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PubMedDate not supplied

Organizational factors that influence information technology diffusion in academic health sciences centers.

OBJECTIVE: To identify the organizational factors which influence the diffusion of end user online literature searching, the computer-based patient record, and electronic mail systems in academic health sciences centers in the United States. DESIGN: A total of 1335 individuals working in informatics and library areas at 67 academic health sciences centers in the U.S. were surveyed. Multivariate techniques were used to evaluate the relationship between the set of six organizational factors and two measures of innovation diffusion. MEASUREMENTS: A Guttman-like scale was developed to measure infusion, or depth or sophistication, of each of the three innovations at each institution. Diffusion was measured by a question previously developed for another study. Six independent variables were measured via five formerly developed scales and one new one. RESULTS: The overall response rate was 41%. The set of organizational variables produced significant results in the diffusion of each of the three innovations, with individual variables influencing diffusion to varying degrees. The same set produced significant results in relation to infusion only for online searching. There was little or no correlation between infusion and diffusion for each innovation. CONCLUSION: Organizational attributes are important predictors for diffusion of information technology innovations. Individual variables differ in their effect on each innovation. The set of attributes seems less able to predict infusion. It is recommended that both infusion and diffusion be measured in future studies because there is little relation between them. It is further recommended that individuals charged with implementing information technology in the health sciences receive training in managing organizational issues.

Academic Medical Centers↗
PubMed2001

Technology innovation.

Technology is the way dentistry is practiced--the materials and methods, characteristics of the dentist and staff, and nature and values of patients. Innovation is a conscious process of improving that technology. Dentists, not researchers or manufacturers, are the source of most innovation in dentistry. Characteristics such a innate curiosity, sophistication, discretionary income, and practice isolation contribute to innovativeness. Innovation diffusion has a characteristic S-shape, with few early and late adopters and a rapid spread in the middle phase. Much is known regarding the personality and behavior of early and late adopters and those types of innovations that are likely to diffusion rapidly.

Dentists↗
PubMed1998

Heart Partners: a strategy for promoting effective diffusion of school health promotion programs.

Heart Partners uses a straightforward, interpersonal approach to increase acceptance and use of innovations in school health promotion. In accord with the linkage model of innovation diffusion, developers of a new program or technology (i.e., resource system) simply designate and train selected members to be recruiters and allies of individual advocates at the campus-level (i.e., user system). Linkage is supported by supplying advocates and allies with guidelines and materials that encourage ongoing, interactive, interpersonal partnerships to promote effective implementation of the new technology at the school. Empirical assessment of this simple strategy implemented by the Texas Affiliate of the American Heart Association showed a twofold to fourfold increase in actual use and reach of school health promotion packages, with an average reported volunteer time of less than three hours per month.

American Heart Association↗
PubMed1990

Changing patient management: what influences the practicing pediatrician?

To explore some determinants of physicians' decisions to change practice habits, we posed three questions: To what extent are some particular innovations diffused among office-based primary care physicians? What characterizes the physicians who have adopted these innovations? And, what caused them to change their behavior and adopt the innovations? Three "markers," recent innovation in medical practice, were chosen using an expert consensus technique. A telephone survey of 200 office-based pediatricians was conducted, and the physicians were asked whether or not they used the following three innovations in medical practice: continuous rather than intermittent phenobarbital for the prevention of febrile seizures, glycosylated hemoglobin measurement in the management of diabetes, and slow release theophylline in the management of asthma. The questionnaire was completed by 156 pediatricians. Of the 110 pediatricians who cared for diabetics, 73% used glycosylated hemoglobin measurement; of the 145 who saw patients with febrile seizures, 77% prescribed the continuous use of phenobarbital (if they used it at all); and, of the 152 pediatricians who cared for asthmatics, 86% reported using slow-release theophylline. The characteristics significantly associated with using the innovations were board certification, group rather than solo practice, teaching, medically related publications, academic appointment, younger age, and caring for a greater number of patients per week. For two of the innovations, discussion with a colleague was the most important source of information leading to a change of practice. The subjects cited local specialists as the colleagues who most often sparked the adoption of an innovation.

Biomarkers↗
PubMed1995

Cross-site study of the implementation of information technology innovations in health sciences centers.

An interpretive oral history technique was used to identify factors most important in the implementation stage of information technology innovation diffusion. Electronic mail, end user literature searching, and aspects of the computer-based patient record were the innovations selected for study at academic health sciences centers. Transcripts of thirty-four interviews with key individuals were analyzed to determine six categories of factors. Word counts were then used to determine underlying emphases. Analysis of variance tested whether there were significant differences in uses of words by categories of individuals, by those at different institutions, and when different innovations were described. Results indicate that the innovations themselves correlate significantly with different word categories, where category of individual and institution do not. Words related to the computer based patient record characterize further critical factors in implementing that particular innovation.

