Factors Related to the Implementation and Use of an Innovation in Cancer Surgery

Abstract

ConclusionsAn improved understanding of the multilevel factors influencing the implementation of innovations is critical to planning effective change interventions in health care. Further study is needed to explore differences in the use of the innovation between breast and colorectal cancer surgeons. Findings will inform the study of additional cases of synoptic reporting implementation, enabling cross-case analyses and identification of higher-level themes that may be applied in similar settings or contexts. KEY WORDSImplementation, synoptic reporting, cancer, surgery BACKGROUNDThe operative report records details of a surgical procedure and findings, and thus documents information that is important to subsequent patient care and management. The traditional method of reporting findings from surgery is the narrative report, involving a descriptive free-text account of the procedure, suspected or confirmed findings, and proposed treatment. Although report dictation is an important practice, a survey of academic general surgeons found that only 18% of general surgery programs provide training in this skill 1 . As medicine becomes increasingly multidisciplinary and technology-supported, several issues related to narrative reporting provide an impetus to change reporting mechanisms.First, for patients with cancer, a clear and thorough record of the surgical procedure and findings supports accurate diagnosis and staging, and therefore facilitates improved estimates of prognosis and postoperative treatment planning. The completion of a cancer operation is a unique point in time at which the surgeon has not only specific knowledge of the technical details of the procedure, but also detailed knowledge of important presentation, diagnostic, staging, and presurgical care ABSTRACT ObjectiveNationally, efforts to implement an innovation in cancer surgery-a Web-based synoptic reporting tool-are ongoing in five provinces. The objective of the present study was to identify the key multilevel factors influencing implementation and early use of this innovation for breast and colorectal cancer surgery at two academic hospitals in Halifax, Nova Scotia. MethodsWe used case-study methodology to examine the implementation of surgical synoptic reporting. Methods included semi-structured interviews with key informants (surgeons, implementation team members, and report end users; n = 9), nonparticipant observation, and document analysis. A thematic analysis was conducted separately for each method, followed by explanation-building to integrate the evidence and to identify the key multilevel factors influencing implementation. An audit was performed to determine use. ResultsKey factors influencing implementation were these: In a 6-month period after implementation, 91.2% and 58.0% respectively of eligible breast and colorectal cancer surgeries were reported using the new tool.

Factors affecting the implementation and use of electronic templates for histopathology cancer reporting

“…Despite the apparent benefits of electronic synoptic histopathology reporting, and the successful regional implementation of such a reporting system in Ontario, Canada, 5 others have reported that the implementation and use of electronic histopathology reporting is no easy organisational task 6,7 . Similar challenges have also been reported regarding the implementation and use of a web-based synoptic reporting tool for cancer surgery 8,9 . From a management and organisational perspective, the list of possible causes for project failure with respect to information technology development, implementation and use is long 10 .…”

Improving Cancer Control in Canada through Knowledge Translation: From in-The-Field Projects toPolicy Initiatives in a New Standing Section in Current Oncology

“…The first paper, by Urquhart et al 6 , described multi-level factors that influenced the implementation of synoptic reporting for breast and crc surgery in Halifax, Nova Scotia. That initiative was part of a pan-Canadian pilot project funded by the cpac in five Canadian provinces to implement a Web-based surgical medical record (Websmr).…”

Exploring the Usefulness of Two Conceptual Frameworks for Understanding How Organizational Factors Influence Innovation Implementation in Cancer Care

“…84 Based on our knowledge of the initiatives, neither framework fully depicts the implementation of SRTs in Nova Scotia, yet both offer important insight into the organizational factors that are important to their implementation. For example, a pilot study on one initiative 85 demonstrated that the presence of champions, innovation-values fit, and strengthening the implementation climate 8 have played important facilitating roles in the implementation and use of this innovation in practice. Effective leadership 1,17 was also closely linked to many of the factors that enabled successful implementation.…”