Innovation implementation in the context of hospital QI: lessons learned and strategies for success

Abstract

Abstract:In 1999, the Institute of Medicine (IOM) reported that 98,000 people die each year due to medical errors. In the following years, the focus on hospital quality was intensified nationally, with policymakers providing evidence-based practice guidelines for improving health care quality. However, these innovations (evidence-based guidelines) that were being produced at policy levels were not translating to clinical practice at the hospital organizational level easily, and stark variations continued to persist, in the quality of health care. Circa 2009, nearly a decade after the release of the IOM report, the health care organizational literature began referring to this challenge as "innovation implementation failure" in health care organizations (HCOs), ie, failure to implement an evidence-based practice that is new to a HCO. This stream of literature drew upon management research to explain why innovation implementation failure occurs in HCOs and what could be done to prevent it. This paper conducts an integrative review of the literature on "innovation implementation" in hospitals and health systems over the last decade, since the spotlight was cast on "innovation implementation failure" in HCOs. The review reveals that while some studies have retrospectively sought to identify the key drivers of innovation implementation, through surveys and interviews of practitioners (the "what"), other studies have prospectively sought to understand how innovation implementation occurs in hospitals and health systems (the "how"). Both make distinctive contributions to identifying strategies for success in innovation implementation. While retrospective studies have helped identify the key drivers of innovation implementation, prospective studies have shed light on how these drivers could be attained, thereby helping to develop context-sensitive management strategies for success. The literature has called for more prospective research on the implementation and sustainability of health care innovations. This paper summarizes the lessons learned from the literature, discusses the relevance of management research on innovation implementation in HCOs, and identifies future research avenues.

<p>Implementation of Health Policy on Establishment of Provincial Center of Diseases Control (CDC) in Vietnam</p>

“…The data supports the original Innovation Implementation Framework, 42,44 specifically the importance of management support (coordinated organizational communication on the rationales and priority to establish CDC); implementation policies and practices (Procedures to set up CDC and proposal for CDC operation); implementation climate (responding to changing disease patterns, avoiding fragmentation, compliance to Party Resolution); and values fit (best practice of international model). The findings are also consistent with other studies 39,41,44,51 and also show that different elements of the framework are clearly inter-related. For example, values fit by the staff from the preventive medicine centers determine the implementation climate at the province level and together with management support from the MOH and province health department contribute to the effectiveness and speed of implementation of the MOH policy of an establishment of a provincial CDC network.…”

“…Innovation implementation in a healthcare setting refers to the implementation of anything new to the organization, be it an evidence-based practice, policy, or technology. 39 Adoption of innovations in healthcare has been widely accepted as a complex, organizational process that is much more humanistic than mechanistic. 40 The review of innovation implementation in the context of healthcare setting, identified as the "Innovation Implementation Framework," originally developed by Klein et al in 1996 and refined by Helfrich et al in 2007, was a popular theoretical framework used to explain factors driving innovation implementation success, particularly in works that sought it retrospectively.…”

“…40 The review of innovation implementation in the context of healthcare setting, identified as the "Innovation Implementation Framework," originally developed by Klein et al in 1996 and refined by Helfrich et al in 2007, was a popular theoretical framework used to explain factors driving innovation implementation success, particularly in works that sought it retrospectively. 39,41 We conceptualize the implementation of policy on provincial CDC establishment as implementation of a complex innovation that required collective, coordinated behavior change by many organizational members. 42 By definition, the establishment of provincial CDCs required organizations at different levels (provincial authorities, provincial department of health, centers of preventive medicine network) to develop and implement innovative practices across multiple functions (administrative and technical activities).…”

“…Building on the innovation adoption literature, we adopted the Innovation Implementation Framework developed by Klein and colleagues 42,43 and Helfrich et al, 44 and which has been increasingly applied to implementation of innovations within healthcare organization. 39,41,44,51 According to the original framework, implementation effectiveness is defined as the consistency and quality of the targeted organizational members' use of innovation and comprises: a) fit between the innovation and the user's values and b) implementation climate. Implementation climate refers to organizational members' shared perceptions that innovation implementation is considered as an organizational priority and is therefore promoted, supported, and rewarded.…”

<p>A qualitative study of interprofessional learning related to electronic health record (EHR) medication reconciliation within a social knowledge networking (SKN) system</p>

“…The mechanism should facilitate tacit knowledge exchange on issues experienced with current practices, as well as possible resolutions to those issues.Conduct proactive, periodic communications (from senior leadership) on benefits of adhering to best practices and consequences of not adhering to them.Create shared understanding of the value of best practices (ie, the link between practices and outcomes) or the answer to the question of “why” practices need to change, to gain provider engagement in changing practices, before embarking on IT-training of providers to address sociotechnical challenges.Develop capacity to collect, analyze, and disseminate data on best-practice measures among providers to promote a scientific (research-based) approach to learning and improvement.Enable champions for change to emerge from among providers, to voice the need for culture change for enabling successful best-practice implementation; and reinforce these messages with proactive, periodic communication from senior leadership.Create a “learning health system,” by synthesizing lessons learned to facilitate “collective learning (aha) moments” across provider subgroups and care settings; and encourage providers to spread the learning within the broader institution. Management research has suggested framing practice issues as a “learning challenge” rather than a “performance challenge,” and addressing them in the form of non-threatening pilot research projects, to engage providers in improvement 32 , 33. This project fulfilled both criteria to demonstrate meaningful results.…”