections around who was involved or precise nature of activities).

Further data analysis: Comparing case studies with social innovation theory

Having established the case study innovation stories from the analytical process explained above, we sought pre-existing evidence or theory that would help us to examine what had occurred. As noted above, we ultimately drew upon the literature of social innovation. We decided to do this as the innovations we observed were from grassroots and community stakeholder-driven, thus potentially relating more to literature on community-based social innovation, rather than literature about innovation in health services. We did explore the latter, but found it tends to cover the diffusion of top-down and technical health innovations (e.g. [ 21 ]).

We applied grassroots social innovation theory to the case studies derived to understand the extent to which the cases might be interpreted as social innovation. We sought to understand if social innovation theory could help in understanding the emergence, implementation, sustainability and diffusion of co-designed ideas about how to provide local health services that come from the grassroots of communities. Based on social innovation literature relevant to that purpose, we derived a model of the grassroots social innovation process highlighting three key stages and significant elements within these (Fig.  1 ). We applied this model as an analytical frame to the case studies of innovation we had derived from initial analysis. Below, we provide an explanation of the social innovation stages based on literature that we used to inform model development. Literature was derived from a systematic search of Scopus and Google Scholar, identifying literature combining concepts of community and social innovation.

Theory of Grassroots Social Innovation

Stage 1: Growing the idea

There is an assumption that ideas emergent from system grassroots are significant as they are located close to where problems occur. Thus, innovators understand problems in context and so are more readily able to assess the viability of potential solutions [ 22 ]. Social innovation literature suggests that many ideas for community innovations stagnate at the planning stage and are never physically realised [ 23 ]. Others suggest innovations can be so contextually enmeshed that their design and implementation necessitates people resourced to negotiate local power structures [ 24 ].

This begins to hint at the significance of partnerships between grassroots citizens and policy/service management-level actors if community-led ideas are to flourish beyond the design stage. Grassroots innovation ideas that grow to fruition may be those that coalesce citizens understanding of local problems, context and feasible local solutions; with managers and policymakers understanding of how to navigate new service implementation.

Stage 2: Developing the innovation

Grassroots social innovation ideas are fragile and they begin to gain traction only within supportive ‘niches’ ([ 22 ], p.1). These protect the new ideas from ‘too harsh selection pressures from incumbent regimes’ ([ 22 ], p.2), and nurture them to a piloting stage. Protection and nurturing of new ideas may be particularly significant in healthcare where a conservative technical culture demanding research evidence of cost-effectiveness can stifle survival of new ideas from penetrating the incumbent regime [ 25 ]. Again, a supportive political environment may be crucial. People acting as boundary spanners between innovative ideas and regime norms (for example, service managers) could be significant in supporting pilot of new ideas within systems of established practice [ 26 , 27 ]. Such people may even re-interpret and promote innovations to fit prevailing policy discourses so that they are seen as politically desirable [ 24 , 27 ].

Stage 3: Sustainability and/or diffusion

A novel practice is accepted when it moves to implementation beyond its experimental niche (Jaeger-Erben et al. [ 28 ]). Social innovations can be: scaled-up - increased use of the innovation; replicated – used in new locations; and partially translated – where elements of innovations are adopted, adapted and used elsewhere [ 29 ]. Raven [ 30 ] identified features of innovations that diffuse beyond their niche setting. They involve: a shared vision and expectations among stakeholders; involvement of stakeholders’ social networks for support and resources; and provide opportunities for shared learning among stakeholders. Hatzl et al. [ 25 ] explain that shared expectations provide clear direction and feasibility, while shared learning creates feelings of excitement and solidarity between innovators and policy/management actors that can ease innovation acceptance at regime level. Hatzl et al. [ 25 ] suggest stakeholder groups involving local policy-level organisations could implement innovation systems to support design, implementation and diffusion of promising community-based initiatives.

To gain acceptance, social innovations often have to negotiate a political as well as practice landscape [ 31 ]. Dominant political interests tend to resist change inspired by others [ 24 ]. Social innovations tend to diffuse only when compatible with the prevailing macro-level (policy) regime [ 22 ]. Given that the more radical social innovation literature highlights the centrality of changing established social and political order [ 32 ], the implementation and diffusion of grassroots innovations may require new organizational relationships, including change in operational or governance structures, for example opening-up new roles for ‘lay’/ non-technical community members. It is plausible that where social innovations are commercially profitable such changes might be implemented. For example, Hatzl et al. [ 25 ] show how the rise of community renewable energy initiatives has led to community ownership and governance, causing considerable system disruption.

Having devised the three-stage model of grassroots social innovation from literature, we applied it to the case studies of co-designed innovations we derived from Rural ECOH project data. This provided a frame to examine the process of design, development and implementation of innovations, understanding them and the co-design process producing them, as social innovations.

Below we describe five cases that we identify as relatively complex service innovations that were designed and implemented during the 2014–16 timeline of the Rural ECOH project. We discuss how ideas emerged and developed and the prospects, given current evidence, of their sustainability and diffusion. In the Discussion section, we examine the cases in light of social innovation theory.

Innovation 1: Health-check reminder stickers

The idea was to develop stickers reminding parents to take their child for a dental check-up. Stickers would be placed into a Child Health Development book by a health practitioner, generally a Maternal and Child Health Nurse (MCHN). Child Health Development books are provided for all children by the Australian government and a system of stickers is used to remind parents of milestones, e.g. immunisation dates. Participants in the co-design process identified that there was no sticker to remind parents about dental checks.

The leaders in identifying this innovation were two community members who had a nursing background, at Settings 2 and 3. As well as noting the idea of the stickers was already established, they said the idea because was equitable; stickers would stimulate a conversation with all parents and health practitioners would not be seen as ‘picking on’ individuals. PHN staff supported the idea by having stickers designed and produced, with a printable template placed on the PHN website for others to use. The stickers were used during the Rural ECOH project, but wider diffusion requires a sustained promotional campaign beyond the project.

Innovation 2: ‘Dry’ toothbrushing program

This innovation was developed for use at schools that do not have access to hygienic sinks. Community participants in co-design at Setting 2 included local school and dental clinic staff. Having seen examples of toothbrushing programs at Workshop 3, community participants asked the project facilitator for help to research programs that could be implemented at a local school where there was no access to clean sinks. This resulted in designing a school-based ‘dry’ toothbrushing program plus new dry tooth-brushing guidelines for schools. The guidelines and innovation were then tested in a pilot project by Dental Health Services Victoria (State government dental agency).

Innovation 3: Classroom toothbrush holder

The innovation is a cheap, hygienic toothbrush rack to hold the toothbrushes of a class of school students. Hygienic storage is important for school-based toothbrushing programs (i.e so brushes do not touch each other); and mobility is important so brushes can be moved for cleaning. Existing ‘brush-bus’ products were explored, but found to be expensive and small-size. Participants at Setting 2 designed a cheap, hygienic, portable, large brush-container.

Three different-sized plastic containers and a new drill ‘bit’ were purchased. Holes were drilled in the ‘brush-buckets’ at spaces so that brush-heads would not touch; and different sized containers arranged so that brushes were kept separate and sealed by a large lid, for clean transportation plus drainage and air-drying (important for infection control). The total cost was $14, compared with around $100 for existing ‘brush-bus’ products. The new container was used successfully in Setting 2. Overall, the main challenge to sustaining the toothbrushing program was identifying volunteers to assist at schools.

Innovation 4: Oral health education and screening at school immunisation sessions

This innovation involves using time in school immunisation sessions to provide oral health screening and/or education. The idea was suggested by community members that worked as school nurses and teachers. They identified time while school students are waiting before and immediately after immunisations, to provide other health inputs. The idea was that teachers or school nurses - appropriately trained - could provide oral health education and/or screening. Later the idea of deploying dental students on local placements, emerged as another resource.

An initial challenge was discovering who should ‘approve’ this innovation – stakeholders included the area school immunisation co-ordinator, directors of oral health services and school principals; all of whom were engaged by the Rural ECOH facilitator through contacts with the PHN as lead agency for the project.

Engaging the university dental students involved agreement from university placement co-ordinators. Ultimately, this involvement of dental students emerged as having potential to be sustainable. Involving the students harnessed an ‘additional’ resource which avoids negotiating extra work for existing health and school staff, although they do still have to co-ordinate the sessions. Existing practitioner working circumstances are not affected as student inputs are episodic and for learning purposes. The students suggested they enjoyed helping out and they gained experience of working in a school. The university can help to sustain the initiative by sending students who are on clinical placements locally. However, if ongoing provision of the service innovation hinges on student inputs, then the initiative relies on maintaining enthusiasm of university staff and finding resources for student travel.

Innovation 5: Oral health training program for non-oral health practitioners

This innovation is a one-day face-to-face training program in oral health to equip local individuals who are not oral health specialists, to conduct oral health education and basic screening (e.g. at school immunisation sessions). The idea arose because community participants at Setting 4 saw the example of the “Lift the Lip” screening program presented at Workshop 3.

An existing Australian training program was identified, but it was deemed overly expensive so the Rural ECOH facilitator commenced development of a bespoke course for local participants. She had a experience of educational design and garnered other input from staff of local service providers and state dental agencies, some of which were Rural ECOH partner organisations. The facilitator drove development because health agencies were reorganising at that time and she was tasked with ensuring the initiative happened. Funding to develop and run the training program was provided by a Medicare Local. A Registered Training Organisation (RTO) provided formal assessment so participants would receive a qualification from an accredited provider. Ultimately, 17 participants were trained.

Following training, at Setting 4, discussions in health and education organisations led to a decision that only formal oral health practitioners should conduct screening. No reasons were formally given for this decision. There were informal suggestions it could be linked to concerns about appropriate use of staff time and/or to concerns over practitioners’ scope of practice. At Setting 5, where younger children were the focus, MCHNs received training and went on to conduct oral health checks at pre-school. This new practice may be more straightforward to implement in this setting because it aligns with existing child health practices and parents are present to give consent.

Over the longer term, the RTO and the Medicare Local that funded training program development, both disbanded. This threatens the program’s longer-term sustainability, although some local organisations have expressed an interest in hosting it.

In Rural ECOH, community participation led to co-design of a range of innovations, including some quite complex innovations highlighted here that involved multiple stakeholders and actions that were implemented during the 24-month project timeline. As indicated in explanation of the cases above, and summarised in Table  1 , some of these innovations may be unsustainable in the longer term. Below, we use grassroots social innovation theory as a frame to examine the community-based ideas that emerged, development of innovations and to consider longer-term impacts. Based on our use, we suggest that grassroots social innovation theory is useful for analysing how to improve aspects of community participation for co-designed services.

In constructing the three-stage model of grassroots social innovation we showed that the process of social innovation from idea to diffusion requires a series of careful balancing acts. Ideas - adapted for local context - can be formulated within communities by gathering an appropriate assemblage of citizens and knowledge. An example is Case 2 where the facilitator provided a literature search to assist community members with developing a toothbrushing guideline. Implementation of ideas requires a protected niche. In our study, the Rural ECOH project provided funding, human resources and interest of PHN managers so experimentation could occur in relatively unthreatened circumstances. For the subsequent innovations to be implemented and diffused, the support of management and policy level actors appears necessary. In our study, this was borne out by the rapid implementation and diffusion of guidelines in Case 2 when the state dental health agency provided support, while Case 5 has an uncertain future because service managers became dubious about non-oral health practitioners undertaking training.

Growing the idea

Unsurprisingly given the methodological approach of Rural ECOH, the ideas emergent from co-design tended to be inspired by initiatives previously developed and tried elsewhere (we showed these at co-design Workshop 3). The innovations developed form a loose typology of those: extending an existing successful practice (stickers); developing a cheaper version of an existing product (toothbrush container); adapting an existing practice for a different context (dry tooth-brushing); applying an existing practice in a new practice ‘space’ (adding oral health education and screening into an immunisation program); and, directly translating an idea from existing evidence (oral health training program).

Given our placing of co-design as social innovation (as a process itself, but also producing social innovations as outputs), it is significant to note how adaptation of existing evidence and initiatives for local contexts, occurred. Firstly, there were contributions of community participants who were also services practitioners (council, education, health). All of the cases had public services workers central to the initial idea and/or its implementation – child health nurses (Case 1), teachers and oral health clinic staff (2 and 3), school nurses and teachers (4) and multiple health practitioners, managers and educators (5). In creating feasible solutions to local challenges, they combined their knowledge of: a public health challenge, local context and how health systems function. The well acknowledged phenomenon of boundary crossers applied in these rural communities [ 33 ]. Health and other public service professionals were service deliverers but also were community members. Such people can contribute from their own lived experience of the community but also from their professional experience. Facilitators tended to act as bricoleurs [ 34 ]. They assembled helpful resources, including: networks of local people with useful knowledge; and external actors including public sector managers, policy-level stakeholders (such as state dental health agency) and university staff. For example, in Case 5, the facilitator brought together health professionals and managers with ideas, university educators to design a program, a RTO to accredit training and funding from a Medicare Local. As well as connecting community participants and other resources, the facilitators - because they worked at the behest of policy-level organisations, but also at arms-length distance from senior managers - were able to provide an empowering space where community participants were both ‘given permission’ to consider service change and time-out from everyday routines, to draw on their knowledge and be creative. While this protective niche was significant for growing innovations, having facilitators to act as bricoleurs was an added resource brought about using project monies. The artificial nature of this resource raises the question of whether innovation-generating opportunities could be made more widespread - because that would require considerable resources.

