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PubMed1988

The use of combined estrogen-progestin replacement therapy.

The evaluation of innovations which use old technology poses different problems than does the evaluation of new technologies. The main necessity is the targeting of its use rather than the technology itself. The need to evaluate the extent of use and its problems is illustrated by the example of progestin use among menopausal and postmenopausal women in the United States. There progestins are not officially approved for use in menopause, even though they have been on the market for a long time with other indications. Estrogen-replacement therapy was widely used from the early 1960s until 1975, when the claim that estrogens cause endometrial cancer notably decreased their use. The use of estrogens increased again in the early 1980s, and one reason for this revival was the claim that progestins offered protection against endometrial cancer. When recommendations for combined estrogen-progestin therapy have been made, other health effects have been ignored. Two consensus conferences as well as the drug control authority have recommended against combined estrogen-progestin therapy until further research is completed. Absence of good research, specialization in medicine, and advantages for prescribers and the drug industry may have contributed to the wide use of this unassessed treatment. Possible solutions for prevention of the diffusion of these kinds of innovations are discussed.

Communication↗

PubMed2004

Adoption of innovations by specialised nurses: personal, work and organisational characteristics.

BACKGROUND: To gain insight in the factors that influence the adoption of professional information by specialised nurses, we studied the effects of individual, work and organisational characteristics on the extent to which continence nurses gained knowledge and made use of a book on nursing diagnosis and interventions for patients with urinary incontinence, which they received as a present. METHODS: Subjects were all members of the Dutch Association of Continence Nurses. Data collection took place via a postal questionnaire with closed questions. In total, 109 valid questionnaires (78%) were received back. Stepwise selected ordered logit models were estimated with reading the book and knowledge and use of five selected parts of it as dependent variables and individual, work and organisational characteristics as independent variables. RESULTS: The most important factors found to promote reading of the book and taking knowledge of the parts of it were a personal characteristic of the nurses called "information directedness" (or eagerness to acquire professional information from other sources), the presence of an "innovative atmosphere" at the department, and "relevance" of the information for daily nursing practice. The most important factors found to promote the use of the book are (again) information directedness, working at a (relatively) small department and having experience with nursing diagnosis. CONCLUSIONS: Results suggest that nurses differ in the degree to which they are open to innovations and that information directedness might be a useful indicator of this characteristic. In addition, the degree of innovativeness of the atmosphere at the department and the relevance of the innovation for nursing practice are important factors influencing the success or failure of innovations in nursing practice.

Age Factors↗

PubMedDate not supplied

Nurses information-processing patterns: impact on change and innovation.

This descriptive study, based on the Organizational Engineering conceptual framework, investigates the information-processing styles of nursing staff (RNs, LPNs, nursing assistants, and unit secretaries) that impact how they accept and deal with change and innovation. The study sample was made up of 578 nursing staff and nurse managers. The major finding is that both nursing staff overall and RNs as a separate group are clustered in the "Conservator" (Logical Process--Hypothetical Analyzer) quadrant of the Organizational Engineering Model. In contrast, the nurse managers were significantly more likely to be in the "Changer" (Reactive Stimulator--Relational Innovator) quadrant.

Analysis of Variance↗

PubMedDate not supplied

A successful teaching strategy for applying evidence-based practice.

Evidence-based practice (EBP) is the conscientious use of the best evidence contained in the literature to guide healthcare decisions. The authors describe how their baccalaureate program prepares its graduates to be successful in implementing EBP in their nursing practice. Outcomes of sustained student projects in agency settings are presented. They posit that bachelor of science in nursing students, agency personnel, and faculty can lead practice innovations supported by EBP.

Attitude of Health Personnel↗

PubMed2005

Hormone replacement therapy: an example of McKinlay's theory on the seven stages of medical innovation.

AIM AND OBJECTIVES: The aim of this paper is to explain the history and use of hormone replacement therapy (HRT) using McKinlay's theory of medical innovation. The paper will examine why a drug, HRT, was prescribed for mainly healthy women. It reflects on the controversies surrounding HRT and examines some of the possible reasons why, despite an almost complete lack of verifiable research, HRT became one of the most widely prescribed drugs of our time. BACKGROUND: Twenty-four years ago McKinlay published From 'Promising Report' to 'Standard Procedure': Seven Stages in the Career of a Medical Innovation. McKinlay argued that many, if not most, innovations in medicine undergo a process of which assessment of effectiveness is only a late stage placing many patients at risk of receiving treatments which are useless or malign. CONCLUSION: This paper argues that HRT was a medical innovation whose 'career' followed the seven stages describes by McKinlay. This suggests that the Nursing and Medical professions continue to accept innovation uncritically. RELEVANCE TO CLINICAL PRACTICE: This paper underlines the importance of critically assessing the research-based evidence for altering practice and introducing new treatments. It suggests that Nurse Prescribers and other clinicians question the assumed scientific basis of new innovations in clinical practice.

Attitude of Health Personnel↗

PubMed2005

Bariatric surgery: assessing opportunities for value innovation.

