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PubMed1984

[Economic analysis of the dissemination of a medical innovation: prenatal diagnosis by early amniocentesis as an example. Part 2. Facilitating decision making in public health for optimal dissemination of an innovation].

Only a specific public health policy can resolve the technical, ethical, and financial problems posed by the diffusion of prenatal diagnosis by amniocentesis for the prevention of Down's syndrome. The purpose of this article is to facilitate decision making in this field by evaluating the costs and benefits associated with the different prevention strategies. Beginning with projections of the number of Down's syndrome births to be expected among women of 35 and older to the year 2000 (assuming that no prenatal diagnosis are made), various objectives combining the age of the target population and usage rates are presented and discussed. An evaluation of the overall costs of prenatal diagnosis and caring for Down's syndrome patients shows that a policy reaching a 50% usage rate for women 38 and older would save up to 66 millions French francs (using the 1981 franc value). On the other hand, it is shown that lowering the incidence of Down's syndrome in a target population of women over 35 to the level of the younger population would imply a usage rate of at least 80%. This goal is unrealistic unless amniocentesis were to become a compulsory examination. In such case, women would be deprived of an essential freedom, in view of the related ethical issues. The authors lastly discuss the different means of increasing usage rates without inhibiting women's freedom of choice.

Adult↗
PubMed2006

Innovation in surgery: a historical perspective.

OBJECTIVE: To describe the field of surgical innovation from a historical perspective, applying new findings from research in technology innovation. BACKGROUND: While surgical innovation has a rich tradition, as a field of study it is embryonic. Only a handful of academic centers of surgical innovation exist, all of which have arisen within the last 5 years. To this point, the field has not been well defined, nor have future options to promote surgical innovation been thoroughly explored. It is clear that surgical innovation is fundamental to surgical progress and has significant health policy implications. A process of systematically evaluating and promoting innovation in surgery may be critical in the evolving practice of medicine. METHODS: A review of the academic literature in technology innovation was undertaken. Articles and books were identified through technical, medical, and business sources. Luminaries in surgical innovation were interviewed to develop further relevance to surgical history. The concepts in technology innovation were then applied to innovation in surgery, using the historical example of surgical endoscopy as a representative area, which encompasses millennia of learning and spans multiple specialties of care. RESULTS: The history of surgery is comprised largely of individual, widely respected surgeon innovators. While respecting individual accomplishments, surgeons as a group have at times hindered critical innovation to the detriment of our profession and patients. As a clinical discipline, surgery relies on a tradition of research and attracting the brightest young minds. Innovation in surgery to date has been impressive, but inconsistently supported. CONCLUSION: A body of knowledge on technology innovation has been developed over the last decade but has largely not been applied to surgery. New surgical innovation centers are working to define the field and identify critical aspects of surgical innovation promotion. It is our responsibility as a profession to work to understand innovation in surgery, discover, translate, and commercialize advances to address major clinical problems, and to support the future of our profession consistently and rationally.

General Surgery↗
PubMed2003

In search of the quickest way to disseminate health care innovations.

RESEARCH QUESTION: Innovations in health care are slowly disseminated in The Netherlands and elsewhere. That's why the researchers defined their research question: What is the quickest way of disseminating health care innovations? RESEARCH METHOD: The design was a comparative, qualitative case study. The researchers invited a group of 52 authors to describe their 21 health care innovations. All case descriptions were published in a book of 261 pages. RESULTS: Six types of innovations were distinguished. Most innovations simultaneously improved quality from the patient's point of view (18 out of 21 cases), professional pride (18/21) and speed of introduction (16/21). Clinical outcomes were better or comparable in 13 of the 21 cases. Brainstorm sessions took place with the innovators and the 22 experts on the quickest way to disseminate the innovations more widely in The Netherlands. These sessions looked for the critical success factors for the dissemination of the 21 projects and identified nine. The following factors were identified: 1. A clear distribution of responsibilities between professionals within the innovation (20/21). 2. Enough educational programs about the innovations for the professionals (18/21). 3. Adequate ICT support for the running of the innovations (15/21). 4. Suitable publicity for the innovations (12/21). 5. An adequate payment system for innovative care providers (7/21). 6. The right size of catchment's area for the innovations (6/21). 7. Enough professional freedom to adopt the innovation (5/21). 8. Fast managerial and public decision-making about the adoption of the innovation (3/21). 9. The embedding of the innovations in quality management assurance policy (1/21). DISCUSSION: The results of the study had some influence on the political health agenda in The Netherlands, leading to greater emphasis on innovations and quality of care.