In disseminating evidence-based ideas from literature and other communities, Rural ECOH’s facilitators informed and empowered community discussions and this resulted in generating new initiatives. This shows that, effectively, co-design projects can themselves act as a means of diffusing innovation and disseminating ideas between settings.

Development of innovations

The Rural ECOH project provided a supportive niche for innovations to be designed, developed and protected. Working with PHN staff to implement the initiatives, facilitators’ roles as bricoleurs was also significant as ideas were developed and ‘nurtured’. They acted to connect emerging innovations with policy-level and management actors, bringing initiatives to the attention of those who could harness resources and aligning them with system practices. For example, when participants at Setting 2 decided to create a dry toothbrushing program, the facilitator linked them with State dental health agency staff. Quite quickly, this State agency obtained funding to trial dry toothbrushing in other places. Draft guidelines that were drawn-up by the facilitator with community members, were refined, endorsed and used by the State agency.

Case study 5 exemplifies where implementation apparently faltered, perhaps because the innovation was insufficiently embedded within the existing health regime. For reasons that were valid given health system disruption at the time, the facilitator developed materials of the oral health training course herself. Once the initial supporting organisations had disbanded, there was insufficient buy-in from other partners that affected the sustainability of running training. As well, discussion around scope of practice and burdens of additional work, affected who was ‘allowed’ to undertake oral health screening in the communities. It is arguable that, in this case, partnerships with stakeholders were insufficiently developed to ease the path to uptake of new practice. Particularly, forging strong partnerships with policy level actors representing affected health practitioner groups might have helped.

Where innovations were successfully implemented they tended to be presented as compatible with existing regimes. For example, the stickers in case study 1 were an extension of established practice.

It might be argued that the range of initiatives designed by communities appear relatively conservative – perhaps particularly if compared with literature where communities develop sophisticated initiatives such as renewable energy schemes [ 23 ]. We can speculate on reasons why this might be the case. First, many community member participants tended to have little initial knowledge about rural oral health deficits and so the participatory process was partly an exercise in awareness-raising. Second, PHNs sponsored the process, thus the range of potential activities had to fit within the PHN remit and scope for action – i.e. largely about public health improvement and with little direct power to change clinical dental services. Third, participants tended to be influenced by the group of exemplar initiatives brought at Workshop 3 (although the choice of these was guided by their interests). Fourth, there was an implicit understanding that community members would be involved in implementing the initiatives and that there would be minimal resources, as the PHN did not have new resources. Finally, we only scrutinised here, ideas of communities that were fully implemented during the 24 months of Rural ECOH. Community members did raise other ideas that would take longer to deliver; for example, water fluoridation was desired at one setting. We do not judge that community co-design will always be conservative, but rather it is constrained by contextual factors and, understanding these, community members tend to be shrewd about expending their efforts. Desiring fluoridation of the water supply was a suggested innovation and is not a conservative activity. While it, and other less conservative innovations that were suggested, did not happen in 24 months, community members may have built capacity and networks that they can apply - after Rural ECOH - to pursue their more adventurous aspirations into the future.

Sustainability and/or diffusion

The Rural ECOH project was completed recently so insufficient time has passed to evaluate which, if any, of the implemented innovations will persist. It appears that all are technically feasible, given their derivation from exemplars and existing practices. Consideration of social innovation theory gives us avenues to predict what could occur. Projected cost savings may be of minor importance to sustainability. Two innovations (Case studies 3 and 5) that demonstrate potential cost savings may not be sustainable, or diffuse. Case Study 3, produced a low-cost toothbrush holder, but so far as we know, the design has not been taken-up elsewhere. And the toothbrushing program itself was threatened, in the setting, due to lack of local volunteers. It is also noteworthy that Rural ECOH innovations were generated within a healthcare regime focused on operational service provision and without a systemic mechanism for identifying and promoting innovation diffusion between sites. The Primary Health Networks have interest in identifying and diffusing promising innovation, but there is little guidance, as yet, of how this might occur (in policy or research literature).

Implementation and diffusion seems particularly dependent on harnessing policy-level support to demonstrate the compatibility of innovations with prevailing system/regimes. This point is exemplified by Case 5 where the innovation of a training program failed to gain a new owner at policy level when its original sponsors disbanded, threatening its long-term viability.

One case demonstrates successful diffusion outside the immediate setting. Case study 2 is a novel dry toothbrushing program (developed from grassroots, adapted from an exemplar) that has been adopted by Dental Health Services Victoria. Key to this we suggest, is that policy-level support and funding for development, were successfully and quickly engaged. The innovation has thus been accepted within the existing health regime. Together these findings imply that if grassroots health innovations are to be diffused / achieve sustainability, then they need to be presented as compatible with the existing regime, and that innovators need to actively seek support from policy and management level actors.

It is significant to remember the suggestion that social innovations are not all readily transferrable between contexts. Larsson and Brandsen [ 24 ] say that many social innovations are so context-specific that it is unrealistic to expect them to succeed elsewhere. This may pertain to the grassroots health innovations we have considered, although superficially all appear to be ideas that could be widely applicable.

Our study provides useful findings for policy and practice. Firstly, community members will design and participate in implementation of innovative health activities over a prolonged period of time. This could be expedited with the support of a skilled facilitator to pull together diverse people and information. However, this would be costly if community participation in co-design and implementation was to be scaled up. Drawing on the terminology of social innovation – protective niches are expensive to resource at scale. This leads into our second suggested useful finding which is that literature of community social innovation appears insightful in informing about processes for bringing the innovative ideas from community co-design into fruition as service innovations. We think, when working with communities, that evidence from other fields about how communities implement activities, e.g. community energy initiatives, could be more informative than the literature of health service innovation which tends to examine top-down organisation and health system innovation. Thirdly, we found that – while driven to involve communities in designing contextually appropriate services - PHNs and local service providers were actually unused to dealing with accommodating these ideas into practice. If community co-design is to occur more widely – and indeed to change the health system to be more customer-centric and community governed, then understanding how systems can accommodate novel ideas from the community, requires greater consideration in health policy. We suggest that insufficient thought has been given to potential outcomes of involving diverse partners in service design – i.e. that innovations will emerge, require to be accommodated within a conservative system and might be usefully transferred across communities, at least in part. This causes us to warn – be careful what you wish for, in the health system, when you invite community members to design innovative services. The situation at least calls for regional commissioning organisations to consider mechanisms for disseminating fruitful service innovations within their jurisdictions. In social innovation theory terms, most of the effort to date seems to be on ‘growing the idea’ in community participation – with less thought given to development, sustainability and diffusion phases.

Considering more theoretical contributions of our work, we propose that deployment of social innovation as an analytical frame for analysing community coproduced healthcare initiatives is useful. It addresses the apparent gap in literature covering the implementation of community co-designed innovation.

Through the lens of social innovation theory, we identified that community participation in co-design led to low-cost and technically feasible evidence-based service and product innovations. These were grounded in local community members’ experiences of problems and context. The key facilitators of effective co-design were identified as i) protective niche to generate ideas; ii) local compatibility to implement ideas and iii) political relationships to sustain changes.

The Rural ECOH community participation in co-design project created a supportive niche for innovations to be tried. Our findings highlight that low costs and technical feasibility are not in themselves sufficient for grassroots innovations to be sustained or diffused. Social innovation theory highlights the need to engage stakeholders at meso (management) and macro (policy) levels of systems to diffuse innovations. At the micro (community organisation) level this means that innovators / bricoleurs need to craft innovations as consistent with existing regimes and engage powerful stakeholders, leading to innovation take-up and advocacy.

The concept of social innovation (as understood in public policy) is built on suggestions that reframing social networks enables less powerful actors with a greater understanding of social problems to co-design new solutions. Our data suggest that - applied to the health context - this holds true. Such a system requires an acceptance that with innovation comes risk, but community participants can start with relatively non-disruptive (or conservative) changes, as participants in Rural ECOH communities did. However, this would appear to rule out locally-generated ideas likely to challenge existing funding and policy structures. The case studies generated relatively safe ideas such as reminders, toothbrush racks and education, raising the question as to whether conservatism is an inherent limitation of co-design processes that are actually driven instrumentally by health organisations? Understanding what to do with grassroots innovation when it occurs seems an essential next step if consumer and community partnership is to grow and fulfil on its promise. Otherwise community stakeholders might become disillusioned when managers and policymakers do not implement their power to trial, but also to accommodate innovations that address local problems through harnessing local resources.

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Acknowledgements

We acknowledge the role of Sarah Larkins in the overall Rural ECOH study.

Funding was provided by the Australian National Health and Medical Research Council through application no. 1057362. Other than providing the funding, the funder had no role in the study.

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Jane Farmer

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James Cook University, Townsville, QLD, 4811, Australia

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All authors, other than ST were involved in design of the research study. KC, VDS, AK, JT, KM and MG contributed to data collection. All authors contributed to data analysis and interpretation. JF, KC, JT, VDS and ST were responsible for first drafting of the paper. All authors contributed to further drafts of the paper and all have read and approved the final manuscript.

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Farmer, J., Carlisle, K., Dickson-Swift, V. et al. Applying social innovation theory to examine how community co-designed health services develop: using a case study approach and mixed methods. BMC Health Serv Res 18 , 68 (2018). https://doi.org/10.1186/s12913-018-2852-0

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Social business and social innovation: the Brazilian experience

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Article publication date: 15 July 2021

Issue publication date: 29 March 2022

The aim of this article is to contribute to the field of social businesses, particularly considering the dimension of social innovation.

Design/methodology/approach

The authors adopted a qualitative approach, whose purpose is to gather in-depth insights into a problem to understand its contextual elements and interrelations. The authors used an exploratory descriptive design and a multiple case study, which allows the identification of similarities and differences in the research subjects. They developed a scale that enables the classification of the operation logic of the social businesses analyzed.

It became evident that social businesses present a few differences in their modus operandi: those based on a social logic are more concerned with the generation of socio-environmental value, however with small-scale innovation; in contrast, social business guided by a market logic do not intend to generate socio-environmental value in different dimensions and are more concerned with the wider range of their innovations.

Research limitations/implications

This research analyzed social businesses from a founder and manager perspective and did not comprise all stakeholders. The purpose of this study was not to measure the effective impact generated by innovation, but to understand its potential to generate socio-environmental value.

Practical implications

The generation of socio-environmental value and the strategies to expand practices of social innovation are associated with the operation logic of social business.

Originality/value

The created scale allowed the classification of social businesses in terms of operation logic (greater emphasis on market or social aspects) and proposes a few dimensions to evaluate a socio-environmental innovation.

• Social entrepreneurship
• Social innovation
• Social business
• Socio-environmental value

Comini, G.M. , Fischer, R.M. and D'Amario, E.Q. (2022), "Social business and social innovation: the Brazilian experience", Innovation & Management Review , Vol. 19 No. 2, pp. 140-155. https://doi.org/10.1108/INMR-06-2020-0081

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Copyright © 2021, Graziella Maria Comini, Rosa Maria Fischer and Edison Quirino D'Amario

Published in Innovation & Management Review . Published by Emerald Publishing Limited. This article is published under the Creative Commons Attribution (CC BY 4.0) licence. Anyone may reproduce, distribute, translate and create derivative works of this article (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this licence maybe seen at http://creativecommons.org/licences/by/4.0/legalcode

1. Introduction

The emergence and expansion of social businesses in different parts of the planet makes this phenomenon the focus of administrative sciences not only by diving into its empirical characteristics, but also to apply knowledge stemming from organizational theory and the possibilities of modeling appropriated management tools.

Nicholls & Collavo (2019) affirm that social business is inherently a different phenomenon to define and describe because its nature demands a combination of typical logics and activities of social and public sectors with logics and activities associated with the entrepreneurial sector. One distinctive feature of social businesses is not the institutional elements they incorporate, but the organizational patterns, logics and structures used by them. This sort of actions is capable of taking advantage of the organizational hybridity to boost innovation and changes focused on social and environmental results through the generation of positive externalities and participation of communities in their own empowerment and/or improvement ( Nicholls & Collavo, 2019 ).

Within the social business field, new hybrid organizational structures are emerging, which pursue the accomplishment of two objectives previously considered incompatible: financial sustainability and generation of socio-environmental value ( Alter, 2007 ). Social businesses, inclusive business, social business and social impact companies are some of the terms currently used to assess organizations that aim to solve socio-environmental problems efficiently and to achieve financial sustainability through market mechanisms.

