A Portfolio Approach for Innovation in Public Health: Introducing the Innovation for Equity Matrix

Public health organizations should incorporate a strategic innovation process to maximize their likelihood for success. A portfolio approach to innovation is one way to support a strategic innovation process by analyzing the mix of an organization’s current and planned work. A portfolio approach can be an important part to your organization’s idea generation phase.

This July, the Journal of Public Health Management and Practice issued the supplement Transformation and Innovations in Public Health. This issue called attention to many of the important innovations and transformational efforts currently underway in public health. The article Public Health Department Accreditation and Innovation: A Brief Report of the Approaches Used to Promote Innovation reminds us that innovation is part of public health quality improvement. This article also shows that PHAB-accredited health departments are supporting innovation through partnerships, culture change, training, and setting goals for innovation. Creating more innovative public health organizations is important because it allows us to solve wicked societal problems and improves our long-term growth and adaptability.


The Public Health National Center for Innovations at the Public Health Accreditation Board (PHAB) defines public health innovation as “the creation and implementation of a novel process, policy, product, program, or system leading to improvements that impact health and equity.” Innovation is one part creativity and one part implementation. Strategic innovation follows a general path from idea generation, to concept development, to testing and implementation (Figure 1).

Figure 1: The Innovation Process

Public health organizations should incorporate a strategic innovation process to maximize their likelihood for success. A portfolio approach to innovation is one way to support a strategic innovation process by analyzing the mix of an organization’s current and planned work. A portfolio approach can be an important part to your organization’s idea generation phase.


The portfolio approach advanced by Nagil and Tuff recognizes that there are various forms of innovation and that they all can be beneficial. Innovation can range from small changes to existing programs (improvement), new ways of working to address existing challenges (creation) and reimagining the goals and purpose of an organization (transformation). Nagil and Tuff suggest that businesses invest in 70, 20, 10 percent mix of innovations. Similarly, we know that public health interventions work through various targets for change across the socio-ecological framework. Public health programs can focus on changing people, places, policies, and power. The Innovation for Equity Matrix helps public health organizations visualize the mix of their current and planned work across the continuums of innovation and targets for change. This is needed because we know health equity interventions tend to slide back towards individual approaches, foregoing policy and systems change, and capacity building, which are better suited for improving health equity. We also know that many organizations are keenly focused on their existing programs but fail to recognize changes in their environment that threaten their viability. The Innovation for Equity Matrix helps organizations see the mix of their programs and identify gaps.


By diagnosing your program portfolio, you can identify where your focus is (or isn’t) and select processes most appropriate to generate ideas aligned with your needs. While there are a variety of processes to support creativity, I chose three for the Innovation for Equity Matrix because they are focused specifically on the goals for each level of innovation.

  • Generating Ideas to Improve Existing Programs: The plan, do, study, act (PDSA) model is well suited for generating ideas to improve existing programs. It focuses you on the key goals of your programs by measuring and monitoring indicators for success. Ideas are generated by program staff and clients/stakeholders as they review their successes and failures. The PDSA model aims to optimize your existing programs, but it does not seek to change their aims or goals.
  • Generating Ideas to Create New Programs: Appreciative Inquiry is well suited for generating new ideas to accomplish existing goals. It focuses you on your organization’s existing strengths and past success. Ideas are generated as staff and stakeholders identify ways to maximize your organization’s positive core. Appreciative Inquiry aims to help new ideas emerge from the best of what already exists in your organization. But it does not aim to replace what already exists.
  • Generating Ideas for Transformation: Transformative Learning is well suited for shifting organizational strategy and culture. It helps you shift your mindset by challenging deeply held assumptions and seeking out new perspectives. This is usually in response to a disorienting dilemma – something that threatens the viability or success of your organization. Transformative Learning helps create radical change by bringing people through a process where they recognize large-scale change is needed and that there are ways to do this that support, not threaten, them individually.


Now let’s see how the Innovation for Equity Matrix works. Imagine that a public health organization wanted to address its innovation portfolio for cancer disparities. Leaders brought together their program staff to list out all their existing work, as well as any new projects that were in the pipeline. After some discussion, they agreed on the innovativeness and targets for change of the programs and listed them in the Innovation for Equity Matrix (Figure 2).

Figure 2: The Innovation for Equity Matrix

Their work focused mainly on providing direct services and supporting others’ advocacy agenda. Their portfolio was missing transformational strategies and strategies that addressed the structural determinants of cancer inequities. Seeing this, they decided to use a transformational learning process. They framed their disorienting dilemma by acknowledging that funding for cancer screening was shrinking and cancer disparities were not improving. If they did not change, improvements wouldn’t be made, preventable deaths would occur, and the long-term viability of their program may be in jeopardy. They were purposeful about challenging the assumptions of their cancer screening program. Were they just another service provider? Or was there something unique they could provide? After much dialogue, they recognized there hadn’t been a coordinated approach to cancer prevention advocacy and outreach in their jurisdiction and that their organization was well positioned to lead these efforts based on the strengths of their staff and as a hub for community partnerships.


More public health organizations need to incorporate a strategic approach to innovation. The Innovation for Equity Matrix is a useful tool that can help you develop a portfolio approach for your work. Public health organizations need to use a mix of programs that span across the innovation continuum and target different levels of change. Think about this post and the Innovation for Equity Matrix the next time you have a quality improvement meeting or a strategic planning retreat.

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