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Key messages

• This manuscript describes organisational innovation within wound management from an EWMA perspective. Organisational innovation within wound management has three overarching objectives: improved patient outcomes, facilitated access to health care professionals and better utilisation of resouces for health care providers.
• The paper presents an overview of EWMA’s activities and vision targeting organisational innovation.
• EWMA in 2023 launched activities towards implementing guidelines and leveling disparities in treatment and outcomes for managing Diabetic Foot Syndrome. Barriers and bottlenecks in innovation, shortages of health care professionals, lack of project funding and the need for better advocacy are focus areas being strengthened by EWMA.

Organisational innovation in wound management has three overarching objectives: improved patient outcomes, better  access to health care professionals and better resource utilisation for health care providers. Collaboration between the public and private sectors is vital to deliver new solutions that help to achieve these objectives effectively in a difficult and complex environment for health care.

Several EWMA documents over the last decade have addressed and provided recommendations for the organisation of wound care.^1,2,3 One important aspect is the promotion of integrated patient care pathways to improve outcomes and reduce disparities. Close collaboration between primary care (home care and health care centers) and secondary and tertiary wound clinics is essential to break silos and barriers.

Some of the important challenges driving organisational innovation on which EWMA will focus are:

• implementing evidence-based guidelines
• enhancing access to multidisciplinary care
• expanding clinics to different geographical areas
• optimising clinical processes
• improving diagnostic procedures and referral pathways in primary care
• enhancing patient monitoring
• maximising utilisation of human and economic resources
• strengthening evidence of outcomes
• educating patients, caregivers, and health care professionals
• advancing innovative ideas for new technologies and products
• securing clinical space for entrepreneurship
• ensuring access to clinical trial sites

Below is a brief overview of EWMA’s activities and vision targeting organisational innovation.

Integration of pathways for patient care

In July 2022, EWMA supported the launch of the Diabetic Foot Valley Tuscany project to implement guidelines for managing Diabetic Foot Syndrome, and to level disparities in treatment and outcomes among various Tuscan regional treatment centers.⁴ All the fourteen regional clinics joined the initiative, with three regionally-funded sub-projects, aimed at reducing disparities in regional diabetic foot care and improving the integrated DF pathway. Additionally, a regional patient data registry is prepared with funding from the regional authorities and three industrial clinical trials have been initiated. By initiative of the EWMA Diabetic Foot Ulcer Committee, the encouraging learnings and experiences from the Diabetic Foot Valley Tuscany project are now being rolled out to other European countries and regions.

Pooling innovation stakeholders

In July 2023 EWMA established the EWMA Innovation Alliance (www.ewmainnovationalliance.org) with the aim of establishing a European Wound Management Innovation Ecosystem. EWMA Innovation Alliance focuses both on fostering innovation pathways from bench to bedside (including products and services), as well as on implementing systemic changes in wound management (such as organisation of patient treatments).

The private sector has enthusiastically embraced EWMA Innovation Alliance with new members joining almost weekly. Efforts now are concentrated on attracting public authorities, hospitals, clinics, and knowledge transfer networks as members, with the first joining in January 2024. EWMA Innovation Alliance has been organising the EWMA Innovation Forum 2024 (by invitation only – email innovation@ewma.org) during the EWMA annual conference, bringing together startups, spinouts, established companies, clinicians with innovative ideas and investors to facilitate discussions, and foster fruitful partnerships.

EWMA Innovation Alliance fulfills the objectives of the EWMA translational research group (TRG) that aims to reinforce and bring together stakeholders involved in the development of wound care products.  TRG serves as a forum for discussing innovation and supporting the implementation of evidence-based practices and new technologies in wound management.

Access and recruitment to Health Care Professionals

EWMA has for years worked intensely on the qualification of health care professionals within wound management by publishing several curricula for nurses and physicians.⁵ However, the widespread shortage of personnel in Europe also affects the wound management area, thus EWMA will direct efforts towards identifying ways addressing this critical issue, in addition to enhancing the staff qualifications and the identification of a competency framework for the specific carers involved in wound care.

EWMA is committed to raising awareness in this issue starting with the promotion of content highlighting the attractiveness of the profession and fostering initiatives to discuss the lack of health care professionals. Additionally, EWMA will explore how organisational innovation can assist health care systems in better utilising resources, particularly human resources. These efforts will pave the way for new EWMA initiatives, which are also interlinked with the recent endeavors presented above, such as improved clinical collaborations in Tuscany and the promotion of systemic changes facilitated by the Innovation Alliance, alongside the promotion of new technologies and their harmonisation with available human resources, which are sometimes in short supply.