Considering it is a new terminology derived from the entrepreneurial environment, it has been the target of heated debates between scholars and practitioners. The lack of a homogenous vision is explained by two main factors: the different ways to define the social character of ventures and the different ways of assessing the innovative character in this sort of organization. In this broad spectrum of actors, the configurations of these businesses take on different formats. Each organization will position itself according to its own objectives and interests and will give different weights to each of the factors that make up the concept.

This article presents the results of an exploratory descriptive research whose general aim was to analyze the relationship between social innovation and social business in the 27 states of Brazil. For such, we developed a theoretical framework to allow the classification of the different social businesses and their contributions in terms of socio-environmental value. The innovations implemented by these organizations were analyzed to identify characteristics and patterns that could help formulate hypotheses on social innovation and social entrepreneurship.

The present article thus aims to fill a gap in the theoretical field of administration, particularly regarding the configuration of innovative models of social businesses and the generation of socio-environmental value. In this sense, clarifying the distinction between determinants and analytical dimensions of innovation, providing insights under the lens of results, and decoupling social innovation from only nonprofit organizations can contribute to advances in literature by addressing such research gaps. Finally, we expect that the reflections presented herein can contribute to understanding the limits and the potentials of social entrepreneurship in order to promote sustainable development through innovative solutions, be they of an incremental character or capable of causing disruptions that may lead to transforming social changes.

2. Literature review

2.1 social businesses: different approaches.

One can find in literature three main lines of through that explain social businesses. The European perspective, derived from the traditional social economy (associativity and cooperativity), emphasizes the operation of civil society organizations with public functions. The North American perspective understands that these businesses are private organizations guided by the logic of the market focused on solving socio-environmental problems. The third perspective, predominant in developing countries, considers social businesses as socio-environmental ventures that operate according to the logic of the market and that aims to reduce poverty and the transformation of social conditions that marginalize or exclude people ( Comini, Barki, & Aguiar, 2012 ).

A research carried out by SEKN (Social business Knowledge Network, 2010) emphasizes the role of small and medium-sized companies, cooperatives, and civil society organizations to provide solutions aimed at low-income population. According to such perspective, the population at the bottom of the pyramid is often playing the role of producers instead of simple consumers.

When analyzing the different definitions and characteristics of social businesses available in literature ( SEKN, 2010 , Celli & González, 2010 ; Sen, 2000 , Nicholls & Collavo, 2019 ), it is possible to list four factors that distinguish the differences among the approaches/lines of thought found in literature on social businesses, namely: the purpose of the venture, value chain, governance structure and financial sustainability.

Although there are different views on the format and management of social businesses, there is a consensus around the fact that these ventures pursue the intrinsic generation of economic and socio-environmental value. Social businesses are, therefore, characterized as hybrid organizations ( Battilana & Lee, 2014 ; Battilana, Lee, Walker & Dorsey, 2012 , Alter, 2007 ); however, with a very diverse spectrum in their modus operandi: some are more like traditional companies, with stronger emphasis on the market; others operate according to a logic similar to that of civil society organizations (regardless of their legal nomenclature) with greater concern for the generation of socio-environmental value. The present study proposes a continuum to describe the types of social business.

2.2 Generation of socio-environmental value

In literature on social businesses, there is a tendency to associate generation of social value primarily with the generation of income, which reflects a limited view on the meaning of poverty. As emphasized by Sen (2000 , p. 10), development consists in the elimination of deprivations of liberty that limit people's choices and opportunities to exercise their condition as agents. The reversal of poverty involves the provision of and access to fundamental social and economic conditions, such as education, health services, energy, housing, and opportunities to generate income ( Sen, 2000 ).

Torres, Barki & Comini (2015) highlight that combating poverty relates to an increase in the assets of a determined population: physical capital, including land and material goods; human capital, including education, health and work power; and social capital, which relates to the extension and nature of social relations. When the notion of capital is expanded, comprising several types of assets that make up the heritage of a population, the scope and complexity of sustainable development start to demand an essential prerequisite: society's access to full participation and to means of communication and information exchange ( Ostrom, 1999 ; Bak, 2018 ; Patiño & Faria, 2019 ). Thus, it is possible to affirm that the generation of socio-environmental value is closely related to combating the causes of social exclusion and inadequate exploitation of the environment.

Based on the analysis of 33 social businesses in the Ibero-American region, SEKN (2010) identified a few legal, symbolical, and cultural obstacles involved in the social exclusion that prevent the satisfaction of needs and the exercise of rights in promoting citizenship. One of the main aspects is the difficulty for low-income population to build an identity as members of a wider society and the sense of belonging, which goes beyond the borders of their own community.

In addition to the increase in assets, social businesses may also contribute to lower transaction costs for small producers or population in need. The famous argument regarding poverty penalty i.e. the phenomenon that poor people tend to pay more for consumer goods, can also be thought of as a specific type of transaction cost incurred by families ( Mendoza, 2011 ). In fact, the particular living conditions of some groups of the poor – especially regarding the place of residence – can imply much higher costs in terms of access to private products and services, as well as in terms of proximity to labor and access to public services (even if free).

Biodiversity and ecosystem services are natural assets that play a key role in sustainable development. Sustainable tourism activities, community activities focused on tree-planting, and the use of agroforestry systems that minimize risks of soil degradation inherent in agricultural activities and optimize productivity are examples of contributions to enhance natural capital. In this sense, Schartinger (2019) highlights that a more sustainable economy is an important issue for social innovation in the environmental field. It depends on more sustainable production chains in every aspect of the circular economy (i.e. design of long-life products, maintenance, restoration, reuse, remanufacturing, renovation and recycling) and in consumption patterns and consumer choice.

Taking into consideration the literature references presented in this subsection ( Bak, 2018 , Torres, Barki & Comini, 2015 ; Mendoza, 2011 ; Sen, 2000 ; SEKN, 2010 ), in this article we propose nine categories to assess the contribution of social businesses in the generation of socio-environmental value: increase in the quantity of physical capital, increase of productive capital, increase of human capital, increase of social capital, increase of cultural capital, citizenship, reduction of transaction costs, increase of natural capital, contribution to low-carbon economy and reuse of materials ( Figure 2 ).

The way in which social businesses structure and offer products and services in order to generate socio-environmental value leads us to the debate on social innovation. Just like the concept of social businesses, social innovation is also considered a polysemic concept closely related to new solutions to meet social needs ( Bignetti, 2011 ; Defourny & Nyssens, 2012 ). Authors like Terstriep and Kleverbeck (2019) point out that finding the appropriate business model to generate economic value while maintaining and increasing socio-environmental value is, therefore, extremely important for the long-term success of social innovation organizations.

2.3 Social innovation as a research field

Social innovation has stood out in literature as a research field in formation. D'Amario & Comini (2020) , when considering this still incipient research field in literature, developed and validated a scale to understand how social entrepreneurs identify the social innovations created by their ventures. In this study, the authors classified the types (product, process, marketing and organizational) and the intensity of social innovations (disruptive, institutional and incremental).

It is possible to observe that several international studies have mapped the evolution of research in the field of social innovation throughout the 20th century and have pointed out the multidisciplinary nature of this area, which comprises sociology, economics, geography, political sciences, environmental engineering, administration, among others ( Crossan & Apaydin, 2010 ; Sharra & Nyssens, 2010 ; Moulaert, Maccallum, Mehmood & Hamdouch, 2013 ). De Bruin and Stangl (2013 , p. 1) point out that “while the term social innovation is relatively new, its practice is not. The practice of individuals, partnerships and community groups working together in innovative ways to devise and implement resourceful solutions to complex social problems, has a long history.”

Sharra & Nyssens (2010) show that there are two main approaches in literature to understand such social phenomenon: result-oriented and process-oriented approach. In the first case, the perspective is more normative. Social innovation is then conceptualized as a more effective, efficient and sustainable solution to a social problem than the existing alternatives ( Phills, Deiglmeier & Miller, 2008 ). According to this current of thought, there are three criteria used to analyze a social innovation: originality (the solution must be new for the user, context or market), type of unmet social demand, and the purpose, which must be primarily social. The second perspective prioritizes the analysis of the process, i.e. how the innovation emerges, how it is adopted, and how it is disseminated. These two perspectives explain the reasons why the concepts of social innovation are so different. According to Pol & Ville (2009 , p. 881), “social innovation is a term that almost everyone likes, but nobody is quite sure of what it means.”

Bignetti (2011) presents five dimensions that distinguish technological innovation from social innovation. First, there is a difference in the values : technological innovation emphasizes value appropriation (self-interest of economic agents that may benefit from high profits through the exploitation of an opportunity) while social innovation highlights the creation of value (accomplishing unmet needs of the community in a satisfactory way). The second difference relates to strategy ; while the traditional innovation literature focuses on competitive advantages, literature on social innovation emphasizes the need to establish partnerships and collaboration in order to enable long-lasting social transformation.

The third dimension refers to the locus of innovation . According to Bignetti (2011) , the locus of traditional innovation is centered on the company, which is provided with many resources to carry out research and development. In the case of social innovation, actions are structured in the community through small and local efforts. The fourth difference refers to the process : technological innovation has been approached in sequential phases controlled by management tools. In contrast, for a social innovation to be successful, it must the result of a collective construction. It means that the phases of conception, development and implementation are closely interconnected and are carried out through the cooperation between the actors involved in a continuous process.

Nevertheless, it is important to point out that literature on innovation created by profit-seeking companies has advanced in terms of development process. Authors like Chesbrough (2006) emphasize a few benefits stemming from the cooperation with other partners within the concept of open innovation: “If firms cannot or don't wish to develop sufficient absorptive capacity themselves, they may utilize alliances in order to gain such knowledge or utilize complementary resources to exploit that knowledge” ( Chesbrough, 2006 , p. 9).

The fifth dimension indicates the most important difference, since it approaches the diffusion of knowledge. Intellectual property protection mechanisms seek to prevent a developed idea or technology from being copied and used by competitors; social innovations, however, are guided by diffusion mechanisms that favor the replication and expansion of results to other communities ( Bignetti, 2011 , p. 7).

Social innovation literature does not make a clear distinction between the determinants and the dimensions of innovation ( Crossan & Apaydin, 2010 ). Based on a systematic review of articles on innovation from 1981 to 2008, we propose a framework that distinguishes the determinants of innovation (leadership, organizational competencies, and management) from the analytical dimensions of innovation (process and results). From a process perspective, the basic question is: How does innovation occur? (How?). From a result perspective, the question is what is being done and for what purpose (What and What kind?).

In this article, we consider social innovation from a result perspective; in other words, from the generation of socio-environmental value for a community through the introduction of new products/services or process in a determined market or context. Such definition was defended at the first Forum on Social innovations carried out in 2000 through the OECD Local Economic and Employment Development (LEED) program. It means that, in this article, the aim is to distinguish a traditional innovation from a social innovation, and not to assess the locus/actors that conceives and implements it ( Phills, Deiglmeier & Miller, 2008 ; Pol & Ville, 2009 ; Chesbrough, 2006 ). This aspect is very important because social innovation studies with a social entrepreneurship approach associate innovation only with nonprofit organizations. “Scholarly study has progressed sufficiently to accept that the locus of social innovation is not only civil society. Social innovation can occur in the non-profit sector, the private or public sectors and intersect across sectors” ( De Bruin & Stangl, 2013 , p. 1).

De Bruin & Stangl (2013) propose specific dimensions to analyze social innovation as an outcome. The authors pointed out three aspects to be considered, namely: type of innovation, magnitude and extent of scale/impact. The type of innovation refers to the description provided by the Oslo Manual ( OECD, 2005 ), which defines innovation as the implementation of a new or significantly improved product (good or services), or significant changes in production and logistics methods (process innovation), or a new way of serving the customer (marketing innovation), or new organizational practices (organizational innovation). Magnitude implies analyzing whether the proposed solution is aimed at supplying a market failure, presenting in this case nothing but an incremental innovation, or to reconfigure the market structure, becoming an institutional innovation. An innovation can yet change the social system, becoming a disruptive innovation. The extent of the scale/impact can be classified as local, national or global. Considering that social businesses, i.e. the focus of this research, differentiate through their socio-environmental objectives, it is essential to add to the model developed by the authors a fourth dimension of analysis in order to materialize the purpose (generation of socio-environmental value). Table 1 presents the perspectives used in our study.

3. Methodological procedures

We adopted a qualitative research approach, whose purpose is to gather in-depth insights into a problem to understand its contextual elements and interrelations ( Maanen, 1979 ). We used herein an exploratory descriptive design ( Selltiz, Jahoda, Deutsch & Cook, 1974 ) and present a multiple case study, which allows the identification of similarities and differences in the research subjects ( Eisenhardt, 1989 ; Yin, 2003 ). In terms of primary data collection, we made use of 27 in-depth interviews, 27 focus groups, and observation. In addition, a documentary research was also carried out through websites of social ventures available online and testimonies recorded by entrepreneurs.