Academic Medical Centers↗
PubMedDate not supplied

Organizational integrative mechanisms and adoption of innovations by nurses.

The relationship between organizational activities and structures that increase information flow (integrative mechanisms) and nurse adoption of innovations (research results) was studied using Rogers' theory of innovation diffusion. Analysis of variance demonstrated a significant interaction effect between level of integrative mechanism use, institution size, and nurse adoption of innovations. In small hospitals a higher level of integrative mechanism use was related to increased nurse innovation adoption; however, in large hospitals the opposite was found. Of the five categories of integrative mechanisms identified, only Research Conduct and Publication were significantly related to innovation adoption, and then only in small hospitals. In large hospitals, Conference and Presentation, Position and Committee, and Publication categories were demonstrated to be significantly, but negatively, related to innovation adoption among nurses.

Communication↗
PubMedDate not supplied

Antecedents of clinical information technology sophistication in hospitals.

Grounded in the resource-based theory and the innovation diffusion theory, this article develops and tests a research model for assessing the antecedents of hospital innovativeness with regard to clinical information technology (IT) applications. A cross-sectional survey was conducted in a sample of U.S. hospitals (n = 74) to assess three dimensions of clinical IT sophistication. Secondary data were used to measure the antecedents, namely, four groups of organizational capacity variables. Bivariate and regression analyses were conducted to identify significant associations. A significant percentage (45-61%) of the variance in clinical IT sophistication was explained, mostly by leadership and knowledge sharing capacities. In particular, IT tenure and technical knowledge resources were significantly related to clinical IT sophistication. Surprisingly, managerial tenure and hospital's belonging to a network showed significant negative associations with two dimensions of the clinical IT sophistication construct. To address the challenges they face, hospitals should consider encouraging career development for current individuals in charge of IT activities, and attracting professionals with an IT background who have the knowledge and ability to trigger new ideas and favor the adoption and use of clinical IT applications in these settings.

Cross-Sectional Studies↗
PubMed2005

Diffusion of breast conserving surgery in medical communities.

Excluding skin cancers, breast cancer is the most common form of cancer in women. Due to an increased focus on early detection, many more cases of breast cancer are now diagnosed at an early stage, which makes the use of breast conserving surgery (BCS) an efficacious and often more desirable treatment choice than mastectomy. An analysis of the variation in the use of BCS in the United States was performed using data from the years 1988 and 1994, and stratifying hospitals on the basis of teaching status. In both 1988 and 1994, BCS was highest in academic teaching hospitals and lowest in community hospitals. This finding is interpreted within the framework of classical diffusion theory. Social and cultural norms in local medical communities have a strong effect on the degree to which innovations diffuse rapidly or not. This analysis is useful in the understanding of geographic and hospital-based variations in treatment for early stage breast cancer and other illnesses that have long and strongly held traditions of treatment.

Academic Medical Centers↗
PubMedDate not supplied

Transition to a Web-supported curriculum.

Stimulating faculty to adopt an innovation of online learning in a registered nurse (RN) completion program was the focus of a faculty retreat seminar to launch a transition to a Web-supported curriculum. This article follows the planning and implementation that initiated curriculum transition to a Web-supported format using Roger's innovation-diffusion framework. Web-supported courses include an online component in combination with face-to-face instruction. The factors that influence innovation adoption, specifically relative advantage, compatibility, complexity, trialability, and observability, framed the discussion of principles. Approaches used to garner faculty involvement in the curriculum transition are discussed, and highlighted are considerations for teaching the utilization of course management software, along with faculty preparation for initiating online learning for the first time.

Attitude to Computers↗
PubMedDate not supplied

Computerized medical records in family medicine journals, 1981-1990: diffusion of an innovation.

This study examined whether references to computerized medical records in family medicine journals had increased over the past decade as an example of diffusion of innovations. The abstract and methods sections of articles in Family Medicine, the Journal of Family Practice, and the Journal of the American Board of Family Practice were reviewed from 1981 to 1990 for explicit references to computerized medical records. The proportion of articles citing computerized medical records did not significantly increase overall or in any one journal during this time. Articles referenced computerized medical records with regard to sample selection for research studies (54%), description of computerized medical record systems (26%), and generation of health maintenance reminders (4%). These results are discussed in the context of family medicine literature and in terms of factors that typically impede the diffusion of innovations.

