Determining the predictors of innovation implementation in healthcare: a quantitative analysis of implementation effectiveness

Abstract

BackgroundThe failure rates for implementing complex innovations in healthcare organizations are high. Estimates range from 30% to 90% depending on the scope of the organizational change involved, the definition of failure, and the criteria to judge it. The innovation implementation framework offers a promising approach to examine the organizational factors that determine effective implementation. To date, the utility of this framework in a healthcare setting has been limited to qualitative studies and/or group level analyses. Therefore, the goal of this study was to quantitatively examine this framework among individual participants in the National Cancer Institute’s Community Clinical Oncology Program using structural equation modeling.MethodsWe examined the innovation implementation framework using structural equation modeling (SEM) among 481 physician participants in the National Cancer Institute’s Community Clinical Oncology Program (CCOP). The data sources included the CCOP Annual Progress Reports, surveys of CCOP physician participants and administrators, and the American Medical Association Physician Masterfile.ResultsOverall the final model fit well. Our results demonstrated that not only did perceptions of implementation climate have a statistically significant direct effect on implementation effectiveness, but physicians’ perceptions of implementation climate also mediated the relationship between organizational implementation policies and practices (IPP) and enrollment (p <0.05). In addition, physician factors such as CCOP PI status, age, radiological oncologists, and non-oncologist specialists significantly influenced enrollment as well as CCOP organizational size and structure, which had indirect effects on implementation effectiveness through IPP and implementation climate.ConclusionsOverall, our results quantitatively confirmed the main relationship postulated in the innovation implementation framework between IPP, implementation climate, and implementation effectiveness among individual physicians. This finding is important, as although the model has been discussed within healthcare organizations before, the studies have been predominately qualitative in nature and/or at the organizational level. In addition, our findings have practical applications. Managers looking to increase implementation effectiveness of an innovation should focus on creating an environment that physicians perceive as encouraging implementation. In addition, managers should consider instituting specific organizational IPP aimed at increasing positive perceptions of implementation climate. For example, IPP should include specific expectations, support, and rewards for innovation use.

Validating the Implementation Climate Scale (ICS) in child welfare organizations

“…Finally, although research in non-health-related settings (e.g., Klein et al, 2001) and in medical settings at the individual level (Jacobs et al, 2015) provide support for effects of EBP implementation climate on implementation outcomes, more research is needed to further demonstrate the benefits of cultivating such an organizational climate in child welfare and other allied health settings. Research of this nature could include other climate-related measures (e.g., Glisson et al, 2008) as well as measures of other aspects of the organizational context (e.g., organizational readiness for change; Helfrich, Li, Sharp, & Sales, 2009; Shea, Jacobs, Esserman, Bruce, & Weiner, 2014) to show how these various issues build on each other and work together to understand implementation effectiveness.…”

“…When implementation climate is high in the organization, employees perceive the organization values EBPs and is supportive in practicing them. It has been proposed that such perceptions lead to increased levels of attention and motivation for EBP implementation, ultimately enhancing EBP outcomes (Aarons, Ehrhart, Farahnak, & Sklar, 2014; Ehrhart Aarons, & Farahnak, 2014; Jacobs, Weiner, Reeve, Hofmann, Christian, & Weinberger, 2015; Weiner et al, 2011). …”

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

“…At the organizational level, several articles have [25][26][27][28][29]36,37 Other studies that have used frameworks like the Barriers Scale and Middle Manager's role in innovation implementation have also found support for individual components of the Innovation Implementation Framework, like "presence of a champion" and "support from management." [30][31][32][33][34] At the clinician level, applications of frameworks like Disruptive Innovation theory, Deskilling and Adaptation, and Sense-Making theory, among others, have helped to demonstrate the crucial role of "innovation-values fit" for enabling behavior change and innovation implementation among frontline clinicians.…”

What is the degree of innovation routinely implemented in Dutch radiotherapy centres? A multicentre cross-sectional study

“…The failure rates for implementing complex innovations in healthcare are high. 13 The failure rate for RT is unknown. Previously, we conducted a Delphi study to determine indicators for innovation for the four types of innovations described (Table 1).…”