As at the time this study was accomplished (2013–2014) there was no available database in Brazil with information on social businesses, the strategy used for the selection of cases was the consultation of experts and organizations operating in the social entrepreneurship ecosystem. We approached 23 organizations, namely: accelerators (Artemisia, Quintessa, Nesst, B-Polo), organizations that promote social businesses (Ashoka, Social Good, Ande, Endeavor, B-Polo, NegociosSociais.com ), and impact investment funds and social finances (Vox Capital, Mov/Pragma, Ventura, Kaetê, Bamboo, BRIiX, Sitawi, LGT, Bamboo, Village Capital). We mapped 1,194 possible indications of social businesses in the entire country.

The next step in the selection of cases involved filtering such indications by our research team. Businesses indicated by more than one organization were prioritized. The existence of the social businesses was confirmed through institutional websites, telephone calls, and electronic mail. The cases confirmed were organized according to the federal state in which they were located and categorized according to three dimensions: nature, purpose and operation of the business. These dimensions were used as criteria for the fieldwork. We listed all social businesses by state, emphasizing the most frequent operating segments in that location. The enterprises operating for a longer time and that ensured a diversity of performance in the national sample were prioritized.

During the fieldwork, we carried out fieldtrips to the locations where the operations of the analyzed social businesses took place in order to know their operations, their managers and their surroundings. These fieldtrips can be considered learning expeditions, since they involved working hours and learning; in addition to contacting entrepreneurs and business managers, during these trips, meetings were held to which students and individuals interested in social entrepreneurship were invited. In these focus groups, the focus of analysis in the given region was presented and debates on its characteristics were conducted.

Langley & Abdallah (2011) emphasize that the major challenge of qualitative research is not data collection, but to validate data and information. In this research, we made use of content analysis through thematic analysis ( Bardin, 1994 ; Vergara, 2012 ). According to orientations provided by Martins & Theóphilo (2009) , three steps were taken for content analysis: pre-analysis (data collection and organization), analytic description (definition of units of analysis and thematic categories), and inferential interpretation (the contents are revealed depending on the purpose of the study). Eisenhardt (1989) recommends, initially, a detailed analysis of each case (within-case analysis) in order to seek patterns between cases (cross-case patterns) through categories or dimensions elaborated from the research issue or existing literature.

All results obtained from learning journeys (videos and descriptive information on each case) were utilized as reference materials to identify and analyze the occurrence of social innovation in the cases investigated herein. The products and services created by the selected social ventures were analyzed according to four dimensions: purpose (desired impact); form (type of innovation); level (magnitude of the innovation), and coverage (diffusion of innovation).

Primary effect: generation of socio-environmental value directly related to the central activity of the venture; the effect materializes the mission of the venture and is a direct result of the venture (Weight 2).

Secondary effect: generation of socio-environmental value obtained indirectly; it expresses a positive collateral effect of the activities developed by the venture, constituting a positive externality and an indirect result (Weight 1).

The number of points of a venture indicates its impact potential: the higher the number, the higher the impact potential. It is expected that social ventures that aim at provoking deep social changes generate socio-environmental value in more than one category. We carried out an analysis to verify if there is a relationship between generation of socio-environmental value and the types of innovation presented by each venture analyzed.

All social businesses mapped by the Brasil27 Research have hybrid organizational models, since the generation of socio-environmental value and financial performance are part of their mission. However, the level of hybridity is not homogenous. We created a scale with factors that classified social businesses according to their positioning (market logic vs. social logic). The elaborated scaled helped classify social businesses and highlighted the diversity of this sort of venture in the 27 Brazilian states. A heterogeneity of formats was observed, as according to the literature review, i.e. with no predominance of one type of innovation in relation to the others. Figure 3 presents that the distribution of the cases analyzed is quite uniform; in other words, there are 13 cases that operate based on a logic very similar to those of traditional companies, since they guide their actions with greater concern for competitiveness. The other 14 ventures guide their performance in a very similar way to a civil society organization, in which the achievement of social objectives is central to managers' actions and decision making.

The factors that most differentiated the ventures analyzed were governance and value chain; in other words, ventures with stronger social emphasis tend to promote the participation of individuals in the communities where they operate. In addition, they also seek to hire collaborators and suppliers from the population in a situation of greater socioeconomic vulnerability. In contrast, it is interesting to notice a possible trend in the performance of businesses with greater market orientation due to the offer of products with greater added value, aiming at consumers concerned with issues of sustainability and wellbeing. For example, consumption of organic food, Amazonian derived products, certified timber, unique and artisanal items, among others.

It was also observed that there is a tendency for social businesses structured as cooperatives and associations to operate based on a logic more focused on social objectives and results. However, such configuration is not mandatory; cases like Solar Ear and Terra nova are examples of ventures concerned with the generation of socio-environmental value, although legally established as private limited companies. In the case of solidarity ventures, it can be said that all of them are guided by values of solidarity, community participation, trust, and income generation for segments with greater vulnerability. Thus, its operation logic is more focused on social aspects with a concern for growth through the replicability of innovation.

In general terms, the analyzed social businesses emphasize primarily the generation of income (productive capital), professionalization, access to health services, and the offer of healthy products (human capital). The surveyed data indicate that there is still a wide space for the creation of social ventures with greater environmental concern: less than half of the observations (10) developed activities aimed at the conservation of biodiversity; only four contribute to a low-carbon economy.

The social ventures that operate with a market logic represent a more heterogeneous group; there is a greater variation in the categories of socio-environmental value generation. Social ventures with greater focus on social aspects tend to prioritize the generation of socio-environmental value in the categories human capital and productive capital through the design of a business model that also provides value in the dimensions of social capital and citizenship.

The most observed type of innovation in social businesses is organizational, which is defined according to the Oslo Manual ( OECD, 2005 ) as a new organizational method in the business practices of a company (new methods to organize daily activities and procedures for conducting work), in the organization of the workplace (new ways to distribute responsibilities and decision-making power), or in external relationships (new types of collaboration and partnership). Most social ventures (17) innovated based on a strategy aimed at building partnerships and alliances. Few social ventures (only seven) developed new production or logistic methods focused on cost reduction (process innovation). Social businesses have been focusing on the advantages from market opportunities through the introduction of new products or different sales channels. Table 3 summarizes the results.

As observed in Figure 5 , there is a tendency for social businesses to introduce one-off innovations: 14 ventures developed only one type of innovation.

Process innovation did not receive much attention from the analyzed social ventures. Only one case (Fazenda Tamanduá) introduced a new product (spirulina) and simultaneously modified the productive process to save natural resources, like water.

Most social businesses associated one type of innovation (market or product) to a modification in the business model. It means that the social venture makes the most of the experience and knowledge between partners to enable innovation. This fact seems to be the differential of social businesses in relation to traditional companies, in which the establishment of partnership with other actors to structure innovative products and/or services is more difficult, since they fear to lose their competitive advantage. In contrast, social ventures defend open and collaborative innovation.

The analyzed cases pointed out that Brazilian social businesses have the ability to take advantage of gaps in the market, probably due to failures in the performance of the government or lack of interest by large corporations (50% of social ventures implemented a market innovation that involves the sale of a product or service at a differentiated price or through a differentiated sales channel).

When analyzing the relationship between social businesses' performance and types of innovation, the data indicate a positive relationship between organizational innovation and ventures whose social orientation prevails. It means that social businesses with a social logic tend to value the establishment of partnerships among organizations and stimulate knowledge sharing among actors. In social businesses guided by a market logic, there was a greater tendency for product and marketing innovation in addition to a strategy aimed at benefiting from consumption and niche market opportunities.

In the cases analyzed, only three social ventures (Terra Nova, Banco Palmas and Solar Ear) can be considered strongly innovative organizations because they make significant improvements in the four categories (product, process, market and organizational) of innovation.

Regarding the level of innovation, only a few social ventures have the potential to reconfigure the structure of their market based on an institutional innovation (Fazenda Tamanduá, AAPPE, Ouro Verde, Justa Trama, Amata and Você Aprende Agora); and a fewer are capable of provoking systemic changes through disruptive innovation, which entails the creation of a new segment in the industry (Banco Palmas, Terra Nova and Solar Ear). Most of the cases (66%) implemented only incremental innovations in determined locations, i.e. they simply detected an opportunity stemming from failures in government performance or market failures.

Replicability seems to be the great challenge for Brazilian social businesses: 17 cases analyzed have local coverage. This space can be covered by enterprises with a broader market vision or by ventures that provide open social technology and pursue innovation in the production process to enable quantitative growth and increased economy of scale.

The rich biodiversity provided by the country and the negative impacts generated by a high-carbon economy are not being explored by the social businesses studied herein. One of the possible explanations could be the priority given by social business accelerator programs operating in the social field by alleviating or replacing the services offered by the government – particularly in urban environments – and neglecting the market potential in rural areas.

When jointly analyzing the results on generation of socio-environmental value and the level and coverage of innovation, a possible difference was observed between social businesses guided by a social performance logic and enterprises more focused on the market. On the one hand, most part of social ventures with social logic have demonstrated greater concern to generate socio-environmental value in different dimensions, however focusing on a particular location. To this end, the ventures implement organizational innovation considering the ability to form alliances and partnerships that enable addressing a market failure. The contribution of such businesses to sustainable development seems to be of greater depth; in other words, qualitative with great potential to enable socio-environmental transformations.

On the other hand, businesses focusing on the market seem to be more innovative, since they diversify products, process, and distribution channels with potential to trigger a reconfiguration in its operating segment. Its contribution is mainly related to scope – in other words, quantitative and scalable. However, they contribute to a smaller number of dimensions in terms of socio-environmental value.

In short, the logic of social action is responsible for triggering stronger impacts on local development and social transformation. In contrast, the logic of the market tends to provoke stronger impacts in specific dimensions of sustainable development. Considering that social exclusion and environmental degradation are chronic issues, the coexistence of social businesses with different logics in the social business ecosystem is extremely relevant, in addition to the use of technology to increase the scale of the impact. Banco Kiva is a good example of social business that makes use of technology to boost impact, along with social entrepreneurs. In the upcoming section, we will present the final considerations and the limitations of this research.

5. Final considerations

In a retrospective and reflective analysis on the field of social entrepreneurship and social businesses, the researchers Barki, Comini, Cunliffe, Hart, & Rai (2015) listed four approaches to carry out studies in the area: the first dimension refers to the conceptualization of this sort of venture, which is essential to create a new study field ( Comini, Barki & Aguiar, 2012 ). Despite the existence of different terminologies and lines of thought, there is a consensus that this sort of organization differs from a traditional company. Maximizing profits for shareholders gives way to maximizing the generation of socio-environmental value for society ( Austin, Stevenson & Wei-Skillern, 2006 ; Martin & Osberg, 2007 ). The second relevant research dimension relates to strategies and management of hybrid organizations , i.e. how these organizations structure to achieve goals hitherto seen as contradictory: profitability and social impact ( Alter, 2007 ; Battilana & Lee, 2014 ; Smith, Gonin & Besharov, 2013 ). The third theme refers to social innovation ; in other words, how to implement new solutions to improve society and to solve social and environmental problems that arise from a disorderly and unsustainable economic growth ( Murray, Caulier-Grice & Mulgan, 2010 ; Bignetti, 2011 ). The last dimension is related to the measurement of the impact generated by social businesses. Investment funds that gather resources for social businesses must quantify the results obtained ( Bannick & Goldman, 2012 ).

The aim of this research was to contribute to the field of social entrepreneurship, especially regarding social innovation, considering we identified a few important research gaps in literature. First, the studies found on social innovation to the present date do not bridge the gap between traditional/technological innovation and social innovation; the latter is handled as a completely different study field. Second, a clear distinction is missing between the determinants of innovation and the analytical dimensions of innovation (process and result). Third, there is a predominance of studies that analyze innovation from a process perspective; there are, therefore, a few works that analyze social innovations from a result perspective.

Finally, social innovation studies with a social entrepreneurship approach associate this sort of innovation only with nonprofit organizations. The expansion of market initiatives that aim to generate social and economic value, which occurred at the turn of the twenty-first century, implies revising this assumption, considering that the locus of social innovation may also be profit-seeking companies or the public sector. Based on these gaps, the research problem was outlined: to what extent are social business models generating socio-environmental innovation?

In order to obtain answers to this academic issue, a research group known as Brasil27 was created, which received funding from Rockfeller Foundation, Avina and Omidyar. The objectives of the research were: (1) to identify and describe existing ventures in the 27 Brazilian states that could be characterized as social businesses; (2) to identify the extent to which social businesses are a source of innovation; and (3) to evaluate the possible existing correlations between characteristics of the social venture and the type of innovation implemented. Social innovation was analyzed from a result perspective, i.e. new solutions (product, process, market, or organizational) that have the potential to generate socio-environmental value for a community.

