A conference entitled "User Driven Innovation in the Healthcare Sector",was held in Copenhagen, Denmark, which has presented the results of two cross-border project open innovation in the health sector made up of three regions of Denmark Sweden and Norway (respectively Midtjylland, Skane and Helse Bergen). Both projects, Innovation4Care and "New Methods for User-driven Innovation in the Health Care Sector" have been financed by the Nordic Innovation Center.

Two fundamental aspects of Innovation4Care have drawn our attention and have encouraged us to reach Copenhagen to attend the Conference: cross-border dimension and its focus on the needs of users as a source of innovation and the use of crowdsourcing as a tool for channeling suggestions, ideas and improvements from users.

The main objectives are:

1. promoting a culture of collaboration between the three northern regions with the aim of facilitating the exchange of experiences and the introduction of incremental and radical innovations 

2. introducing the concept of user driven innovation in the three participating health regions.

To pursue these goals has been an important effort by all actors involved (the project has reached about 75,000 users) due to cultural, organizational, technological and linguistic differences among the different actors involved in the project.

Open innovation in the health sector
The auser-driven approach of Innovation4care reminds us that innovation in the health sector is not the exclusive domain of the R & D of large multinational pharmaceutical or biotechnology companies, and is not necessarily related to the introduction of new drugs or medical technologies. As in other sectors, including in the health field the traditional "research driven innovation" is increasingly complemented with the "user driven innovation", especially when it comes to new ways to organize and manage the services offered. Users understood as doctors, nurses, managers of healthcare organizations and patients (including their families) have skills, knowledge and perceptions about these problems very different yet complementary. The collaboration among these users, each with its  experience and information, can create new inputs for decision making and in many cases encourages original ideas and new solutions.

Innovation4care has identified an initial target users comprising about 75,000 employees of the healthcare organizations of the three participating regions. The first target has been directly involved in crowdsourcing activities in order to facilitate the exchange of knowledge and encourage proactive participation by all users in innovation processes. A secondary group of users has also been identified and include patients, citizens and industry representatives.

The support tool for healthcare crowdsourcing activities has been the collaborative web platform developed by Hybrid State, which has allowed the three regions to share ideas, knowledge and proposals for its professionals (doctors, nurses and managers of healthcare organizations). Within 12 months 16 crowdsourcing initiatives have been developed, involving about 3,000 people, 400 of which have contributed very actively to the generation of new inputs and ideas on improving health care services within their countries. The interactive website has been used by groups of professionals in all healthcare organizations participating in several innovative projects in various stages of development.

Difficulties in practice

The results achieved so far have been quite positive but the difficulties encountered in introducing the concept of user driven innovation in the three northern health regions have been numerous. The main barriers to open innovation in the health care sector mentioned during the conference can be summarized as:

• Lack of time and resources devoted to innovation processes;
• A little knowledge of digital innovation tools;
• Lack of crowdsourcing techniques and their potential to generate new ideas;
•  Low culture of open innovation within health care organizations;
• Hierarchical structures that obstacle communication among professionals, the flow of ideas, opinions and knowledge especially from the lowest to the highest health organizations;
• Lack of clear incentives and rewards to the introduction of the innovation;
• Poor visibility of the results of innovation;
• Poor scalability of innovative health services.
• Fear of failure.

Overcoming these barriers is neither short nor easy process. It requires a cultural change within healthcare organizations involving greater horizontal collaboration between all levels, greater involvement of frontline staff in the processes of innovation, greater flexibility and transparency, greater access to skills and knowledge of users (eg through crowdsourcing), the definition of an appropriate system of remuneration for innovation, speed of action and a continuous feedback from the agents involved in the innovation process, a clear interpretation of property rights, a wider acceptance of failure and greater communication.

Results and progress
Innovation4care has attempted to provide an advance in this direction within the three northern health care regions. Although it was a first experience, this initiative has brought a new way of tackling innovation in the healthcare organizations, has put users at the heart of innovation processes, has fostered the exchange of innovative experiences and information between organizations of different countries even outside crowdsourcing activities (the relations between y Region Midtjylland and Region Skåne have been intensified), has encouraged greater collaboration between health care organizations and private industry as in the case of the prototyping adjustable beds for hospitals which involved an airline company.

As widely recognized by the conference organizators there is still much work to do in the field of User Driven Innovation. Open innovation in the health care sector is a relatively new concept and difficult to spread without a strong commitment from the entire organization, especially from the leaders. But as in other sectors, healthcare organizations today are faced with a client (the patient) who is increasingly informed and demanding, aware of his/her needs and the healthcare supply, whose  decision power has dramatically increased due to the new computer technologies. Familiarity with these needs is a fundamental requirement to generate new solutions capable of meeting them. User driven innovation can no longer be ignored.