Diffusion of Innovation↗
PubMedDate not supplied

Implementing a multidisciplinary cancer pain education program.

Cancer pain remains problematic for many patients. No standardized guidelines were available for the management of cancer pain until the early 1990s. In addition, many healthcare personnel have not been trained adequately in pain management, despite the abundance of literature. As a result, clinicians often manage patient's pain poorly. This article provides an overview of the process of development and implementation of a 5-year multidisciplinary cancer pain education program, begun in 1989 by the University of Pennsylvania School of Nursing, School of Medicine, and Cancer Center. The program was comprised of a multidisciplinary cancer pain consultation panel that sought to educate healthcare personnel in community hospitals and nursing homes in southeastern Pennsylvania about cancer pain. This was accomplished by providing consultations for agencies with patients experiencing uncontrolled and/or progressive cancer pain. The panel also provided education through lectures, newsletters, and symposia. A total of 1949 healthcare personnel attended 92 consultations, lectures, and symposia during the 5 years that the program has operated. With the linkage approach to innovation diffusion framework used in this consultation program, and the implementation of the guidelines now available, many healthcare personnel may be able to increase their skills and manage pain more effectively, thus reducing and/or eliminating needless suffering for patients. Developing role models in the area of pain management at community hospitals may be the most effective means of incorporating pain control guidelines and fostering innovation.

Diffusion of Innovation↗
PubMed1996

Innovation in nursing management: professional, management and methodological considerations.

There are many changes occurring in the National Health Service (NHS) at this time, not just to economic and funding policies, but also at the very heart of nursing delivery. The introduction of "managerialism" into the senior clinical grades of nursing, midwifery and other professional staff has characterized the past few years. Against this backdrop is the increasing belief that NHS organizations must find improved ways of delivering patient care and other services. This has inexorably led to the consideration of diffusing innovation into practice as a way to improve performance and competitiveness. While there have been a number of clinical attempts at understanding this process, there has been very little written about innovation from the perspective of the nurse (or midwifery) clinical manager. This paper discusses some of the issues surrounding management innovation including the planning of interventions aimed at introducing innovation, and some of the methodological difficulties of studying complex organizations. The wider issues of innovation, nursing management and professional staff are also discussed.

Diffusion of Innovation↗
PubMed1997

Testing a community level research utilization intervention.

Research supports changing practice from heparinized to saline flushes for adults, yet heparin continues to be used in clinical practice. The primary aim of this study was to test the effectiveness of a community level innovation diffusion intervention as a method of stimulating research utilization at three acute care facilities in one community simultaneously. The change advocated was the flushing of intermittent intravenous devices (IID) with saline rather than heparin. Pilot IID units were chosen on which to test the change from the use of heparin to saline flushes. The innovation focused on staff empowerment and was implemented in five phases. The change to saline flushes was successful and has been maintained.

Adult↗
PubMed1992

Gaps and contract: evaluating the diffusion of new information. Part I. A description of the strategy.

Time and fiscal constraints on oncology nurses require that continuing education programs yield demonstrable benefit to the clinician, the institution, and patient outcomes. This article describes "gaps and contract," a strategy that provides nurses with a tool to transfer knowledge from theory to practice, in a measurable form. The framework for this strategy lies within the concept of innovation diffusion. This strategy was used by two universities collaborating to educate 912 oncology health professionals in 38 continuing education programs. Part II of this article will describe the measurement of this strategy.

Child↗
PubMed1994

The persistence of high fertility in the American South on the eve of the baby boom.

Pockets of high fertility persisted in some areas of the American South through the Great Depression. Most other areas of the country adopted modern fertility patterns considerably earlier in the century; these "laggard" areas are clear exceptions to the national demographic revolution in family building. In this paper we attempt to identify the factors that account for the persistently high fertility in some southern regions. We use county-level data for 1940 to assess the utility of three theoretical models of fertility: structural, diffusion-innovation, and health. Differences by race are also considered, in view of the distinctly different histories of whites and African-Americans in the south. Our findings suggest that unicausal explanations for the persistence of high fertility are too simplistic; all three theoretical perspectives receive empirical support. Considerable similarity is observed in the findings for blacks and for whites. Yet important differences also emerge, especially the more powerful effects of structural variables on white fertility. We conclude that the evidence indicates the need for "diversity" in the study of demographic behavior. Not only should we examine a variety of causal mechanisms for demographic phenomena; we also should consider the varying utility of those mechanisms across different social groups.

Black or African American↗