Obesity has been increasing over the past two decades, and the amount of medical and media attention given to bariatric surgery as a promising option for morbidly obese individuals is growing. The growth of bariatric surgery also has been attributed to improved surgical technique, the increase in surgeons trained in laparoscopic procedures, as well increased public awareness with celebrities having successfully undergone surgery. The number of surgeons and hospitals offering bariatric services is increasing. How then does a surgeon or a hospital develop a competitive strategy? The first step is to understand the health-care industry. The key forces are rivalry among present competitors, and the bargaining power of suppliers and buyers. While bariatric surgery currently is in a growth phase, time and competition will force practitioners to compete on the basis of price, unless they find true competitive advantage. Value innovation, is a means of creating new marketing space by looking across the conventionally defined boundaries of business--across substitute industries, across strategic groups, across buyer groups, across complementary product and service offerings, and across the functional-emotional orientation of an industry. One can compete by offering similar services focusing primarily on cost efficiencies as the key to profitability. Alternatively, one can break free from the pack by innovating and focusing on delivering superior value to the customer. As the market for bariatric surgery becomes increasingly overcrowded, profitable growth is not sustainable without developing a clear differential advantage in the market. Value innovation allows you to develop that advantage.

Bariatrics↗

PubMed1994

Health care innovation: progress report and focus on biotechnology.

Funding for biomedical research has shifted from government to the private sector. One reason is rapid expansion in the number and strength of U.S. biotechnology companies, which collectively spend more than $6 billion a year on biomedical research. Most of these companies are not yet profitable and therefore depend on flows of capital from private investors, Wall Street, and large pharmaceutical company collaborations. Investment in the new drugs, devices, and vaccines in this pipeline is sensitive to signals emanating from the debate on health care reform, suggesting that new federal policy will have a major impact on steering the type of innovation to emerge in the future.

Biotechnology↗

PubMed1996

The changing environment for technological innovation in health care.

A distinguishing feature of American health care is its emphasis on advanced technology. Yet today's changing health care environment is overhauling the engine of technological innovation. The rate and direction of technological innovation are affected by a complex of supply- and demandside factors, including biomedical research, education, patent law, regulation, health care payment, tort law, and more. Some distinguishing features of technological innovation in health care are now at increased risk. Regulatory requirements and rising payment hurdles are especially challenging to small technology companies. Closer management of health care delivery and payment, particularly the standardization that may derive from practice guidelines and clamping down on payment for investigational technologies, curtails opportunities for innovation. Levels and distribution of biomedical research funding in government and industry are changing. Financial constraints are limiting the traditional roles of academic health centers in fostering innovation. Despite notable steps in recent years to lower regulatory barriers and speed approvals, especially for products for life-threatening conditions, the Food and Drug Administration is under great pressure from Congress, industry, and patients to do more. Technology gatekeeping is shifting from hundreds of thousands of physicians acting on behalf of their patients to fewer, yet more powerful, managed care organizations and health care networks. Beyond its direct effects on adoption, payment, and use of technologies, the extraordinary buying leverage of these large providers is cutting technology profit margins and heightening competition among technology companies. It is contributing to unprecedented restructuring of the pharmaceutical and medical device industries, leading to unprecedented alliances with generic product companies, health care providers, utilization review companies, and other agents. These industry changes are already having considerable effects on investment patterns and the development, adoption, and use of new technologies. Until recently, new technologies that offered the prospect for health benefit, however, marginal or unproven, were paid for with little or no regard to cost. Technical wizardry alone no longer carries the day in health care. Today's health care market increasingly demands what other markets do--measurable improvements in benefits at acceptable costs--and innovators have begun to respond accordingly. Even so, certain key venues for health care innovation are at risk.

Biomedical Technology↗

PubMed2006

Disruptive innovation for social change.

Countries, organizations, and individuals around the globe spend aggressively to solve social problems, but these efforts often fail to deliver. Misdirected investment is the primary reason for that failure. Most of the money earmarked for social initiatives goes to organizations that are structured to support specific groups of recipients, often with sophisticated solutions. Such organizations rarely reach the broader populations that could be served by simpler alternatives. There is, however, an effective way to get to those underserved populations. The authors call it "catalytic innovation." Based on Clayton Christensen's disruptive-innovation model, catalytic innovations challenge organizational incumbents by offering simpler, good-enough solutions aimed at underserved groups. Unlike disruptive innovations, though, catalytic innovations are focused on creating social change. Catalytic innovators are defined by five distinct qualities. First, they create social change through scaling and replication. Second, they meet a need that is either overserved (that is, the existing solution is more complex than necessary for many people) or not served at all. Third, the products and services they offer are simpler and cheaper than alternatives, but recipients view them as good enough. Fourth, they bring in resources in ways that initially seem unattractive to incumbents. And fifth, they are often ignored, put down, or even encouraged by existing organizations, which don't see the catalytic innovators' solutions as viable. As the authors show through examples in health care, education, and economic development, both nonprofit and for-profit groups are finding ways to create catalytic innovation that drives social change.

Diffusion of Innovation↗

PubMedDate not supplied

[Barriers in implementing innovative nursing research concepts. Results of a study].

The question of knowledge transfer into the practice of nursing is gaining more and more importance due to the urgently required innovations for the practice-last but not least also the question of the barriers of transforming them: Beginning with the problem of what shall be definitely determined as theory and what as practice, or possible transport damages, which knowledge suffers from in the process of transforming scientific findings into action recommendations that are usable in nursing practice with inclusion of the barriers with which those pragmatists have to struggle who wish to transform theoretical knowledge into institutions-disturbing factors wait everywhere: simple linear ideas of transformability of theoretical knowledge are not appropriate. Looking at the example of participants of a training course for "specialized nurses for geriatric medicine and rehabilitation" the authors investigated transformation barriers in the knowledge transfer on innovative nursing concepts and developed plans regarding transfer optimization.

Aged↗

PubMedDate not supplied