Making sense of evidence in management decisions: the role of research-based knowledge on innovation adoption and implementation in healthcare. study protocol

Implementation Science

Alison Holmes¹  Raheelah Ahmad¹  Yiannis Kyratsis¹ 

[1] National Centre for Infection Prevention and Management, Faculty of Medicine, Imperial College London, London, UK

关键词: Implementation;    Hospital;    National Health Service (NHS);    Qualitative;    Infection prevention;    Innovation adoption;    Sensemaking;    Evidence;   

Others  :  828902
DOI  :  10.1186/1748-5908-7-22

 received in 2012-01-21, accepted in 2012-03-21,  发布年份 2012

【 摘 要 】

Background

We know that patient care can be improved by implementing evidence-based innovations and applying research findings linked to good practice. Successfully implementing innovations in complex organisations, such as the UK's National Health Service (NHS), is often challenging as multiple contextual dynamics mediate the process. Research studies have explored the challenges of introducing innovations into healthcare settings and have contributed to a better understanding of why potentially useful innovations are not always implemented in practice, even if backed by strong evidence. Mediating factors include health policy and health system influences, organisational factors, and individual and professional attitudes, including decision makers' perceptions of innovation evidence. There has been limited research on how different forms of evidence are accessed and utilised by organisational decision makers during innovation adoption. We also know little about how diverse healthcare professionals (clinicians, administrators) make sense of evidence and how this collective sensemaking mediates the uptake of innovations.

Methods

The study will involve nine comparative case study sites of acute care organisations grouped into three regional clusters across England. Each of the purposefully selected sites represents a variety of trust types and organisational contexts. We will use qualitative methods, in-depth interviews, observation of key meetings, and systematic analysis of relevant secondary data to understand the rationale and challenges involved in sourcing and utilising innovation evidence in the empirical setting of infection prevention and control. We will use theories of innovation adoption and sensemaking in organisations to interpret the data. The research will provide lessons for the uptake and continuous use of innovations in the English and international health systems.

Discussion

Unlike most innovation studies, which involve single-level analysis, our study will explore the innovation-adoption process at multiple embedded levels: micro (individual), meso (organisational), and macro (interorganisational). By comparing and contrasting across the nine sites, each with different organisational contexts, local networks, leadership styles, and different innovations considered for adoption, the findings of the study will have wide relevance. The research will produce actionable findings responding to the political and economic need for healthcare organisations to be innovation-ready.

