Problems and promises of innovation: why healthcare needs to rethink its love/hate relationship with the new

Abstract

Innovation is often regarded as uniformly positive. This paper shows that the role of innovation in quality improvement is more complicated. The authors identify three known paradoxes of innovation in healthcare. First, some innovations diffuse rapidly, yet are of unproven value or limited value, or pose risks, while other innovations that could potentially deliver benefits to patients remain slow to achieve uptake. Second, participatory, cooperative approaches may be the best way of achieving sustainable, positive innovation, yet relying solely on such approaches may disrupt positive innovation. Third, improvement clearly depends upon change, but change always generates new challenges. Quality improvement systems may struggle to keep up with the pace of innovation, yet evaluation of innovation is often too narrowly focused for the system-wide effects of new practices or technologies to be understood. A new recognition of the problems of innovation is proposed and it is argued that new approaches to addressing them are needed.

Clinical Evidence, Practice Guidelines, and β-Blocker Utilization Before Major Noncardiac Surgery

“…[33][34][35][36] Conversely, some recent work has also described the potential for innovations with high degrees of intuitive appeal to diffuse rapidly into clinical practice, even if definitive proof of efficacy is lacking. 37,38 In this present study, we observed a rapid adoption of preoperative β-blocker treatment after initial reports that suggested clinical efficacy. 4,5 Notably, this trend in clinicians' behavior occurred before similar recommendations by perioperative practice guidelines.…”

Implementation science in healthcare: Introduction and perspective

“…Normalisation process theory [2] Sociology Practices are determined by perceived coherence of intervention, cognitive participation of target group, collective action, and reflexive monitoring. Organisational readiness theory [3] Organisational science…”

“…Investments in basic and clinical research remain wasted if effective clinical or preventive interventions, medical devices or organizational models are not applied in practice. On the other hand, resistance to change is appropriate if it helps to preserve good practices [3].…”

Strategies for Safety

“…On the one hand, it is a critical determinant and means (perhaps the most signifi cant) of improving safety in the long term. Innovation may also introduces new risks as well as resolving old ones particularly in the short term during the period of transition and disruption (Dixon-Woods et al 2011 ). Safety may be degraded in the short term due to rapid diffusion of insuffi ciently tested new methods and uncontrolled individual experimentation.…”