Networking consolidation

EWMA and its members are key players with considerable accumulated knowledge about organisational changes within health care, making their contribution indispensable in addressing this issue. Nonetheless, the involvement of other stakeholders, such as health care authorities and policy makers is still highly relevant. Thus, EWMA aims to collaborate more closely with them in joining projects targeting public health care systems – both within and outside Europe.

EWMA envisions, when the financing models allow it, becoming a relevant partner or sub-contractor in EU, national and regional funded projects which deal with organisational innovation aiming to achieve goals such as:

• improving clinical processes, standards and guidelines implementation;
• promoting clinical collaboration models at regional, national and the European level;
• creating regional, national or European pathology-specialised hubs;
• increasing recruitment of health care professionals in wound management;
• strengthening public/private collaboration on innovation;
• developing tailored solutions for patient treatments;
• undertaking post-graduate and extra-curricular education of wound care specialists.

EWMA also is foreseeing directly assisting public health care authorities in organisational change projects, drawing inspiration from methodologies developed and being implemented in Europe to improve clinical collaboration and integrated patient pathways. This support is provided through high level advisory and advocacy from EWMA’s world-leading clinical experts.

EWMA State-of-Affairs report

EWMA aims to provide an overview of potentials, challenges, and solutions for European wound management in the years to come through a state-of-affairs report, that will relate wound management concerns to facts about the health economy and relevant policies. The report will include the results from surveys conducted among the EWMA members pinpointing specific critical issues, such as digital health integration, data analytics, artificial intelligence, patient and lay carers’ education and empowerment, diagnostic pathways and training and recruitment of health care professionals.

In addition, the report will identify emerging technologies of particular interest for health care professionals and discuss patient-centered innovation, exploring ways to involve patients and lay carers in co-creating innovative solutions for wound management to better understand their needs and preferences in wound care.

Conflict of Interest

The authors declare no conflicts of interest.

Funding

The authors received no funding for this study.

Author(s)

Kirsi Isoherranen*¹ MD, PhD, Sebastian Probst² PhD, Andrea Pokorná³ PhD, Alexandra Marques⁴ PhD,
Dimitri Beeckman⁵ PhD, Alberto Piaggesi⁶ MD
¹Specialist in Dermatology, Helsinki University Hospital and Helsinki University, Dermatology Clinic and Helsinki Wound Healing Centre, Finland
²Professor of Tissue Viability and Wound Care, Geneva School of Health Sciences, HES-SO University of App. Sci. and Arts ,Switzerland; Care Directorate, University Hospital Geneva, Switzerland; Faculty of Medicine Nursing and Health Sciences, Monash University, Australia; College of Medicine Nursing and Health Sciences, University of Galway, Ireland
³Associate Professor, Department of Nursing, Masaryk University, Czech Republic
⁴Coordinating Researcher, 3B Research Group, University of Minho, Portugal
⁵Professor of Skin Integrity and Clinical Nursing, Ghent University, Belgium
⁶Professor of Endocrinology, Director, Diabetic Foot Section, Department of Medicine, University of Pisa, Italy

*Corresponding author email Kirsi.Isoherranen@hus.fi

References

1. Franks PJ, Barker J, Collier M, Gethin G, Haesler E, Jawien A, et al. Management of patients with venous leg ulcers: Challenges and current best practice, J Wound Care. 2016 Jun;25 Suppl 6:1–67
2. Moore Z, Butcher G, Corbett, LQ, McGuiness W, Snyder RJ, van Acker K. AAWC, AWMA, EWMA Position Paper: Managing Wounds as a Team. J Wound Care. 2014;23 (5 Suppl.): S1–S38
3. Probst S, Seppänen S, Gerber V, Hopkins A, Rimdeika R, Gethin G. Home care-wound care. J Wound Care. 2014 May;23 Suppl 5a:1–44
4. Piaggesi, A. The Diabetic Foot Valley Project: A model for implementing diabetic foot syndrome management. Integrated Care Journal; October 11, 2023
5. EMWA. EMWA Curricula. Frederiksberg, Denmark. Available from: https://ewma.org/what-we-do/education/ewma-curricula