【 授权许可】

   
2012 Kyratsis et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Berwick DM: Disseminating Innovations in Health Care. JAMA: The Journal of the American Medical Association 2003, 289:1969-1975.
• [2]Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O: Diffusion of Innovations in Service Organizations: Systematic Review and Recommendations. Milbank Quarterly 2004, 82:581-629.
• [3]Department of Health: Innovation Health and Wealth, Accelerating Adoption and Diffusion in the NHS. In Book Innovation Health and Wealth, Accelerating Adoption and Diffusion in the NHS. City: Department of Health NHS Improvement & Efficiency Directorate Innovation and Service Improvement; 2011:36. (Editor ed.^eds.)
• [4]Rogers EM: Diffusion of Innovations. 4th edition. New York: Free Press; 1995.
• [5]Rogers EM: Diffusion of Innovations. 5th edition. New York: Free Press; 2003.
• [6]Williams F: Gibson DV: Technology Transfer: A Communication Perspective. London: Sage Publications; 1990.
• [7]Van de Ven AH, Polley DE: Garud Ra, Venkataraman S: The Innovation Journey. Oxford, New York: Oxford University Press Inc; 1999.
• [8]Fitzgerald L, Ferlie E, Wood M, Hawkins C: Interlocking Interactions, the Diffusion of Innovations in Health Care. Human Relations 2002, 55:1429-1449.
• [9]Ferlie E, Fitzgerald L, Woods M: Getting Evidence into Clinical Practice: An Organisational Behaviour Perspective Journal of Health Services Research Policy. 2000, 5:6.
• [10]Dopson S, FitzGerald L, Ferlie E, Gabbay J, Locock L: No Magic Targets! Changing Clinical Practice To Become More Evidence Based. Health Care Management Review 2002, 27:35-47.
• [11]Denis J-L, Hébert Y, Langley A, Lozeau D, Trottier L-H: Explaining Diffusion Patterns for Complex Health Care Innovations. Health Care Management Review 2002, 27:60-73.
• [12]Atun RA, Kyratsis I, Jelic G, Rados-Malicbegovic D, Gurol-Urganci I: Diffusion of complex health innovations--implementation of primary health care reforms in Bosnia and Herzegovina. Health Policy and Planning 2007, 22:28-39.
• [13]Ferlie E, Fitzgerald L, Wood M, Hawkins C: The Nonspread of Innovations: The Mediating Role of Professionals. Academy of Management Journal 2005, 48:117-134.
• [14]Fitzgerald L, Dopson S: Knowledge, Credible Evidence, and Utilization. In Knowledge to action? Evidence-based health care in context. Edited by Dopson S, Fitzgerald L. Oxford University Press; 2005.
• [15]Ferlie E, Gabbay J, Fitzgerald L, Lockock L, Dopson S: Evidence-based medicine and organisational change: an overview of some recent qualitative research. In Organisational Behaviour and Organisational Studies in Health Care: Reflections on the future Edited by Ashburner L, Basingstoke, Palgrove. 2001.
• [16]Weick KE: Sensemaking in Organizations. Sage. 1995.
• [17]Weick KE KMS, Obstfeld D: Organizing and the Process of Sensemaking. Organization Science 2005, 16:12.
• [18]Weick KE, Sutcliff KM: Hospitals as cultures of entrapment: A reanalysis of the Bristol Royal Infirmary. California Management Review 2003, 45:11.
• [19]Ferlie E, Dopson S: Studying Complex Organizations in Health Care. In Knowledge to Action? Evidence-based Health Care in Context. Edited by Dopson S, Fitzgerald L. Oxford: Oxford University Press; 2005:8-26.
• [20]Management Practice in Healthcare Organisations Ref MP241: Call for proposals. [http://www.netscc.ac.uk/hsdr/files/project/SDO_PRO_09-1002-38_V02.pdf] webcite 2008.
• [21]Eisenhardt KM: Building Theories from Case Study Research. Academy of Management Review 1989, 14:532-550.
• [22]Yin R: Case Study Research - Design and Methods. 3rd edition. Thousand Oaks, London, New Dehli: Sage; 2003.
• [23]Abrahamson E: Managerial Fads and Fashions: The Diffusion and Rejection of Innovations. The Academy of Management Review 1991, 16:586-612.
• [24]Pope C, Ziebland S, Mays N: Analysing qualitative data. BMJ. 2000, 320:114-116.
• [25]Sofaer S: Qualitative Methods: What Are They and Why Use Them? Health Services Research 1999, 34:17.
• [26]Bradley EH, Curry LA, Devers KJ: Qualitative Data Analysis for Health Services Research: Developing Taxonomy, Themes, and Theory. Health Services Research 2007, 42:1758-1772.
• [27]Kyratsis Y, Ahmad R, Holmes A: Understanding the Process of Innovation Adoption in 12 NHS trusts - technology selection, procurement and implementation to help reduce HCAIs. [https:/ / www.wp.dh.gov.uk/ hcai/ files/ 2011/ 07/ Technology-Adoption-Study_DH-Approv ed_FINAL-FULL-REPORT_Feb-2011_inclu ding-Acknlowledgments.pdf] webciteDepartment of Health, England; 2010, 331.
• [28]Glaser B, Strauss A: The discovery of grounded theory. Chicago Aldine; 1967.
• [29]Patton MQ: Qualitative Research and Evaluation Methods. 3rd edition. Thousand Oaks, Sage; 2002.
• [30]Hammersley M: What is wrong with Ethnography?. London: Routledge; 1992.
• [31]Maitlis S: The Social Processes of Organizational Sensemaking. The Academy of Management Journal 2005, 48:21-49.