Adoption of Surgical Innovations

Wright, Frances C.; Gagliardi, Anna R.; Fraser, Novlette; Quan, May Lynn

doi:10.1177/1553350611409063

Cited by 11 publications

(5 citation statements)

References 28 publications

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“…In some cases, the implementation of TAVI resulted in a better collaboration between both departments. The interviews indicate that this depended on central actors, which underscores previous research [ 22 ]. Champions, eager to implement the method, facilitated the dialogue between both departments and took initiative to drive the process forward.…”

Section: Discussionsupporting

confidence: 76%

“…Several theories and models can be applied to better understand the implementation and diffusion of innovations in healthcare—most notably, Everett M. Rogers’ Diffusion of Innovations (DOI) theory [ 19 ], as well as the diffusion of innovations model described by Greenhalgh et al [ 20 ]. Both have been adopted in numerous studies analyzing the implementation and diffusion of innovations in healthcare (see, for example, [ 1 , 21 , 22 ]). Roger’s DOI theory has been picked up by multiple researchers in various contexts and disciplines to explain the spread of emerging innovations.…”

Section: Introductionmentioning

confidence: 99%

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The transcatheter aortic valve implementation (TAVI)—a qualitative approach to the implementation and diffusion of a minimally invasive surgical procedure

Merkel¹,

Eikermann²,

Neugebauer³

et al. 2015

Implementation Sci

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BackgroundThe transcatheter aortic valve implantation (TAVI), a minimally invasive surgical procedure to treat patients with severe symptomatic aortic stenosis, showed a rapid diffusion in Germany compared to the international level. The aim of this study is to identify and analyze factors affecting the implementation and diffusion of the procedure in hospitals using a qualitative application of the diffusion of innovations theory.MethodsWe conducted problem-centered interviews with cardiologists and cardiac surgeons working in German hospitals. The multi-level model “diffusion of innovations in health services organizations” developed by Greenhalgh et al. was used to guide the research. Data was analyzed using content and a thematic analysis.ResultsAmong the ten participants who were interviewed, we found both barriers and facilitators related to the innovation itself, system readiness and antecedents, communication and influence, and the outer context. Key issues were the collaboration between cardiologists and cardiac surgeons, reimbursement policies, requirements needed to conduct the procedure, and medical advantages of the method.ConclusionsThe findings show that there are multiple factors influencing the diffusion of TAVI that go beyond the reimbursement and cost issues. The diffusion of innovations model proved to be helpful in understanding the different aspects of the uptake of the procedure. A central theme that affected the implementation of TAVI was the collaboration and competition between involved medical departments: cardiology and cardiac surgery. Against this background, it seems especially important to moderate and coordinate the cooperation of the different medical disciplines.

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Section: Discussionsupporting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

The transcatheter aortic valve implementation (TAVI)—a qualitative approach to the implementation and diffusion of a minimally invasive surgical procedure

Merkel¹,

Eikermann²,

Neugebauer³

et al. 2015

Implementation Sci

View full text Add to dashboard Cite

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“…This result was mirrored by Anderson et al; studying the adoption of minimally invasive prostatectomy during the early 2000s, they commented that surgeons were more likely to adopt and continue novel surgical practices if working with other urologists and trained in those techniques. From a systems perspective, Wright et al (2011) reported that the adoption of sentinel lymph node biopsy for breast cancer was more avid where high-volume surgeons actively championed the technique, while hospital administrators were more likely to accept variation in practice when presented with guidelines statements to support the change [25]. Perhaps the adoption of supine RALP will lag until a critical mass of surgeons vocally supports or advocates for it to the broader urologic community.…”

Section: Discussionmentioning

confidence: 99%

Trends in Positioning for Robotic Prostatectomy: Results From a Survey of the Endourological Society