The Brazilian experience of social businesses analyzed in this study emphasizes that in Brazil there is no predominance of a single social business model. On the contrary, there is a coexistence of different legal formats (company, association, cooperative) with a diversified operation logic in the five macro-regions. In Western Europe, Asia and North America, specific regulations have been created to precisely delimit the format of social businesses and, at the same time, to enable a more conducive environment for its consolidation. In Latin America, the debate on the importance of creating a specific legal format for hybrid organizations have been boosted by the actors participating in the B 12 system, a movement whose purpose is to stimulate the structuring of businesses aimed at generating shared value ( Rodrigues, Comini, Fischer, Dujardin, & Santos, 2015 ).

The characterization of social businesses, i.e. the object of this study, occurred through the analysis of the purpose of their actions and not by its legal format, which precludes the definition of the real research universe and the representativeness of the 27 cases analyzed. The inexistence of a structure database at the time the research was conducted demanded the constitution of an estimated social business universe based on indications from the main actors in the field (accelerators, funding agencies, and investors). Since it is an exploratory study with qualitative approach, the obtained results must be contextualized and not generalized. However, the findings presented herein indicate assumptions that can be verified in studies with quantitative approach, such as the relationship between the type of social innovation and the operation logic of social businesses. In the sample of this research, for instance, social businesses with a social operation logic develop more organizational innovations and that social businesses guided by a market logic develop more product innovation.

This study revealed that social businesses with market and social logic play different roles and contribute differently to the proposition of alternatives for a sustainable development: social businesses with a strong social orientation tend to prioritize local actions and pursue the generation of socio-environmental value in different dimensions. In this sense, it is possible to affirm that the contribution is qualitative and with greater depth of impact. In contrast, social businesses with market operation logic are more concerned with sales, greater capacity to introduce product or market innovation, and tend to trigger institutional changes in the industry. It is possible to conclude, therefore, that the contribution of such ventures is quantitative and with greater breadth of impact.

Even though there are very different social business models, we identified a possible relationship between the purpose of the venture and the generation of socio-environmental value: ventures with greater social orientation (social logic) are multidimensional in their contribution to social exclusion and environmental degradation and favor subjective elements, such as social capital, citizenship and cultural capital – as opposed to social businesses that operate with a market logic. The appreciation of traditions, strengthening of ties in the territory, recovery of history and empowerment are a few examples.

It is important to emphasize that the principle of this analysis was to assess the purpose of the venture, not to measure its impact. We recommend for future studies on generation of socio-environmental value to identify situations with misled missions and to measure the impact generated by these ventures.

Even though social businesses generate a lot of socio-environmental value, their innovative capacity is still low: most cases (66%) implemented only incremental innovations in a given location, taking advantage of market failures or failures in government performance. Only a few social businesses offer products/services with the potential to reconfigure the structure of the market or to create a new segment in the industry. However, these businesses do have the potential to reconfigure the market in terms of principles and values, since they contest the traditional modus operandi of capitalist companies, whose only purpose is profit maximization without considering the generation of socio-environmental value.

We recommend future research to evaluate the different strategies utilized by social businesses to widen the scale of their impact. Riddell & Moore (2015) point out three strategies: scale out (expansion of the number of beneficiaries/customers), scale deep (cultural changes) and scale up (influence on public policies). Social businesses with social operation logic can choose different strategies to increase their impact than ventures guided by market operation logic.

Finally, we consider important to emphasize that the effective contribution of hybrid organizations – such as social businesses – to a more inclusive and environmentally responsible society entails that managers of this sort of venture recognize the principle of institutional incompleteness, i.e. no single institution will manage to solve the major problems related to poverty and environmental degradation. The creation of socio-environmental value must be seen as a priority and the creation of economic value as a necessary objective.

Another limitation of this study is related to the data collection strategy, which only comprised founders and managers of social businesses. Future studies should broaden the field of social businesses by incorporating the perspective of customers, beneficiaries and employees.

Continuum – positioning of social businesses

Categories of the generation of socio-environmental value

Social ventures analyzed

Social businesses and generation of socio-environmental value

Types of innovation identified from observations

Dimensions to analyze social innovation

Generation of socio-environmental value

Type of innovation

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The application of social innovation in healthcare: a scoping review

Lindi van niekerk.

1 London School of Hygiene and Tropical Medicine, London, UK

Lenore Manderson

2 School of Public Health, University of the Witwatersrand, Johannesburg, South Africa

3 School of Social Sciences, Monash University, Clayton, Australia

Dina Balabanova

Associated data.

The data used for this article is available from the corresponding author on reasonable request.

Social innovation has been applied increasingly to achieve social goals, including improved healthcare delivery, despite a lack of conceptual clarity and consensus on its definition. Beyond its tangible artefacts to address societal and structural needs, social innovation can best be understood as innovation in social relations, in power dynamics and in governance transformations, and may include institutional and systems transformations.

A scoping review was conducted of empirical studies published in the past 10 years, to identify how social innovation in healthcare has been applied, the enablers and barriers affecting its operation, and gaps in the current literature. A number of disciplinary databases were searched between April and June 2020, including Academic Source Complete, CIHAHL, Business Source Complete Psych INFO, PubMed and Global Health. A 10-year publication time frame was selected and articles limited to English text. Studies for final inclusion was based on a pre-defined criteria.

Of the 27 studies included in this review, the majority adopted a case research methodology. Half of these were from authors outside the health sector working in high-income countries (HIC). Social innovation was seen to provide creative solutions to address barriers associated with access and cost of care in both low- and middle-income countries and HIC settings in a variety of disease focus areas. Compared to studies in other disciplines, health researchers applied social innovation mainly from an instrumental and technocratic standpoint to foster greater patient and beneficiary participation in health programmes. No empirical evidence was presented on whether this process leads to empowerment, and social innovation was not presented as transformative. The studies provided practical insights on how implementing social innovation in health systems and practice can be enhanced.

Conclusions

Based on theoretical literature, social innovation has the potential to mobilise institutional and systems change, yet research in health has not yet fully explored this dimension. Thus far, social innovation has been applied to extend population and financial coverage, principles inherent in universal health coverage and central to SDG 3.8. However, limitations exist in conceptualising social innovation and applying its theoretical and multidisciplinary underpinnings in health research.

Graphic abstract

People cannot operate in a new way unless they can see afresh their real cultural circumstance [ 1 ]

The global community has made significant investments in realising health for all people. Yet, despite the ambitious Goal 3 of the Sustainable Development Goals (SDGs), universal health coverage has yet to be experienced by millions of people in high-, middle- and low-income countries [ 2 ]. While progress has been made to strengthen health systems, 2020 has been an unprecedented year in which both robust and fragile health systems have encountered significant additional pressures to provide care in the face of the novel coronavirus pandemic, climate-related changes and environmental disasters, economic recession, migration and civil unrest [ 3 – 6 ].

Even prior to the SDGs and most recently the pandemic, social innovation had grown rapidly as an approach to address social challenges across all fields, including in healthcare. The enthusiastic interest in and application of this approach occurred despite a lack of conceptual clarity [ 7 – 10 ]. The hindrance to its wider application, McGowan [ 11 ] argues, is that the term ‘social innovation’ has not been employed clearly or consistently.

However, social innovation is regarded as a label for structural change and social reform [ 12 ]. From historical accounts, two examples in healthcare are cited as being social innovations: Florence Nightingale’s work, supported by the Irish Sisters of Mercy, in pioneering reform of nursing care [ 13 ]; and Cicely Saunders’ creation of what became a global hospice movement for palliative care [ 14 ]. Contemporary challenges and the dominant technocratic culture, that often operates at a cost to the human and humane in healthcare systems, services or programme delivery, provide continued impetus for social innovation.

In this article, we consider how social innovation has been applied conceptually in the past 10 years to support the achievement of global health goals, such as universal health coverage. We firstly provide conceptual clarity and framing of the multi-dimensional nature of social innovation, as underpinned by a variety of theories. Secondly, we synthesise the results of a scoping review of peer-reviewed research literature, published in English from 2010 to 2020 on social innovation in health. We conclude by discussing limitations and gaps in the current literature and directions for future research.

Dimensions of social innovation

Nature and attributes of social innovation.

In 2017, Edwards-Schachter and Wallace [ 8 ] conducted a systematic review and identified 252 discrete definitions of social innovations. In this article, we provide a conceptual framing of characteristic aspects of social innovation based on various definitions (Table ​ (Table1). 1 ). We seek to highlight the different theoretical applications and paradigms related to social innovation. In Fig.  1 , we draw on the work of Ayob et al. [ 7 ], and supplement their proposed framing with factors pertaining to understanding social innovation. In the follow text, we briefly discuss each aspect.

Key social innovation definitions

Components, paradigms, theories, scales and actors of social innovation

The stimulus to social innovation, as for any innovation, is in response to a challenge. By the 1970s scholars had developed an awareness of the limitations of technological innovation and business approaches to effectively meet explicit social needs. Increasingly in the last decade, social innovation has emerged as an alternative to address complex and intransigent societal challenges such as climate change, poverty, the effects of globalisation and inequality, and as a way to produce lasting social change. Social innovation challenges transcend geographic, administrative and political boundaries [ 9 , 25 ]. For this reason, van Wijk and colleagues argue, challenges best addressed by social innovation have been labelled as ‘wicked problems’ [ 26 ], ‘metaproblems’ [ 27 ], ‘grand challenges’ [ 28 ], or complex challenges with interdependencies across multiple systems and actors [ 24 ]. Mulgan [ 16 ] highlights the systemic nature of these challenges by noting that existing systems and structures often fail the very people they intend to serve. Others point to the existence of ‘institutional voids’—absent or weak institutional arrangements—in the context of markets and governments that may hinder the participation of communities. The result is that social and economic inequalities emerge or are reinforced [ 29 , 30 ]. However, Mair argues that these same institutional voids alternatively represent an opportunity for social innovation, allowing new forms of participation by a range of actors with complementary objectives [ 31 ].

Participation

A second distinguishing feature of social innovation, as compared to technological innovation, is its participatory process that promotes social inclusion—reforming existing and promoting inclusive social relationships among individuals, especially those previously neglected from political, cultural or economic engagement [ 19 , 20 , 32 , 33 ]. This is often referred to as ‘innovation in social relations’ [ 15 , 34 ]. It extends beyond the notion of participatory governance, as despite the ability of participatory governance to achieve greater social accountability, it can do so still by focusing only on special interest groups or by limited inclusion [ 33 ]. Co-creation, co-production and co-design have become popular mechanisms, used especially by governments, to actively engage citizens in policy and program development [ 35 – 37 ]. Parra [ 38 ] connects social innovation with sustainable development, by highlighting how alternative forms of expertise, such as indigenous and citizen knowledge, can result in greater collective learning and knowledge building beyond the technical rationality of scientific protocols.

Four actor groups participating in social innovation are commonly identified: individuals (citizens); social movements; organisations including state and non-state entities (governments, non-governmental organisations, charities, community-based organisations); and new hybrid organisations such as social enterprise [ 39 – 41 ]. Social innovation is unique in terms of cross-boundary or cross-sectoral partnerships at the intersections of business and non-profit sectors. Relationships and trust play an important role in fostering these partnerships [ 42 ].

Creative solutions

Most definitions reference social innovations as creating new ideas or solutions but remain agnostic of the form that this could take being it new products, programs, services, processes, activities, practices or social movements [ 9 , 13 , 15 , 21 , 23 , 43 ]. Yet, social innovations are rarely based on something entirely novel; instead they combine or involve a ‘bricolage’ of two or more existing ideas, theories or products [ 44 ]. Diverse theoretical approaches, disciplinary perspectives and even geographic contexts result in different paradigmatic views. One example is the instrumental or technocratic paradigm, originating out of organisational and management studies and public policy from a European context, focused on promoting a neoliberal policy agenda, addressing market failures and reducing public spending [ 34 , 45 ]. This paradigm regard the most important characteristics of social innovations being ‘more effective, efficient, sustainable or just than existing solutions’, and thus often take the form of social enterprises (or other hybrid organisational models), social finance, corporate social responsibility and public private partnerships [ 17 ]. Some scholars have been critical of this paradigm due to its politicised nature. Marques [ 33 ] cautions that social innovation can be used as a way of ‘rebranding of political agendas, community development and corporate social responsibility’ by policy makers or academics, without fundamentally altering the goals or outputs. Montgomery [ 45 ] warns that the technocratic social innovation solutions could reinforce rather than disrupt top-down vertical power distributions within social relations.

