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Fairweather and ESID: contemporary impact and a legacy for the twenty-first century.

This paper illustrates how the articles in this special issue demonstrate the central values, research, and action principles inherent in Fairweather's ESID model. The programs described in these articles address earlier social problems in new forms (e.g., previously, institutionalized mentally ill patients and now, the homeless mentally ill) and new issues (e.g., HIV prevention). Dissemination of innovative programs is abundant, but only recently has research begun in earnest to study the critical processes of dissemination. Moreover, Fairweather has pointed us in important, but yet unrealized directions for how to pursue a theory of social change on the basis of ecological concepts, innovative research methods and data analytic techniques, and salient change agent behaviors and principles.

Diffusion of Innovation↗

Nursing models in a special hospital: cybernetics, hyperreality and beyond.

Two emerging themes that resulted from research carried out in a special hospital on the use of nursing models are identified. The first theme to emerge was the tendency of the subjects to perceive the models as concrete entities thus undergoing a process of reification. The second theme identified was the adherence to the models outside the contextual nature of the setting which limited their effectiveness. A theoretical framework in which to locate the results of the study is explored using cybernetic learning theory and the notion of hyperreality, using the works of Jean Baudrillard. A method for innovation and changing practice in the special hospital setting is suggested.

Cybernetics↗

Hospital marketing and the Internet: the adoption of an innovation.

Given the manner in which the Internet permeates today's society, it is easy to forget that the Internet as we know it is only about a decade old. Due to its newness, the Internet has provided an opportunity to view the manner in which marketers move to adopt such an innovation. To that end, since 1995 a series of studies has tracked the adoption and use of the Internet by hospital marketers. In addition to simply investigating the number of hospitals that utilize the Internet in their marketing efforts, the studies have addressed such questions as: How are hospitals using the Internet to market themselves?, What roadblocks have held hospitals back from adopting the Internet as a marketing tool?, and How happy are hospitals with their Internet investment? This manuscript details the most recent in this series of research studies. In addition, the authors compare the results of this study, conducted in the fall of 2002, with the results from the previous studies. As a result, this study provides a unique opportunity to observe the actual adoption of an innovation, the Internet, by hospital marketing professionals.

Costs and Cost Analysis↗

Using physiologic end points to assess innovations in mechanical ventilation.

It is our view that new ventilatory methods should be withheld from clinical practice until there has been adequate evaluation of their effect on physiologic variables and the link to long-term outcomes has been established. In the past, premature and over-enthusiastic acceptance of ventilatory strategies may have resulted in patient discomfort and even harm, and this can be minimized by a more careful evaluation of the physiologic effects of such innovations before their acceptance into clinical practice.

Diffusion of Innovation↗

Medical insurance, technological change, and welfare.

Concerns have been expressed about the welfare effects of expensive innovations in medical care financed largely through medical insurance. This paper develops a model which considers such issues. It is shown that even if insurance is purchased optimally (subject to a plausible constraint on the form of the contract), innovations may be adopted that have the effect of reducing expected welfare. The question of how the benefits of medical innovations ought to be measured in the presence of insurance is also explored.

Diffusion of Innovation↗

Assessing the implementation of clinical process innovations: a cross-case comparison.

Clinical process innovations (CPI) are central to the ability of organizations to negotiate the challenges of cost containment and quality improvement, yet many CPI have not met expectations. Perhaps most alarming is that the dissemination and implementation of CPI is not well understood. This is the second of two articles addressing the dissemination and use of CPI in integrated delivery systems. This article discusses those factors that have been identified as either facilitating or impeding the various stages in implementing CPI and suggests some intervention strategies to enhance opportunities for continuous CPI. Identifying the process and the factors driving the implementation of CPI is only part of the challenge. The development of CPI adequate to fully meet current challenges will require managers to re-examine existing paradigms and values influencing their actions to date. Within this context, the necessary staging of the innovation process within the life cycle, developing partnerships both within and outside the organization to gather the necessary resources and support, and multidimensional performance monitoring and feedback can prepare organizations and managers to better face the reality of managing the innovation process.

Communication↗

[The current method of handling of test samples and medical reimbursement for POCT in Japan].

Point of care testing(POCT) is defined as clinical testing done at or near the site of patient treatment and care in the medical field, and includes all clinical test other than those performed at hospital laboratories and outside testing centers. Home testing is also a form of POCT relating to residential medical care. The ratio of clinical tests based on POCT has not tended to increase as rapidly in Japan, although such tests are greatly increasing in the US while clinical tests performed at hospital laboratories are decreasing. POCT products are generally applied to direct analysis of test samples obtained from patients. Since storage, transportation or pretreatment after sampling is not necessary in POCT, test data can be obtained in real time. Therefore, it is important to complete testing immediately after obtaining samples without transporting or storing them, when handling POCT samples. Consideration of POCT as a part of health care services covered by health insurance is the same as in the case of conventional testing. Recent technological innovation has provided a wide variety of POCT products that do not require medical equipment or reagents. Further development of novel, innovative POCT procedures in the near future is promising.

Autoanalysis↗

Radical technology: your grandfather's telephone.

More than 100 years ago, a cutting-edge technology offered the potential to improve and better manage care. But like each innovation that was to follow, the telephone wasn't implemented in a day.

Diffusion of Innovation↗

Why innovation in health care is so hard.

Health care in the United States--and in most other developed countries--is ailing. Medical treatment has made astonishing advances, but the packaging and delivery of health care are often inefficient, ineffective, and user unfriendly. Problems ranging from costs to medical errors beg for ingenious solutions-and indeed, enormous investments have been made in innovation. But too many efforts fail. To find out why, it's necessary to break down the problem, look at the different types of innovation, and examine the forces that affect them. Three kinds of innovation can make health care better and cheaper: One changes the ways consumers buy and use health care, another taps into technology, and the third generates new business models. The health care system erects an array of barriers to each type of innovation. More often than not, organizations can overcome the barriers by managing the six forces that have an impact on health care innovation: players, the friends and foes who can bolster or destroy;funding, the revenue-generation and capital-acquisition processes, which differ from those in other industries; policy, the regulations that pervade the industry; technology, the foundation for innovations that can make health care delivery more efficient and convenient; customers, the empowered and engaged consumers of health care; and accountability, the demand from consumers, payers, and regulators that innovations be safe, effective, and cost-effective. Companies can often turn these six forces to their advantage. The analytical framework the author describes can also be used to examine other industries. Cataloging the innovation types and identifying the forces that aid or undermine them can reveal insights on how to treat chronic innovation ills- prescriptions that will make any industry healthier.

Delivery of Health Care↗