The evolution of knowledge exchanges enabling successful practice change in two intensive care units

Rangachari, Pavani; Madaio, Michael P.; Rethemeyer, R. Karl; Wagner, P. D.; Hall, Lauren; Roy, Siddharth; Rissing, J. Peter

doi:10.1097/hmr.0000000000000001

Cited by 30 publications

(50 citation statements)

References 24 publications

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“…As discussed earlier, prospective studies on innovation implementation took exactly this approach. [48][49][50][51][52] They leveraged the PCS framework to design an intervention for enabling tacit knowledge exchange across subgroups of professionals, to facilitate collective learning, and practice change, ie, successful implementation of innovations at the unit level. Moreover, these studies were conducted in the form …”

Section: Relevance Of Management Research To Innovation Implementatiomentioning

confidence: 99%

“…[48][49][50][51][52] The CLB is a set of five evidence-based practices known to prevent Central Line Associated Bloodstream Infection (CLABSIs). The PCS framework suggests that top-down, periodic, and proactive communications may be effective for exchange of tacit knowledge exchange, learning, and practice change in HCOs.…”

Section: Lessons Learned On How Innovation Implementation Occurs (Promentioning

confidence: 99%

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

Rangachari¹

2018

IEH

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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.

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Section: Relevance Of Management Research To Innovation Implementatiomentioning

confidence: 99%

Section: Lessons Learned On How Innovation Implementation Occurs (Promentioning

confidence: 99%

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

Rangachari¹

2018

IEH

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“…A key limitation of the TIP literature however, is that while it helps understand causes of unintended consequences of technology implementation, it does not by itself provide solutions to overcome them. A more recent stream of literature on knowledge-in-practice (KIP), which emanates from the broader literature stream on implementing and sustaining change in healthcare organizations has sought to understand how the creation of new communication (network) structures (or social structures) could enable the creation of new knowledge to in turn facilitate collective learning and organizational change [19][20][21][22][23][24][25][26][27] .…”

Section: Understanding and Detecting The Causes Of Unintended Adversementioning

confidence: 99%

Using social knowledge networking technology to enable meaningful use of electronic health record technology in hospitals and health systems

Rangachari

2014

JHA

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Despite the federal policy momentum towards "meaningful use" of Electronic Health Records (EHRs), the healthcare organizational literature remains replete with reports of unintended adverse consequences of implementing EHRs, including: increased work for clinicians, unfavorable workflow changes, and unexpected changes in communication patterns & practices. In addition to being costly and unsafe, these unintended adverse consequences may pose a formidable barrier to "meaningful use" of EHRs. Correspondingly, it is essential for hospital administrators to understand and detect the causes of unintended adverse consequences, to ensure successful implementation of EHRs. The longstanding Technology-in-Practice framework emphasizes the role of human agency in enacting structures of technology use or "technologies-in-practice". Given a set of unintended adverse consequences from health information technology implementation, this framework could help trace them back to specific actions (types of technology-in-practice) and institutional conditions (social structures). On the other hand, the more recent Knowledge-in-Practice framework helps understand how information and communication technologies (e.g., social knowledge networking systems) could be implemented alongside existing technology systems, to create new social structures, generate new knowledge-in-practice, and transform technology-in-practice. Therefore, integrating the two literature streams could serve the dual purpose of understanding and overcoming unintended adverse consequences of EHR implementation. This paper seeks to: (1) review the theoretical literatures on technology use & implementation, and identify a framework for understanding & overcoming unintended adverse consequences of implementing EHRs; (2) outline a broad project proposal to test the applicability of the framework in enabling "meaningful use" of EHRs in a healthcare context; and (3) identify strategies for successful implementation of EHRs in hospitals & health systems, based on the literature review and application.

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“…The Professional Complex Systems framework was recently tested by the authors in a study related to catheter-related bloodstream infection (CRBSI) prevention [45][46][47] . A prospective study was conducted in two intensive care units at an academic medical center.…”

Section: Literature On Organizational Change Implementationmentioning

confidence: 99%

Role of Social Knowledge Networking technology in facilitating meaningful use of Electronic Health Record medication reconciliation

Rangachari

2016

JHA

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Despite the federal policy impetus towards EHR Medication Reconciliation, hospital adherence has lagged for one chief reason; low physician engagement, which in turn emanates from lack of consensus in regard to which physician is responsible for managing a patient's medication list, and the importance of medication reconciliation as a tool for improving patient safety and quality of care.The Technology-in-Practice (TIP) framework stresses the role of human action in enacting structures of technology use or "technologies-in-practice." Applying the TIP framework to the EHR Medication Reconciliation context, helps frame the problem as one of low physician engagement in performing EHR Medication Reconciliation, translating to limited-use-EHR-inpractice. Concurrently, the problem suggests a hierarchical network structure, reflecting limited communication among hospital administrators and clinical providers on the importance of EHR Medication Reconciliation in improving patient safety. Integrating the TIP literature with the more recent knowledge-in-Practice (KIP) literature suggests that EHR-in-practice could be transformed from "limited use" to "meaningful use" through the use of Social Knowledge Networking (SKN) Technology to create new social network structures, and enable engagement, learning, and practice change.Correspondingly, the objectives of this paper are to: 1) Conduct a narrative review of the literature on "technology use," to understand how technologies-in-practice may be transformed from limited use to meaningful use; 2) Conduct a narrative review of the literature on "organizational change implementation," to understand how changes in technology use could be successfully implemented and sustained in a healthcare organizational context; and 3) Apply lessons learned from the narrative literature reviews to identify strategies for the meaningful use and successful implementation of EHR Medication Reconciliation technology.

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The evolution of knowledge exchanges enabling successful practice change in two intensive care units

Cited by 30 publications

References 24 publications

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

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

Using social knowledge networking technology to enable meaningful use of electronic health record technology in hospitals and health systems

Role of Social Knowledge Networking technology in facilitating meaningful use of Electronic Health Record medication reconciliation

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