Empowerment and agency

A second view of social innovation, the democratic paradigm, extends to include components of empowerment and agency [ 45 ]. Moulaert [ 46 ] regard social innovation as being way to meet human needs by increasing participation levels and empowerment, enabling greater access to resources, and increasing social and political capacities. The quality of participation conceptualised in this view contrasts with that of the technocratic paradigm. While the technocratic paradigm can result in the ‘creative destruction’ of social relations, the democratic paradigm results in the ‘creative transformation of social relations’ [ 45 ]. In a case study on the Great Bear Rainforest, Moore and colleagues [ 47 ] highlight the role and the redistribution of power between citizens and government in social innovation, that led to governance transformations. Development scholars like Tiwari [ 48 ] and Ibrahim [ 49 ] have drawn on Sen’s capability approach for human development [ 50 – 52 ] as a way of explaining a bidirectional relationship between agency and social innovation. They argue that through generating agency, social innovations can help achieve new collective capabilities, which can be used by communities to achieve what they value most in life. This work presents a broader view on empowerment, not only as a transfer of power but as the expansion of people’s agency.

Institutional and systems change

In a subset of definitions, social innovation is presented as institutional change or transformation in complex adaptive systems with authors labelling it the institutional [ 34 ], structural or structuration [ 9 , 33 ] or systemic [ 22 ] paradigm. Theoretically it is underpinned by institutional theory, which is regard rules, norms and beliefs as being socially constructed and where micro-level patterns of interaction influence to the creation of macro-level social structures[ 53 ]. However, institutional theory does not adequately explain the role of actors in reforming or creating new social systems and structures [ 9 ]. Scholars have drawn on neo-institutional and structuration theory to further explore the role of actors as institutional entrepreneurs and their ability to transform the very institutional structures that are meant to constrain action (so called, the paradox of embedded agency) [ 54 – 56 ]. These scholars regard agency as a core catalyst in institutional change which in turn will stimulate transformative change in the social system. In the domain of ecology, scholars have drawn on adaptive cycle heuristic to explain how social innovation generates constant change within social systems by challenging the basic routines, resources, authority flows and beliefs of the social system; so doing social innovation enhances resilience in the system [ 22 , 23 , 44 , 57 ]. This approach helps to explain the multi-scalar nature of social innovation—in that micro-level local innovations (within communities and organisations) can cascade up, leading to transformations at larger scales [ 56 ].

In summary, social innovation is a multi-dimensional concept that has been studied from different theoretical streams and viewed through different paradigmatic lenses. Beyond regarding social innovations as tangible outputs or solutions, created to address unmet societal needs, social innovations at its core challenges the underlying culture and values of the dominant system. As described above, social innovation also includes innovation in social relations and in power dynamics, leading to governance transformation and changes in internalised (mindsets) as well as externalised (structural) institutions. Social innovation thus holds potential to alter the root issues responsible for systems not delivering their intended objectives to society as a whole.

A scoping review was selected as an appropriate method because social innovation has been studied in multiple academic fields such as organisational and management studies, public policy, economics, ecology, urban studies, creativity research and psychology, with each discipline using its own set of research methods. A scoping review assisted us to determine the coverage of the literature on social innovation as pertaining to health, by mapping the available evidence and identifying knowledge gaps or limitations [ 58 , 59 ]. Three questions were identified to be answered through this review:

• How is social innovation as a concept applied to health, health care or health services?
• What barriers inhibit and what enabling factors support the design and implementation of social innovations in health within the health system or wider context?
• What are the limitations of the current literature on social innovations associated with health systems strengthening?

Search strategy

Online databases were examined between April–June 2020, including Academic Source Complete, CINAHL, Business Source Complete, Psych INFO, Pub Med and Global Health. Databases were selected for their disciplinary breath. The following search terms were used:

(social innovation [subject heading]; OR “social innovat*” [abstract]; OR “social innovat*” [title]; OR social N1 innovat* [abstract] OR social N1 innovat* [title]) AND health OR healthcare OR health care OR health system OR health services (abstract).

Inclusion criteria

The inclusion criteria for articles were as follows: (1) published between 2010 and 2020; (2) used the term ‘social innovation’ as a concept and provided a definition; (3) applied social innovation to a dimension of health; (4) described the methods provided; and (5) were available as a full text in English from university databases. A 10-year time frame was selected as it was expected that this period will yield the most significant results, as social innovation research have been on the increase, and also be the most relevant.

Analytical approach

An analytical framework was developed to assist with analysis, informed by the conceptualisation of the dimensions of social innovation and the framework used by Edwards-Schachter and Wallace [ 60 ] (Fig.  1 ). This framework (Fig.  2 ) was used to deductively analyse the different aspects of each article included in the review, with NVivo 12 used for the management and coding of material. The framework derived for this study included six areas that contributed to a broad understanding of the literature, as discussed below.

Analytic framework

Overview of studies included

A total of 27 studies met the eligibility criteria and were included in the scoping review (Fig.  3 ). The majority of articles (21/27) were published between 2015 and 2020. Half (14/27) were published in health-specific journals and the remaining half in a range of other disciplines including management and business studies and programme, policy and planning studies, innovation and informatics, and agriculture. The most common methods were case studies (14/27), and scoping, systematic and general literature reviews (4/27). The literature was dominated by research originating from high-income country contexts, particularly in Europe. Nine published studies were conducted in low-income, low-middle income or upper-middle countries (two in Africa; four in Asia; three in Latin America). Low-income country researchers (first author) and institutions were under-represented in the sample, limited to only three representing institutions in Colombia, Uganda and India.

Literature search and review process

Social innovation has been applied to a variety of disease focus areas and to meet public health policy objectives (Table ​ (Table2). 2 ). Social innovations in low- and middle-income countries (LMICs), 3/27 studies, focused on infectious diseases, targeting prevention and access to services for malaria, HIV and Chagas disease [ 61 – 64 ]. A second focus of social innovations in LMICs, 9/27 studies, was to achieve equity in access to care and this included women’s health issues and social determinants of health such as poverty, rurality, and infrastructure (basic sanitation) [ 61 , 64 , 65 ]. These focus areas were in line with both national health agendas as well as global agendas as set by the Millennium and Sustainable Development Goals. The literature from high-income countries describes a different application of social innovation in terms of disease focus and public health objectives. Many European countries have adopted social innovation to address welfare state failures, particularly related to the inability of governments to sustain rising health expenditures for ageing populations [ 66 – 72 ]. In this context, social innovations have also been developed in response to policy objectives concerning public participation in health, often as a secondary strategy to move the burden of care from the state to individuals and other actors through social enterprise [ 71 , 73 – 75 ]. As this indicates, social innovation is typically applied to address health system failures. Kreitzer et al. [ 76 ], for example, explored the Buurtzorg (Neighbourhood Care) Model in the Netherlands, designed to overcome vertical service delivery, low health worker satisfaction, and burdensome bureaucratic processes of care. De Freitas et al. [ 73 ] presents a participatory process involving families of patients affected by congenital disorders in the design interventions in areas where health systems responsiveness is poor, and Windrum et al. [ 77 ] presents the case of creating a standardised diabetes prevention and management programme based on patient-centred principles. This programme led to the reform of care provision across multiple countries.

Social innovation challenge focus

Form and function

The classification of social innovations was problematic because of their divergent operational definitions. Two articles provided a proposed typology for social innovations in health. Mason et al. [ 66 ] proposed four types of social innovations in health equity: as social movements; services; social enterprises; and digital products. Farmer et al. [ 74 ] proposed a typology developed by frontline providers to promote child dental health as: extending existing practices; developing cheaper versions of existing products; adapting existing practices in different contexts or practice spaces; and translating ideas directly from evidence. From these cases studies of specific social innovations, however, the proposed typologies proved too narrow or restrictive as classification structures. The case studies fell into two functional categories, with social innovation treated either as a process or an outcome.

Four studies focused on social innovation as a process. These studies employed participatory mechanisms to support the development of new solutions to local challenges. The goal in all cases was to enhance patient or public participation in health care and enhance social relationships. Collaborative workshops occurred in the form of design sprints, co-design processes and think tank methodologies [ 73 , 74 , 81 ]. All these workshops were led by professional facilitators who were described as being ‘bricoleurs’, providing inspiration to participants, protecting the innovations, and linking them to resources. Srinivas [ 63 ], for example, presented a case that used crowdsourcing contests to give men who have sex with men the opportunity to design health promotional material to encourage other men to test for HIV.

Where social innovations were described as an outcome, models included different components (services, products, processes, social movements) and delivery in different settings. Neither single component of the model was particularly unique, but the combination or ‘bricolage’ of these components resulted in innovation. Three types of models were identified: care models (6/27 studies); social network/connection models (3/27 studies); and entrepreneurial models (2/27 studies) (Table ​ (Table3). 3 ). These models may or may not have a digital component or a financial component. Innovation in care models involved the re-organisation of care processes, including how services were delivered, often moving facility-based services directly into the community, with the role and scope of providers modified to give more autonomy or allow for task-shifting to non-health professionals [ 63 , 70 , 76 , 77 , 80 , 86 ]. These care models reported positive outcomes on extending access to health services, enhancing affordability and improving effectiveness on disease or wellbeing indicators. The innovative aspect of social network models were the connections and relationships fostered between different actors and sectors [ 79 , 84 , 87 ]. Digital products such as mobile apps or online websites were leveraged to facilitate connections between actors. The outcomes of these models included positive behavioural change, building community social capital, and enhancing women’s participation and roles. The innovation within the entrepreneurial models were mechanisms to reduce costs of services [ 72 , 82 ], while also improving access to services and creating new employment opportunities.

Social innovation as an outcome

In the literature, creators of social innovation can operate either as individuals or as collectives, the latter including citizen movements, cross-disciplinary collaborative actor teams and institutions. The characteristics of individual social innovators in health are not well described, but three case studies offer insight into the role of personal experience, hardship or challenge, or of a community playing a significant contribution in the innovator’s work. Among the indigenous Maori population of New Zealand, innovations can often be constrained by culture and place, especially when diverted from acceptable mainstream western approaches [ 80 ]. However, social innovators in health used cultural, social and place-based capital to create solutions to serve their own communities [ 65 , 80 , 86 ]. In each case, community trust in the innovation was critical to its success.

The collective creation of social innovation in health (8/27 studies), either in cross-disciplinary actor teams or networks, has received greater attention. Firstly, the social innovation development process is used to overcome the siloed nature of health and to foster greater interdisciplinarity and intersectionality [ 61 , 62 , 66 , 67 , 69 , 81 , 82 , 87 ]. This is particularly well illustrated in relation to Chagas disease in Guatemala, where innovation in interventions involved collaboration from epidemiology, biology, anthropology, sociology, engineering and architecture, and various funding agencies, international non-governmental organisations, government and universities [ 61 ]. The benefit of teams and collective networks is their capacity to move beyond boundaries and draw on collective cognition, capital, and the pooling and complementarity of capabilities [ 67 ].

Within these teams, opportunity was created for the participation of non-expert actors. As described in these articles [ 61 , 74 , 81 ], the value of social innovation from a public health policy perspective is the opportunity it affords less powerful actors (patients, families, beneficiaries, community members) to contribute to new health solutions, drawing on experiential knowledge and personal knowledge that can meaningfully contribute to and complement expert or academic knowledge. Applying social innovation as a process in itself leads to new forms of power relations and empowerment. The participation of actors in solution creation in some cases has translated into community action, but little beyond anecdotal evidence is presented in the health literature of sustained intervention success or actor empowerment [ 61 , 73 , 74 ]. Case studies from the management and development literature (3/27 studies) provide more depth and longitudinal evidence to substantiate the extent to which communities can be empowered, ensuring that self-governance and community autonomy of initiatives are achieved. The Kerala Palliative Care model, for example, has scaled far beyond its initial locus of implementation. From 1995 to 2012, 230 community organisations and 26 000 social activists became involved in the delivery of home-based services to 70 000 patients at the end of life [ 86 ]. The Graham Vikas social innovation in India also illustrates that the core to its approach is one hundred percent inclusion of members of the community, particularly women’s involvement in all decision-making processes. As a starting point, the program established a representative committee in each village, and a sustainability fund into which community members contributed, according to their means, to co-fund the work. Throughout project implementation, training was delivered on leadership, accounting and other operational procedures to ensure the community can fully manage the initiative independently [ 65 ]. Another example, the Business-in-a-Box initiative in Pakistan, illustrates how adopting a micro-entrepreneurship approach to extending access to contraception can empower women to become self-employed income generators while meeting their health needs [ 82 ].

In addition to embedding social innovations directly into communities, institutionalised actor networks can work to ensure sustainability. One model which has successfully embedded an initiative across multiple institutional levels is the Therapeutic Patient Education Model for Diabetes [ 77 ] in Austria. This case demonstrates the importance of social innovations engaging in institutional and political work with existing professional bodies at local and international levels, while creating new professional bodies to support its translation from research, its diffusion and its sustainability.

In summary, no category of actor is excluded from social innovation, irrespective of his/her background, organisational affiliation or hierarchical level. Across the literature, social innovation is seen as a democratising catalyst for health, enabling broad-based sectoral action, inclusion of marginalised individuals (including women) and providing communities with opportunities for action.

