Innovation Implementation in the Context of Hospital QI-Lessons Learned and Strategies for Success

Abstract

In 1999, the Institute of Medicine (IOM) reported that 98,000 people die each year due to medical errors. In the following years, the focus on hospital quality was intensified nationally, with policymakers providing evidence-based practice guidelines for improving health care quality. However, these innovations (evidence-based guidelines) that were being produced at policy levels were not translating to clinical practice at the hospital organizational level easily, and stark variations continued to persist, in the quality of health care. Circa 2009, nearly a decade after the release of the IOM report, the health care organizational literature began referring to this challenge as "innovation implementation failure" in health care organizations (HCOs), ie, failure to implement an evidence-based practice that is new to a HCO. This stream of literature drew upon management research to explain why innovation implementation failure occurs in HCOs and what could be done to prevent it. This paper conducts an integrative review of the literature on "innovation implementation" in hospitals and health systems over the last decade, since the spotlight was cast on "innovation implementation failure" in HCOs. The review reveals that while some studies have retrospectively sought to identify the key drivers of innovation implementation, through surveys and interviews of practitioners (the "what"), other studies have prospectively sought to understand how innovation implementation occurs in hospitals and health systems (the "how"). Both make distinctive contributions to identifying strategies for success in innovation implementation. While retrospective studies have helped identify the key drivers of innovation implementation, prospective studies have shed light on how these drivers could be attained, thereby helping to develop context-sensitive management strategies for success. The literature has called for more prospective research on the implementation and sustainability of health care innovations. This paper summarizes the lessons learned from the literature, discusses the relevance of management research on innovation implementation in HCOs, and identifies future research avenues.

Evaluating a patient safety learning laboratory to create an interdisciplinary ecosystem for health care innovation

“…Innovation through care process redesign and improvement in health care delivery is occurring at an unacceptably slow pace and with variable impact (Rangachari, 2018). The complex nature of health care and fragmentation of care delivery has contributed substantially to the inadequacy of innovation efforts (Nembhard et al, 2009).…”

Leadership for reducing medical errors via organizational culture: a literature review

“…The literature pointed to three leadership approaches that generated improvement in patient safety and medical errors. First, transformational leadership, which helps promote values-focus, productive communication and focus on mission, is a strong patient safety and medical error intervention (Boamah et al , 2018; Hu et al , 2016; McFadden et al , 2015; Merrill, 2015; Murray et al , 2018; Polonsky, 2019; Rangachari, 2018; Sfantou et al , 2017; Fischer et al , 2018; Taylor et al , 2015). Authentic leadership, centering on transparency and openness, can also be a factor in patient safety and medical error improvement (Boamah et al , 2018; Kaplan et al , 2017; Murray et al , 2018; Polonsky, 2019; Sfantou et al , 2017; Wong and Walsh, 2020).…”

“…Transformational leaders’ followers respond positively to inspirational motivation, inspiring followers to commit to a shared vision (Northouse, 2019). In health care, transformational leaders can establish a clear idea, creating a safety culture to improve outcomes (Kaplan et al , 2017; Rangachari, 2018). The literature strongly connected strategic leadership to improved outcomes, especially the CEO’s leadership.…”

Meaningful use of electronic health record (EHR) medication reconciliation technology requires a shared understanding of its value among healthcare providers

“…In one academic health center, a leader-moderated knowledge sharing system related to EHR MedRec was developed to enable practitioners to engage in tacit knowledge exchange on issues related to EHR MedRec and benefit from collective learning of best practices. The latter in turn, helped to develop shared understanding of the link between EHR MedRec practices and patient outcomes, which in turn paved the way for more meaningful use of the EHR MedRec functionality (21)(22)(23)(24). For example, the knowledge sharing system developed at this institution, helped to facilitate tacit knowledge exchange and collective inter-professional learning with respect to the EHR MedRec best-practice of "consistent importation of the external Rx history into the EHR system at the start of patient encounters".…”

“…The body of research discussed earlier, has helped to identify evidence-based management strategies for inter-professional learning and change in the context of meaningful use of EHR MedRec. These strategies are summarized in Figure 1 (15,(21)(22)(23)(24). An article featured in this issue by Petry et al entitled "Medication reconciliation and pharmacogenetic reviews: the importance of an accurate medication list" helps to reinforce the value of these evidence-based management strategies by describing how institutional efforts to 1.…”