Journal Article↗
PubMed2004

Determinants of innovation within health care organizations: literature review and Delphi study.

PURPOSE: When introducing innovations to health care, it is important to gain insight into determinants that may facilitate or impede the introduction, in order to design an appropriate strategy for introducing the innovation. To obtain an overview of determinants of innovations in health care organizations, we carried out a literature review and a Delphi study. The Delphi study was intended to achieve consensus among a group of implementation experts on determinants identified from the literature review. DATA SOURCES: We searched 11 databases for articles published between 1990 and 2000. The keywords varied according to the specific database. We also searched for free text. Forty-four implementation experts (implementation researchers, programme managers, and implementation consultants/advisors) participated in the Delphi study. STUDY SELECTION: The following studies were selected: (i) studies describing innovation processes, and determinants thereof, in health care organizations; (ii) studies where the aim of the innovations was to change the behaviour of health professionals; (iii) studies where the health care organizations provided direct patient care; and (iv) studies where only empirical studies were included. DATA EXTRACTION: Two researchers independently selected the abstracts and analysed the articles. The determinants were divided into four categories: characteristics of the environment, characteristics of the organization, characteristics of the user (health professional), and characteristics of the innovation. When analysing the determinants, a distinction was made between systematically designed and non-systematically designed studies. In a systematic study, a determinant analysis was performed and the innovation strategy was adapted to these determinants. Furthermore, the determinants were associated with the degree of implementation, and both users and non-users of the innovation were asked about possible determinants. In the Delphi study, consensus was defined as agreement among 75% of the experts on both the influence of a determinant and the direction towards which that influence tended (i.e. facilitating, impeding, or neutral). RESULTS: From the initial 2239 abstracts, 57 studies were retrieved and 49 determinants were identified that affected (impeded or facilitated) the innovation process. The experts identified one other determinant. Seventeen studies had a more-or-less systematic design; the others did not. After three rounds, consensus was reached on the influence of 49 out of 50 determinants. CONCLUSION: The results of the literature review matched those found in the Delphi study, and 50 potentially relevant determinants of innovation processes were identified. Many of the innovation studies had several methodological flaws, such as not adjusting innovation strategies to relevant determinants of the innovation process, or that data on determinants were gathered only from non-users. Furthermore, the degree of implementation was evaluated in several ways, which made comparison difficult.

Cross-Sectional Studies↗
PubMed1997

How Canadian radiologists adopt innovations: a survey.

BACKGROUND AND OBJECTIVE: Innovations and practice changes occur frequently in modern radiologic practice. In this study the authors sought to understand the process of adopting an innovation and to define the characteristics of some innovations and the effect of these characteristics on innovation adoption. METHODS: An anonymous mail survey of the membership of the Canadian Association of Radiologists was undertaken to obtain details about the process of adopting an innovation. Information on the perceived characteristics of the innovation was obtained, as well as the perception of change in practice. RESULTS: The survey was sent to 1005 radiologists and was returned by 372 (37.0%), of whom 278 gave information on an innovation adopted in the preceding year. The respondents reported heavy use of textual and other material resources throughout the process of innovation adoption, as well as consultation with colleagues. Continuing medical education (CME) events, in comparison, were little used as information sources. Compatibility of the innovation with current practice and a relative clinical advantage over existing practices were the most important characteristics of the innovations adopted. The complexity, relative financial gain and ability to try the innovation were all less important. CONCLUSIONS: This study confirms a high rate of change in radiologic practice and documents the number and variety of learning resources used in the adoption of change. It is important for CME providers and educators to recognize the relatively low use of CME events in the process of change. Characterization of the innovations indicates concern with the clinical impact of the change and the individual physician's ability to accomplish the change within his or her practice.

Canada↗
PubMed2006

ACOG Committee Opinion No. 352: Innovative practice: ethical guidelines.

Innovations in medical practice are critical to the advancement of medicine. Good clinicians constantly adapt and modify their clinical approaches in ways they believe will benefit patients. Innovative practice frequently is approached very differently from formal research, which is governed by distinct ethical and regulatory frameworks. Although opinions differ on the distinction between research and innovative practice, the production of generalizable knowledge is one defining characteristic of research. Physicians considering innovative practice must disclose to patients the purpose, benefits, and risks of the proposed treatment, including risks not quantified but plausible. They should attempt an innovative procedure only when familiar with and skilled in its basic components. A clinician should share results, positive or negative, with colleagues and, when feasible, teach successful techniques and procedures to other physicians. Practitioners should be wary of adopting innovative procedures or diagnostic tests on the basis of promotions and marketing when the value of the procedures or tests has not been proved. A practitioner should move an innovative practice into formal research if the innovation represents a significant departure from standard practice, if the innovation carries unknown or potentially significant risks, or if the practitioner's goal is to use data from the innovation to produce generalizable knowledge. If there is any question whether innovative practices should be formalized as research, clinicians should seek advice from the relevant institutional review board.