To examine the principles and values upon which social innovations are based, articles were sub-classified according to the social innovation paradigm to which they ascribed. As illustrated above (Fig.  1 ), three main paradigms, nested within each other, exist: the instrumental or technocratic paradigm that accounts for social inclusion in the creation of new solutions; the democratic paradigm that accounts for the empowerment of actors through social innovation; and the institutional or structural paradigm that accounts for changes within existing institutions and systems. The majority of articles (16/27) upheld the instrumental or technocratic paradigm in which context social innovation was regarded as a solution to address challenges, and occurred through participatory processes that promoted the social inclusion of different actors. Although encouraging engagement in social innovation, this paradigm does not differ vastly from other approaches to public or patient participation and participatory governance in public health and development. These solutions offer improved ways to ensure greater effectiveness or efficiency, but do not transform relations or structures. These articles originate mainly from Europe, where the approach to social innovation has been influenced by the European Commission’s inclusion of the principle into policy with neoliberal agendas [ 45 ].

A second but smaller number of articles (8/27) engage with empowerment. These go beyond giving actors a voice or opportunity to provide input through consultation, and provide them with the opportunity to take control. By building the capacity of marginalised or under-represented actors, they develop an enhanced level of agency and action which suggests a change in power relations taking effect. Many larger-scale social innovation care models had people-centredness as a core organising principle [ 76 , 80 , 82 ]. Models were designed to involve not only the patient or the beneficiary at the health centre, but also health workers. The Buurtzog Neighbourhood Care model, for example, illustrated how, by enhancing patient and provider (nurse) autonomy, better outcomes in care provision were achieved and provider motivation and satisfaction were enhanced [ 76 ]. The iMOKO (New Zealand) and Business-in-a-Box (Pakistan) cases both illustrate empowerment of the local community by placing access to healthcare in the hands of trusted community members such as teachers, and by giving women in the community opportunities for income generation [ 80 , 82 ]. The Time Bank model ascribed dignity and worth to the life of each person, and this highlighted the value of community members as active participants in healthcare: “The first core value of the Time Bank operations is asset, something of value to share with someone else … no one is worthless in the world … everyone is a contributor to society in his or her own way” [ 84 ]. Social innovations show how trusted community members such as teachers can play a vital role in promoting health and access to services; how women can play a role in the delivery of health products while being lifted from poverty through income generating opportunities; and how elderly people can be both consumers and providers of services [ 61 , 62 , 76 , 80 , 82 , 84 , 87 ].

The third and smallest number of articles (4/27) ascribed and recognised the systemic or structural paradigm of social innovation, and in the research, assessed the changes and dynamics that occurred at an institutional level. The research conducted by Vijay and Monin [ 86 ] in India adopted an institutional perspective to examine how certain contexts are more ‘poised’—receptive and ready—for social innovations. They also examined how actors, operating as institutional entrepreneurs, exercised agency to play an important role to increase the readiness of specific context to innovation and overcome the perceived resistance of existing institutions and structures. The Kerala Palliative Care model demonstrated large scale institutional change as it reframed palliative care provision from a medical frame to a social justice frame, with a professional hospice or hospital model replaced by the bottom-up organisation of services delivered primarily by community volunteers. The Therapeutic Patient Education Model for Diabetes revealed that, at the core of this initiative, systems level change was achieved by the institutional work of actors from national professional associations. They worked to embed the model into existing institutions (e.g. health insurance funds), while they created new institutions (new professional bodies) to ensure that new norms, values and practices were embedded at a systems level. Windrum et al. [ 77 ] recognised the potential of a model of patient centred care as having the potential of democratising medicine.

Lastly, research conducted by Pless and Appel [ 65 ] illustrated how social innovations can transform the norms, values, perceptions and roles within social institutions at community level through several approaches: the complete inclusion of all community members; the establishment of self-governing community structures; the provision of skills building; and service delivery. The project placed community members in the role of clients, so that project staff only acted upon community request. The long-term commitment (> 20 years) of this social innovation ensured that the outcome of an equitable and social society was achievable. This innovation recognised health as an outcome of sustainable development.

Facilitators and barriers

As a final part of the framework analysis, the facilitators and barriers of social innovations were considered that are relevant at different stages of the social innovation life cycle (Table ​ (Table4). 4 ). There were several commonalities across the literature in terms of enablers for idea development and implementation including: creating a safe, protective and facilitated environment; the democratic sharing of knowledge; the importance of timing and context; and implementing self-governance structures to support ongoing implementation and sustainability. Moving beyond the innovation locus to engage more broadly with partners and the existing system influenced innovation transfer, diffusion and scale. Only two studies—Therapeutic Patient Education Model and the Kerala Community Palliative Care model—described the process of institutionalising a social innovation [ 77 , 86 ]. In both cases, a clear strategic approach was adopted by the innovators and implementers to replace prior institutional logics with new logics. This entailed deep contextual awareness and engagement in different forms of institutional work: advocacy to support movement building; locating the challenge in a moral or social justice frame; engaging existing institutions and creating new ones; and investing in the education of those involved in the innovation, both to attain legitimacy and ensure that standards can be maintained. Both of these social innovations have proven sustainable, and as models, they have been scaled to different settings and countries (Austria and India). Barriers negatively affecting across the various stages of social innovation development included cost considerations and resource constraints, a unreceptive or changing political context, limited evidence of effectiveness and implementer attitudes in terms of low motivation and drive.

Enablers and barriers

Social innovation is a multi-dimensional concept used in relation to innovations in social relations, governance transformation, and social and complex adaptive systems. Actors, as individuals or collectives, play a key role in the social innovation process, especially moving initiatives from a localised level to a macro-level. In this article we sought to critically review the application of social innovation in health care and present the results of a scoping review of peer review research published from 2010 to 2020. In doing this, several research gaps and opportunities for social innovation in health and related research emerged.

The 27 research articles revealed the that social innovation draws on diverse disciplines and fields, with half of the articles arising from fields other than health. Case study research was the main method applied in studying social innovation. As a result, the evidence remains exploratory and descriptive, with weak proof of impact. Most case studies are snapshots of social innovations at specific points in time, without strong theoretical underpinning. No case studies adopted a health systems and policy research perspective. The lack of longitudinal or historic evidence underpinned by theory are barriers to the deeper understanding of the evolutionary process by which social innovation develops, how it is sustained over time through community embeddedness, and how systems change as a result of the adoption and institutionalisation of social innovation. Although research on social innovation in health has increased in recent years, there is still very little research originating from low- and middle-income countries. There is consequently ample opportunity and a need to build stronger evidence on social innovation in health, to deepen the investigation, engage more social scientists, draw on theory from management, organisational and institutional studies, adopt a health systems perspective, and build capacity for this concept and its processes and outcomes in LMICs.

When comparing research conducted and published in health journals with those published in other disciplines, health researchers often adopted a reductionistic view of social innovation, limited to the instrumental and technocratic paradigm of social innovation as a means to an end. Most definitions used to conceptualise social innovation in this literature only addressed the first three dimensions of social innovations: addressing a challenge; adopting a participatory process; and creating solutions. The focus of many of the health solutions presented in this literature was to enhance the effectiveness and efficiency of current health systems. The literature from Europe focused on cost reduction and cost savings to reduce the burden of the state, in line with the neo-liberal political agenda. In this literature, social innovations were described as a variety of disconnected solutions without evidence of how these might act in a coherent and complementary way to achieve systems transformation. This approach appears to re-emphasise the prevailing belief of health systems as mechanistic and compartmentalised, led by technical experts. Social innovation has not been studied through a health systems lens that views systems as social and human institutions [ 89 ].

In several studies, the inclusive and participatory process of social innovation has been applied without evidence that led to the empowerment of beneficiaries, patients, frontline workers; social innovation appeared simply as a new buzz word [ 90 ]. In line with this, the health literature emphasises the need for facilitators. But cultivating an enabling environment for social innovation does not necessarily require an external, and often costly, facilitator. This current emphasis raises the question whether social innovation is yet another top-down process in health, instead of one that encourages and supports those actors who already demonstrate embedded agency despite constraining institutional structures or settings [ 55 ]. For these barriers to be overcome and for social innovation to deliver value, it is imperative to move towards a more democratic and systems paradigm of social innovation. Health researchers would benefit by adopting an interdisciplinary research approach, reviewing and engaging with theories used by other disciplinary scholars, while reflecting on their own expert-driven notions of health.

Recommendations for policy

Social innovation provides practical insights into how implementation in health systems and practice can be enhanced. It also provides a framework towards understanding systems innovation—the change and transformation of existing systems, beyond mere incremental improvement, or the creation of new systems organised around people’s needs, realities and desires instead of only based on structures solely designed to achieve functional efficiency.

Social innovation supports the development of people-centred systems by suggesting ways to extend the range of actors beyond those traditionally involved in public health programmes. It enhances equity by giving a voice, and thus power, to ideas and solutions, especially those emerging at the grassroots level. By recognising the value inherent in individuals and the knowledge gained from their lived experience, it achieves deeper insight into the structures of power that dictate and limit the roles, capacities and functions of actors and by shifting the power dynamics, new avenues for involvement and participation in health services are created. In addition, social innovation does not seek to provide symptomatic solutions but often addresses the root causes that produce marginalisation, such as addressing community and societal perceptions around the role and participation of women. By design, social innovation initiatives place ‘the last, first’—those with the least experience or least perceived value by society become the creators, drivers and implementers. It invites beneficiaries, frontline providers and community members to be part of the full continuum of implementation, extending them power and agency to become the leaders and ultimately the owners of health interventions and programmes. In this way also addresses the limits of community engagement noted in public health and extends it beyond mere tokenistic consultation [ 91 ].

Social innovation’s system’s transforming capacity is further derived from it being inherently interdisciplinary and intersectoral, with boundary-spanning incorporating approaches and practices from different fields and to applied in health care, such as from environmental studies. It thus can be a useful tool for policy makers seeking to enhance holistic socio-developmental policies as espoused in the Sustainable Development Goals, and to solve complex systemic challenges outside sectoral silos.

Limitations

This scoping review was conducted only on English peer-review literature. Articles in other non-English languages could provide further insights on the concept as applied to health care. A small number of abstracts could not be retrieved via available university access.

Key in its implementation, social innovation emphasises context. No two contexts are approached in the same way and the nuances and uniqueness are accounted for, so limiting ‘one-size fits all’ models. Case studies illustrate how this has occurred through contextual embedding, adaptation and participation of communities and beneficiaries. Caution should be given however to avoid social innovation becoming a new label for tokenistic participation without a shift in power dynamics across the full spectrum of implementation. Finally, social innovation illustrates the importance of addressing prevailing institutional voids, while holding steadfast the vision of what renewed institutional logics could achieve and providing an inclusive opportunity for all actors to move forward. In this way change occurs slowly, requiring multiple micro-shifts in individuals, communities and health care institutions to ensure sustainability and embedding. To explore the full potential contribution that social innovation offers healthcare, further research is required that adopts an institutional theoretical underpinning and systemic paradigmatic lens.

Acknowledgements

Abbreviations, authors’ contributions.

LvN was responsible for conceptualising and conducting the review and leading analysis and writing. DB was involved in conceptualizing the approach, and DB and LM were involved in writing. All authors read and approved the final manuscript.

Financial support for this study was received from the Commonwealth Scholarship Fund.

Availability of data and materials

Ethics approval and consent to participate.

Ethical approval for the study was obtained from the London School of Hygiene and Tropical Medicine Research Ethics Committee (Reference number: 15476) on 29 June 2018.

Consent for publication

Not applicable.

Competing interests

None declared by the authors.

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These 6 social innovators are unlocking value in marginalized communities

The report shows how social innovators are “integrating racial equity into business practices and … unlocking additional economic growth worldwide. Image:  REUTERS/Njeri Mwangi

.chakra .wef-1c7l3mo{-webkit-transition:all 0.15s ease-out;transition:all 0.15s ease-out;cursor:pointer;-webkit-text-decoration:none;text-decoration:none;outline:none;color:inherit;}.chakra .wef-1c7l3mo:hover,.chakra .wef-1c7l3mo[data-hover]{-webkit-text-decoration:underline;text-decoration:underline;}.chakra .wef-1c7l3mo:focus,.chakra .wef-1c7l3mo[data-focus]{box-shadow:0 0 0 3px rgba(168,203,251,0.5);} Victoria Masterson

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Stay up to date:, social innovation.

• Integrating racial equity into business practices can also unlock additional economic growth worldwide, according to a new report from the Schwab Foundation for Social Entrepreneurship and the World Economic Forum.
• Businesses can partner with social value innovators to help tackle exclusion and create economic benefit in three key ways: expanding markets, unlocking talent and broadening networks.
• From helping people with criminal records get jobs, to protecting the intellectual property rights of Indigenous artists, here are six social innovators leading the way.

Building a more inclusive economy and unlocking value in marginalized communities can go hand in hand, a new report suggests.

Published by the Schwab Foundation for Social Entrepreneurship in partnership with the World Economic Forum, the report shows how social innovators are “integrating racial equity into business practices and … unlocking additional economic growth worldwide”.