Wayne¹,

Wei²,

Atri³

et al. 2021

Cureus

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Purpose: most robot-assisted laparoscopic prostatectomies (RALP) are performed with the patient in lithotomy, carrying risks of positioning-related complications. Newer robot models have allowed for supine positioning, potentially avoiding these pitfalls. We gauged the current sentiment on patient positioning among surgeons who perform robot-assisted surgery. Methods: we surveyed members of the Endourological Society regarding their practice settings and their opinions on positioning for robot-assisted laparoscopic prostatectomy. Summary statistics were reviewed and data were analyzed using chi-square tests and t-tests. Results: our survey had 92 eligible respondents. The majority were fellowship-trained, with 51% trained in robotics and 57% practicing in the U.S. with a mean of 13 years of practice. Most were working in an academic setting (69%) and performing at least 25 robotic prostatectomies yearly. 28 respondents used the Intuitive Surgical Inc. da Vinci® Xi™ exclusively (30%), and nearly two-thirds used it sometimes. Although 54% of respondents considered using supine positioning, less than half of these surgeons used it regularly, while 75% overall preferred lithotomy. A majority attributed this choice to surgical team familiarity with lithotomy positioning. Surgeons in the U.S. and those using the da Vinci® Xi™ were more likely to consider supine positioning. Conclusions: lithotomy position is the standard for RALP procedures; nonetheless, it poses significant risks that might be avoided with supine positioning. Our survey suggests that, although supine positioning has been considered, it has not gained momentum in practice. Addressing factors of inertia in training practices and one’s surgical team might allow for novel and safer approaches.

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“…[9–11] Before SLNB was introduced, the more invasive axillary lymph node dissection (ALND) was the standard of care. [9, 12, 13] Research demonstrated that SLNB is associated with similar survival benefit to ALND, yet has much less morbidity. Several health system factors have been associated with increased probability of a woman having SLNB, while at the same time there is evidence of disparities within some populations.…”

Section: Introductionmentioning

confidence: 99%

Differential Receipt of Sentinel Lymph Node Biopsy Within Practice-based Research Networks

et al. 2013

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Background Provider-based research networks (PBRNs) are promising for accelerating not only research, but also dissemination of research-based evidence into broader community practice. Sentinel lymph node biopsy (SLNB) is an innovation in breast cancer care associated with equivalent survival and lower morbidity, as compared to standard axillary lymph node dissection. We examined the diffusion of SLNB into practice and whether affiliation with the Community Clinical Oncology Program (CCOP), a cancer-focused PBRN, was associated with more rapid uptake of SLNB. Research Design Surveillance Epidemiology and End Results(SEER)-Medicare data were used to study women diagnosed with stage I or II breast cancer in the years 2000 to 2005 and undergoing breast conserving surgery with axillary staging (n=6,226). The primary outcome was undergoing SLNB. CCOP affiliation of the surgical physician was ascertained from NCI records. Multivariable generalized linear modeling with generalized estimating equations was used to measure association between CCOP exposure and undergoing SLNB, controlling for potential confounders. Results Women treated by a CCOP physician had significantly higher odds of receiving SLNB compared to women treated by a non-CCOP physician (OR 2.68; 95% CI 1.35, 5.34). The magnitude of this association was larger than that observed among patients treated by physicians operating in medical school-affiliated hospitals (OR 1.76; 95% CI 1.30–2.39). Conclusion Women treated by CCOP-affiliated physicians were more likely to undergo SLNB irrespective of the hospital’s medical school affiliation, suggesting that the CCOP PBRN may play a role in the rapid adoption of research-based innovation in community practice.

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Adoption of Surgical Innovations

Abstract: SLNB is a complex innovation to adopt. Successful adoption was assisted by a high-volume breast cancer surgical champion, interprofessional communication, and administrative support.

Cited by 11 publications

References 28 publications

The transcatheter aortic valve implementation (TAVI)—a qualitative approach to the implementation and diffusion of a minimally invasive surgical procedure

The transcatheter aortic valve implementation (TAVI)—a qualitative approach to the implementation and diffusion of a minimally invasive surgical procedure

Trends in Positioning for Robotic Prostatectomy: Results From a Survey of the Endourological Society

Differential Receipt of Sentinel Lymph Node Biopsy Within Practice-based Research Networks

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