Decision Making↗
PubMed2006

Racial differences in attitudes toward innovative medical technology.

BACKGROUND: New medical technologies are used at different rates among whites and blacks. This variation may be partially explained by racial differences in patient innovativeness-the propensity of patients to adopt unfamiliar therapies. OBJECTIVE: To measure how innovativeness varies among patients and how it may influence patients' attitudes toward new medical technologies. DESIGN: Cross-sectional survey. PARTICIPANTS: Primary care patients (n=171-108 blacks, 63 whites) at an urban Veterans Affairs medical center. MEASUREMENTS: Respondents answered questions about their general innovativeness and innovativeness regarding medical technology, and they responded to a vignette describing either a hypothetical new prescription drug or implantable device. RESULTS: There were no significant racial differences in general innovativeness, but whites had higher medical technology innovativeness (P=.001). Whites were also more likely to accept the new prescription drug (P=.003), but did not differ from blacks in acceptance of the new implantable device. In multivariate analyses, lower medical technology innovativeness scores among blacks were significantly associated with less favorable reactions to both the prescription drug (P<.001) and the medical device (P<.001). In contrast, although whites with lower medical technology innovativeness were similarly less inclined to accept the new implantable device (P=.02), there was no significant association between medical technology innovativeness and positive attitudes to the new prescription drug among whites. CONCLUSIONS: Blacks and whites have differing attitudes toward medical innovation. These differences are associated with significant racial differences in response to particular health care technologies. These findings suggest potentially remediable causes for racial differences in the utilization of innovative medical technologies.

Attitude to Health↗
PubMed2006

Nurses at the forefront of innovation.

BACKGROUND: This paper is based on a presentation given by the author at the 23rd Quadrennial ICN Congress and 7th International Regulation Congress in Taipei in May 2005. AIM: Nurses worldwide are engaged in innovative practice on a daily basis. In most health systems across the world, nurses provide up to 80% of primary health care and are therefore well positioned to provide critically needed innovative solutions to many global health challenges. The aim of this paper is to increase awareness of the importance and value of innovations in nursing; provide an improved understanding of the contribution nurses make to innovation in health care; and increase understanding of the importance of creating environments that inspire innovation and help shape practice in new and improved ways. DESIGN: This paper explores the concept of innovation, the inherent set of characteristics that need to be present in order for innovations to succeed, and the barriers that impede innovation from occurring. CONCLUSION: There are numerous examples of successful innovations worldwide that are developed and implemented by nurses, some of which are described in this paper. The paper concludes that organizations need to have a support climate that encourages creativity and innovation to occur.

Creativity↗
PubMedDate not supplied

The discipline of innovation.

Some innovations spring from a flash of genius. But as Peter Drucker points out in this HBR Classic, most result from a conscious, purposeful search for opportunities. For managers seeking innovation, engaging in disciplined work is more important than having an entrepreneurial personality. Writing originally in the May-June 1985 issue, Drucker describes the major sources of opportunities for innovation. Within a company or industry, opportunities can be found in unexpected occurrences, incongruities of various kinds, process needs, or changes in an industry or market. Outside a company, opportunities arise from demographic changes, changes in perception, or new knowledge. These seven sources overlap, and the potential for innovation may well lie in more than one area at a time. Innovations based on new knowledge, of course, tend to have the greatest effect on the marketplace. But it often takes decades before the ideas are translated into actual products, processes, or services. The other sources of innovation are easier and simpler to handle, yet they still require managers to look beyond established practices. Drucker emphasizes that in seeking opportunities, innovators need to look for simple, focused solutions to real problems. The greatest praise an innovation can receive is for people to say, "This is obvious!" Grandiose ideas designed to revolutionize an industry rarely work. Innovation, like any other endeavor, takes talent, ingenuity, and knowledge. But Drucker cautions that if diligence, persistence, and commitment are lacking, companies are unlikely to succeed at the business of innovation.

Administrative Personnel↗