Cite this asPichot N, Nadarajah K, Bonan I, Caverot G, Somat A, et al. (2021) Stakeholder involvement in the innovation process: An example in medical robotics, the ROBO-K project. Ann Robot Automation 5(1): 047-050. DOI: 10.17352/ara.000014
Copyright© 2021 Pichot N, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
In the field of medical robotics, many studies have called for the integration of end-users in the innovation process. The objective is to identify the factors that facilitate (or not) the use of the designed robots and thus try to guarantee their diffusion in the care services. This recommendation was followed in the ROBO-K project. The ROBO-K project proposes the design and development of a mobile, interactive robot dedicated to gait rehabilitation. This project was initiated by BA Healthcare, a medical robotics company. The design of a robot was accompanied to achieve the targeted therapeutic objectives by taking into account the requirements related to the needs of the patients and the practitioners; the care activity and the institutions involved. A follow-up by the social acceptability of the technology led to focus the innovation process on a co-construction activity involving all stakeholders.
This co-construction activity was decisive, as it guided the definition of functional expectations and the technical specifications of the prototype developed. It was completed by a test phase of the prototype (in a care situation for 5 months). The results show the relevance to involve all the stakeholders in all the design and development phases of the robotic device. However, they underline the difficulties or limits linked to this type of approach in terms of innovation.
The “innovation process” has been the subject of many theoretical proposals, the first and best known of which is the linear model of innovation. This model argues that innovation passes through four stages: Basic Research, Applied Research, Development and Production, and Diffusion [1,2]. As early as the 1960s, many authors questioned the linearity of the model, which was considered unsuitable or insufficient to grasp all the facets of innovation (e.g. [3-5]). More recently, this observation was also made by de Ana, et al.  when they considered ‘linear’ innovation processes were inappropriate for medical innovations. The authors argue that innovation in the medical field must bring together and address the opinions and needs of all stakeholders who are likely to be affected or may affect the technological device . Without these prerequisites, medical technology innovations such as robotic devices may face diffusion difficulties .
The SIF 131 project ROBO-K is part of this problem since it aims to design and develop a mobile and interactive robot dedicated to gait rehabilitation. This project was initiated by BA Healthcare, a medical robotics company focused on open innovation . Aware of the difficulties associated with the implementation of an innovation process as well as the diffusion of robotized medical devices, BA Healthcare wanted to involve all stakeholders in the definition and development of the ROBO-K project. The objective was to facilitate the individual and collective appropriation of future gait rehabilitation equipment .
To achieve this objective, a first phase identified the stakeholders concerned by the ROBO-K device such as technical partners (BA Healthcare, CAE STIL2) or InvenSense3; clinical partners (the Physical Medicine and Rehabilitation Department (PMR) of the Rennes University Hospital, the Neurology Department of the Mutualist Centre for Re-education and Functional Rehabilitation of Kerpape) and end-users (patients and practitioners involved throughout the ROBO-K project). Then, the second stage of stakeholder analysis mobilized psychosocial skills focusing on the social acceptability of technologies . These skills were used to anchor the innovation process on a co-construction activity with all the actors involved. Thus, the co-construction activity took into account the perceptions and opinions of all stakeholders of the ROBO-K project.
In social psychology, the use of technology is considered to be the result of individual decision-making related to a behavioral intention (e.g. ). The latter is supposed to reflect people’s attitudes towards innovation and can be influenced, for example, by their perception of - a) the utility of the innovative device to perform a given task; b) its usability or ease of use and c) the situation in which the technology is deployed (e.g. what others think of the technology used in the deployment situation...) . These perceptions are studied at different points in the innovation process: before the design (i.e. a priori acceptability), then during the short-term manipulation (i.e. acceptance) and long-term manipulation (i.e. appropriation) of the innovative device (Figure 1) .
The longitudinal study of the representations generated by innovation is particularly important in professional environments. It participates in the definition of the individual or collective support needs for the diffusion of innovative materials (e.g. skills acquisition, organizational changes, etc.) [14,15]. This methodology (Figure 2) starts with an assessment of the existing situation and leads step by step to the design of a prototype.
The design of the ROBO-K implementation process follows the analytical framework explained in section 2.1. It involved the active collaboration of the clinical partners as well as an association: APPROCHE4, and several simultaneous or successive studies (Figure 2). These studies require the application of mixed methods to access work reality: direct and indirect observations and quasi-experiments.
1Single Interministerial Fund.
2Commissariat of Atomic Energy and Alternative Energies, Systems and Technology Integration Laboratories.
3Developing different types of sensors.
4Association for the promotion of new technologies for people with disabilities.
The mobilization of potential or actual users during the different stages of development of the ROBO-K project (Figure 2), led to a co-constructed definition between the different stakeholders of the future robotic device (Figure 3).
Composed of two main elements - a holonomic mobile base and a suspension system that holds the patient in place while preventing him or her from sitting down - the gait rehabilitation robot presented above appears as:
These characteristics of the robot are the result of all the work carried out with and by the end-users (Figure 2). Studying a priori perceptions of the robotic equipment (e.g. its usefulness, its perceived ease of use) helped to better anticipate its future use and to design appropriate training. Its introduction in rehabilitation rooms has been facilitated (in a test phase for 1 month for patients and 5 months for practitioners). The observations indicate that the robotic equipment tested supports existing care practices while generating new ones (e.g. related to dynamic balance work). However, they show the limits of the robotic system (e.g. its “robustness” with regard to continuous use within the services) and will thus contribute to its improvement. These observations mainly highlight its usefulness and emphasize the favorable attitude towards the robotic equipment. They show concern for usability.
Despite its contributions to the definition of the co-designed robot, the mobilization of end-users throughout the innovation process remains difficult to implement. The co-construction activity with all stakeholders takes time, substantial resources (human or financial), the application of specific methodologies (i.e. direct and indirect observation, quasi-experimentation), and, above all, makes the system more complex to meet the multiple requirements of all actors. In the ROBO-K project, four modes of use (e.g. remotely operated, programmed) were considered and 150 functionalities were established. Even if they were not all developed (either because they did not appear useful or usable, or because they required the removal of technological “locks” that were too important), they considerably increased the task of the technical partners. To overcome the problems of diffusion of technological innovations, it seems necessary to involve all stakeholders in the project. In the case of the ROBO-k project, focusing the design process on end-users and their activity also required the support of user associations (i.e. APPROCHE) and thus attests to the social character of technological innovations.
The realization of the ROBO-K project would not have been possible without the involvement of patients and practitioners. They are warmly thanked for their very important contribution as well as the APPROCHE association.
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