The study, Innovating for Equity: Unlocking Value for Communities and Businesses, highlights how businesses can partner with social value innovators to both help tackle exclusion and create economic benefit in three key ways.

Have you read?

How 25 years of social innovation has transformed millions of lives, how social entrepreneurs can drive an inclusive 'africa’s century', from ai to peace, meet the finalists of the schwab foundation 2024 social innovation awards.

These are by reaching new markets in diverse communities; by accessing talent pools that were previously untapped; and by broadening supplier networks to include sellers who may have been historically excluded or marginalized.

Without this approach, a “prosperity cap” is put on the global economy – in the United States alone, the widening racial wealth gap is predicted to cost the country up to $1.5 trillion in economic growth by 2028, the report states.

Here are six social innovators leading the way.

Social innovator #1: Hello Tractor

In Nigeria, Hello Tractor is an app that helps smallholder farmers rent and own tractors.

Set up by Founder and Chief Executive Officer, Jehiel Oliver, the app also helps tractor owners rent out their machinery.

Affordability is a big barrier to owning a tractor for the 60 million smallholder farms in sub-Saharan Africa. The cost of a used tractor in Nigeria can be more than three times a farmer’s annual income.

By helping farmers, the wider social value this innovation delivers includes boosting agricultural productivity. More crops mean more food, less hunger, better health and an improved economy for the local community. Hello Tractor is also encouraging entrepreneurship by helping farmers to own and hire out their own tractors.

Social innovator #2: BlocPower

In the United States, New York-based BlocPower is helping low-income Black and Hispanic residents bring low carbon heating systems into their buildings.

The company uses software to analyze a building’s potential for energy-efficient electric systems like heat pumps and removes the need for upfront payments by leasing the equipment over 10 to 20 years.

Energy costs and greenhouse gas emissions have been “significantly” reduced in the buildings upgraded so far, the report notes.

Led by CEO Donnel Baird, BlocPower is also delivering social value through a green jobs programme called Civilian Climate Corps that is delivering green construction training to thousands of Black and Hispanic people.

Social innovator #3: R3 Score

R3 Score is a social enterprise with a software tool that helps widen access to jobs and mainstream banking products for people with a criminal record.

The software more accurately assesses the risks associated with a candidate’s criminal history compared to traditional background checks. This in turn helps employers better assess the skills and capabilities of candidates “beyond their criminal records”, the report explains. The business was started by Co-founders Teresa Hodge and her daughter Laurin Leonard.

More than 30% of Americans have criminal records and these are disproportionately Black and Hispanic people. R3 Score is creating social value by boosting employment results for both businesses and jobseekers. A third of candidates whose records were screened with the software secured jobs they otherwise wouldn’t have been eligible for. These were mostly Black and Hispanic applicants.

Social innovator #4: Greyston Bakery

Greyston Bakery is a bakery and social enterprise in New York that is creating social value by pioneering a no-barriers, no-bias recruitment process called Open Hiring.

No CVs or background checks are needed. Applicants enter their information into an online waiting list and when a position opens, they receive an offer. A full-time apprenticeship programme and career counselling help ensure employee success.

Greyston President and Chief Executive Officer, Joseph Kenner, now helps other businesses adopt Open Hiring and says he would like to see 40,000 jobs filled this way by 2030.

One of the company’s partners, a global cosmetics and skincare company, says more than 5,500 roles it has filled through Open Hiring are 60% people of colour and 60% women.

Stores using this approach have also seen a 10% increase in sales, the cosmetics company says.

Social innovator #5: Roots Studio

Roots Studio helps artists from Indigenous and minority cultures to protect and licence their art.

Brands and retailers can buy photos and patterns from a protected online library. The system means designs can be traced and royalties paid both to communities of artists and the artist who created the work.

Indigenous communities lose an estimated $12 million in intellectual property rights from the $32 billion annual market for licensing cultural designs to print on fashion and other items.

The business is led by Co-Founder and Chief Executive Rebecca Hui, who has spent extended periods living with Indigenous peoples. Roots Studio is delivering social value by helping Indigenous and rural minority communities benefit from sustainable income and preserve their cultural heritage.

The Future of Jobs Report 2023 found that 75% of companies surveyed expect to adopt AI, big data and cloud technologies in the next five years.

The Centre for the New Economy and Society provides a platform for leaders to share insights on the adoption and efficacy of new technologies, and the readiness of the workforce to use them. Our work includes developing insights and dialogue on growth, jobs, skills, equity and risks.

Learn more about our impact:

• Gender parity: Since 2006, we have annually measured the state and evolution of gender parity in 102 countries, supporting decisionmakers to identify the most effective policies to close gender gaps. In Chile , we helped establish gender parity accelerators and benefitted 728,000 women – reducing the gender gap by 37% in the participating companies.
• Reskilling Revolution: With our partners, we are helping the global workforce future-proof their careers, working with over 350 organizations to provide 1 billion people with better education, skills and economic opportunities by 2030.
• Disability inclusion: Working with the Valuable500, we are collaborating with the largest global network of CEOs committed to closing the disability inclusion gap . Members are making progress by increasing the adoption of digital accessibility best practices and including disability in diversity, equity and inclusion strategies.
• Racial justice: We are collaborating with a global coalition of 55 organizations in 13 industries who are committed to building equitable and just workplaces for professionals from under-represented racial and ethnic identities.

Want to know more about our centre’s impact or get involved? Contact us .

Social innovator #6: PretaHub

In Brazil, more than 60% of the country’s unemployed and underemployed workers are Afro-Brazilian.

PretaHub , based in São Paulo, is an organization that supports Black entrepreneurship by providing physical space, technical training, financial credit and access to retail and corporate networks.

Since it was started in 2002, PretaHub has supported more than 10,000 entrepreneurs, with more than $2 million invested. The company is delivering social value by integrating Black and Indigenous entrepreneurs into corporate supply chains and helping companies diversify what they buy.

PretaHub Chief Executive Officer, Adriana Barbosa, hopes to extend the model to neighbouring countries such as Colombia and Bolivia.

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License and Republishing

World Economic Forum articles may be republished in accordance with the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Public License, and in accordance with our Terms of Use.

The views expressed in this article are those of the author alone and not the World Economic Forum.

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April 4, 2024

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Case Study: How Aggressively Should a Bank Pursue AI?

• Thomas H. Davenport
• George Westerman

A Malaysia-based CEO weighs the risks and potential benefits of turning a traditional bank into an AI-first institution.

Siti Rahman, the CEO of Malaysia-based NVF Bank, faces a pivotal decision. Her head of AI innovation, a recent recruit from Google, has a bold plan. It requires a substantial investment but aims to transform the traditional bank into an AI-first institution, substantially reducing head count and the number of branches. The bank’s CFO worries they are chasing the next hype cycle and cautions against valuing efficiency above all else. Siti must weigh the bank’s mixed history with AI, the resistance to losing the human touch in banking services, and the risks of falling behind in technology against the need for a prudent, incremental approach to innovation.

Two experts offer advice: Noemie Ellezam-Danielo, the chief digital and AI strategy at Société Générale, and Sastry Durvasula, the chief information and client services officer at TIAA.

Siti Rahman, the CEO of Malaysia-headquartered NVF Bank, hurried through the corridors of the university’s computer engineering department. She had directed her driver to the wrong building—thinking of her usual talent-recruitment appearances in the finance department—and now she was running late. As she approached the room, she could hear her head of AI innovation, Michael Lim, who had joined NVF from Google 18 months earlier, breaking the ice with the students. “You know, NVF used to stand for Never Very Fast,” he said to a few giggles. “But the bank is crawling into the 21st century.”

• Thomas H. Davenport is the President’s Distinguished Professor of Information Technology and Management at Babson College, a visiting scholar at the MIT Initiative on the Digital Economy, and a senior adviser to Deloitte’s AI practice. He is a coauthor of All-in on AI: How Smart Companies Win Big with Artificial Intelligence (Harvard Business Review Press, 2023).
• George Westerman is a senior lecturer at MIT Sloan School of Management and a coauthor of Leading Digital (HBR Press, 2014).

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Social Innovation Business Model: Case Study of Start-up Enterprise

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Analysis-When Facebook Blocks News, Studies Show the Political Risks That Follow

A warning that news stories cannot be seen on Facebook by users in Canada, a response by Meta to a new law requiring large internet companies to pay Canadian news publishers for their content, appears in a screenshot taken in Vancouver, British Columbia, Canada April 5, 2024. Social Media Website/Handout via REUTERS

By Byron Kaye

(Reuters) - Since Meta blocked links to news in Canada last August to avoid paying fees to media companies, right-wing meme producer Jeff Ballingall says he has seen a surge in clicks for his Canada Proud Facebook page.

"Our numbers are growing and we're reaching more and more people every day," said Ballingall, who publishes up to 10 posts a day and has some 540,000 followers.

"Media is just going to get more tribal and more niche," he added. "This is just igniting it further."

Canada has become ground zero for Facebook's battle with governments that have enacted or are considering laws that force internet giants - primarily the social media platform's owner Meta and Alphabet's Google - to pay media companies for links to news published on their platforms.

Facebook has blocked news sharing in Canada rather than pay, saying news holds no economic value to its business.

It is seen as likely to take a similar step in Australia should Canberra try to enforce its 2021 content licencing law after Facebook said it would not extend the deals it has with news publishers there. Facebook briefly blocked news in Australia ahead of the law.

The blocking of news links has led to profound and disturbing changes in the way Canadian Facebook users engage with information about politics, two unpublished studies shared with Reuters found.

"The news being talked about in political groups is being replaced by memes," said Taylor Owen, founding director of McGill University's Centre for Media, Technology and Democracy, who worked on one of the studies.

"The ambient presence of journalism and true information in our feeds, the signals of reliability that were there, that's gone."

The lack of news on the platform and increased user engagement with opinion and non-verified content has the potential to undermine political discourse, particularly in election years, the studies' researchers say. Both Canada and Australia go to the polls in 2025.

Other jurisdictions including California and Britain are also considering legislation to force internet giants to pay for news content. Indonesia introduced a similar law this year.

In practice, Meta's decision means that when someone makes a post with a link to a news article, Canadians will see a box with the message: "In response to Canadian government legislation, news content can't be shared."

Where once news posts on Facebook garnered between 5 million and 8 million views from Canadians per day, that has disappeared, according to the Media Ecosystem Observatory, a McGill University and University of Toronto project.

Although engagement with political influencer accounts such as partisan commentators, academics and media professionals was unchanged, reactions to image-based posts in Canadian political Facebook groups tripled to match the previous engagement with news posts, the study also found.

The research analysed some 40,000 posts and compared user activity before and after the blocking of news links on the pages of some 1,000 news publishers, 185 political influencers and 600 political groups.

A Meta spokesperson said the research confirmed the company's view that people still come "to Facebook and Instagram even without news on the platform."

Canadians can still access "authoritative information from a range of sources" on Facebook and the company's fact-checking process was "committed to stopping the spread of misinformation on our services", the spokesperson said.

A separate NewsGuard study conducted for Reuters found that likes, comments and shares of what it categorised as "unreliable" sources climbed to 6.9% in Canada in the 90 days after the ban, compared to 2.2% in the 90 days before.

"This is especially troubling," said Gordon Crovitz, co-chief executive of New York-based NewsGuard, a fact-checking company which scores websites for accuracy.

Crovitz noted the change has come at a time when "we see a sharp uptick in the number of AI-generated news sites publishing false claims and growing numbers of faked audio, images and videos, including from hostile governments ... intended to influence elections."

Canadian Heritage Minister Pascale St-Onge in an emailed statement to Reuters called Meta's blocking of news an "unfortunate and reckless choice" that had left "disinformation and misinformation to spread on their platform ... during need-to-know situations like wildfires, emergencies, local elections and other critical times".

Asked about the studies, Australian Assistant Treasurer Stephen Jones said via email: "Access to trusted, quality content is important for Australians, and it is in Meta's own interest to support this content on its platforms."

Jones, who will decide whether to hire an arbitrator to set Facebook's media licencing arrangements, said the government had made clear its position to Meta that Australian news media businesses should be "fairly remunerated for news content used on digital platforms."

Meta declined to comment on future business decisions in Australia but said it would continue engaging with the government.

Facebook remains the most popular social media platform for current affairs content, studies show, even though it has been declining as a news source for years amid an exodus of younger users to rivals and Meta's strategy of de-prioritising politics in user feeds.

In Canada, where four-fifths of the population is on Facebook, 51% obtained news on the platform in 2023, the Media Ecosystem Observatory said.

Two-thirds of Australians are on Facebook and 32% used the platform for news last year, the University of Canberra said.

Unlike Facebook, Google has not indicated any changes to its deals with news publishers in Australia and reached a deal with the Canadian government to make payments to a fund that will support media outlets.

(Reporting by Byron Kaye in Sydney; Editing by Edwina Gibbs)

Copyright 2024 Thomson Reuters .

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