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

Figures & data

Table 1 Insights from management research on “innovation implementation failures” in health care organizations (HCOs) in the context of health care quality improvement

Why do “innovation implementation failures” occur in HCOs?	What could be done to prevent “innovation implementation failures” in HCOs?	References
Nature of work in HCOs involves uncertainty and risk of patient fatality and entails considerable clinician discretion. Clinicians are averse to experimenting with new ways to deliver care since it could be risky to the patient. As such, clinicians have the liberty to avoid innovation implementation.	Clinician resistance to participate in implementation efforts could be overcome by enabling them to try out innovations in ways that are not threatening, like pilot studies or dry runs. Such opportunities could provide low-risk scenarios where failures do not impact patients.	6–18
Workforce characteristics in HCOs include a strong specialized and hierarchal culture governing interpersonal interactions. Correspondingly, there is a strong professional identification. This results in limited collaboration among clinicians and limited organizational identification (both of which are crucial for innovation implementation).	Leaders must frame the implementation effort as a “learning challenge,” rather than a “performance challenge,” to encourage interprofessional collaboration. Also, leaders must increase organizational identification by enabling clinicians to perceive alignment between their goals and values and organizational goals and values.	19,20
Leader-workforce relations in HCOs are such that leaders have limited control over health professionals, resulting in “transactional” this-for-that exchanges; as such, leaders and workforce are unable to place collective goal (innovation implementation) above self-interest.	Leaders must incorporate “transformational leadership” processes to shift clinicians’ focus from individual goals to collective goals, ie, innovation implementation. Transformational leaders are intellectually stimulating and can motivate health professionals to consider how their own individual goals overlap with the collective goals.	12,21
Performance measurement and control systems in HCOs are underdeveloped; it has been a challenge to design and develop valid and reliable measures of quality; underdeveloped measurement systems deprive HCOs of crucial performance data for monitoring implementation efforts.	Leaders must involve workforce in development of the measurement, share authority in decision-making over components of the system, engage health professionals through ongoing communication, and measure and reward implementation efforts. Since innovations call for clinician interdependence to perform tasks, incentives provided at the group-level may work better compared to the individual level.	22-24

Figure 1 Flowchart of article selection process for integrative review.

Table 2 Characteristics of reviewed articles

Characteristic (variable)	Type (value)	Numerator/ Denominator (%)
Innovations of interest	Evidence-based practice guidelines	12/50 (25%)
	Patient safety protocols	11/50 (23%)
	Health IT	9/50 (18%)
	Patient-and-family-centered care	5/50 (10%)
	Chronic disease management	6/50 (12%)
	Other	5/50 (10%)
Care setting	Hospital–inpatient (including emergency, medical/surgical, intensive care unit, etc)	21/50 (41%)
	Outpatient-subspecialty (eg, cardiology, oncology)	9/50 (18%)
	Outpatient-primary care	6/50 (12%)
	Health system (including Veterans Affairs)-multiple care settings	14/50 (28%)
Article type	Empirical (involving data collection and/or analysis)	39/50 (78%)
	Non-empirical (review, discussion, conceptual, or theoretical)	11/50 (22%)
Theoretical frameworks used in empirical articles	Innovation Implementation Framework	8/39 (21%)
	Barriers Scale	1/39 (3%)
	Middle Managers Role in Innovation Implementation	6/39 (15%)
	Disruptive Innovation Theory	1/39 (3%)
	Diffusion of Innovation Theory	1/39 (3%)
	Systematizing Person-Group Relations Framework	1/39 (3%)
	Deskilling Type Adaptation Model	1/39 (3%)
	Sense-Making Theory	1/39 (3%)
	Innovation Complexity Framework	1/39 (3%)
	Organizational Learning	1/39 (3%)
	Organizational change (planned vs emergent change)	2/39 (5%)
	Professional Complex Systems Framework	5/39(12%
	No theoretical framework used	10/39 (26%)
Study designs used in empirical articles	Retrospective cross-sectional studies (e.g., surveys & interviews)	24/39 (62%)
	Restrospective case studies	9/39 (23%)
	Prospective studies	6/39 (15%)
Data collection methods used in empirical articles	Mixed methods	24/39 (62%)
	Surveys	4/39 (10%)
	Interviews and/or focus groups	6/39 (15%)
	Content analysis	2/39 (15%)
	Archival and/or secondary data analysis	1/39 (3%)
	Other qualitative techniques	2/39 (5%)