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PubMed2001

From irreversibility to participation: towards a participatory foresight for the governance of collective environmental risks.

This paper presents a reflection on the introduction of methods and tools of "participative foresight" for scientific and technology policy as well as environmental policy fields. Future studies have recently made a comeback under the label of foresight. Future technology studies no longer claim to forecast the future, but are presented as a strategic tool for improving interaction between key actors and for anticipatory policy making. They can be defined as a "process by which one comes to a fuller understanding of the forces shaping the long term future which should be taken into account in policy formulation, planning and decision-making" [Foresight in Federal Government Policymaking, Futures Res. Quart. (1985) 29]. We discuss applications of this approach for perspectives on environmental policy and sustainable development. Foresight opens up the possibility of negotiating a new and more fruitful relationship or 'social contract' between science and technology, on the one hand, and society on the other. The focus has moved from merely scientific and industrial insights to social demand, thus emphasizing the importance of both the production and "supply" of innovation, and the "demand" as signaled in the views of citizens.

Decision Making↗
PubMed2003

Implementing evidence-based nursing practice: a tale of two intrapartum nursing units.

Despite concerns that the rise of evidence-based practice threatens to transform nursing practice into a performative exercise disciplined by scientific knowledge, others have found that scientific knowledge is by no means the preeminent source of knowledge within the dynamic settings of health-care. We argue that the contexts within which evidence-based innovations are implemented are as influential in the outcomes as the individual practitioners who attempt these changes. A focused ethnography was done in follow-up to an earlier trial that evaluated the effectiveness of a marketing strategy to encourage the adoption of evidence-based intrapartum nursing practice. Bourdieu's (1990, 1991) concepts of habitus, capital and social field were used in our refinement of the analysis of the ethnographic findings. Nursing leadership, interprofessional struggle with physicians, the characteristics of the community and the physical environment were prominent issues at all of the sites. Detailed descriptions of the sociohistorical context and of the experiences at two sites are presented to illustrate the complexities encountered when implementing innovations.

Adaptation, Psychological↗
PubMed1998

Organizational tactics for the successful assimilation of medical practice guidelines.

Medical practice guidelines are being developed rapidly and advocated as a crucial component in transforming and improving the delivery of health care services. However, little is known about the ability of hospitals to institute guidelines outside of experimental settings. This article approaches guideline implementation from the viewpoint of process innovation assimilation and presents specific recommendations for organizational tactics leading to successful implementation of practice guidelines.

Diffusion of Innovation↗
PubMed2004

Factors impacting on nurse managers' ability to be innovative in a decentralized management structure.

Several studies indicate that management styles and knowledge of organizational structures have an impact on the potential for staff innovation. This exploratory study was conducted to investigate the implications of such variables in relation to nursing managers in a public sector health organization in Victoria, Australia. It reviewed factors that appeared to impact and encourage innovative behaviour amongst nurse managers within a decentralized management structure. To evaluate nurse managers' ability to be innovative, a 55-item survey consisting of both open questions and Likert-type scale questions was developed and distributed to 140 nurse managers working in a public sector health organization. The response rate was 58% yielding 82 usable responses. The study findings revealed that factors of management structures and management styles, in conjunction with the nurse unit managers' perceptions and communication skills, had an impact on nurse manager's ability to exhibit innovative behaviour in the 21st century workplace.

Attitude of Health Personnel↗
PubMed2004

Translating research into clinical practice: making change happen.

OBJECTIVES: To describe the process of adoption of an evidence-based, multifaceted, innovative program into the hospital setting, with particular attention to issues that promoted or impeded its implementation. This study examined common challenges faced by hospitals implementing the Hospital Elder Life Program (HELP) and strategies used to address these challenges. DESIGN: Qualitative study design based on in-depth, open-ended telephone interviews. SETTING: Nine hospitals implementing HELP throughout the United States. PARTICIPANTS: Thirty-two key staff members (physician, nursing, volunteer, and administrative staff) who were directly involved with the HELP implementation. MEASUREMENTS: Staff experiences implementing the program, including challenges and strategies they viewed as successful in overcoming challenges of implementation. RESULTS: Six common challenges faced hospital staff: (1) gaining internal support for the program despite differing requirements and goals of administration and clinical staff, (2) ensuring effective clinician leadership, (3) integrating with existing geriatric programs, (4) balancing program fidelity with hospital-specific circumstances, (5) documenting positive outcomes of the program despite limited resources for data collection and analysis, and (6) maintaining the momentum of implementation in the face of unrealistic time frames and limited resources. Strategies perceived to be successful in addressing each challenge are described. CONCLUSION: Translating research into clinical practice is challenging for staff across disciplines. Developing strategies to address common challenges identified in this study may facilitate the adoption of innovative programs within healthcare organizations.

Aged↗
PubMed1995

E.H. Christopherson Lecture: lessons for the United States From the Worldwide Child Survival Revolution.

It is time to apply in the United States' principles that are emerging from a series of World Summits and United Nations Conference on Children, Environment, Population, Women, and Social Development. After years of top-down programs supported by international agencies, which have made some significant contributions in promoting activities such as childhood immunization but are having problems of sustainability, we need to focus now on integrated human development. The past tendency in international assistance to concentrate on economic development has not helped the people in greatest need. There is growing realization that what improves the quality of life most is what people do for themselves. Sustainability requires social mobilization at the local level. There are thousands of integrated, social development projects around the world that demonstrate the power of community-based, participatory approaches and we know how such local programs can be made to work under any political or economic system. What we haven't learned is how to "go to scale" in extending such projects to cover larger populations. A promising approach seems to be using successful local projects upgraded into Centers for Action Learning to promote the adaptation of science-based innovations to everyday life in a whole region of a country.

Child↗
PubMed1996

[Innovative processes in ambulatory care--AIDS as a pilot project].

Flexibility in nursing practice and the willingness to be innovative are discussed, using the care of patients with AIDS as an example. When this new infectious disorder made its first appearance many countries tried to provide a patient-centred, community based service, in spite of the severity of the illness and the fact that it was usually lethal. A number of innovations were required to achieve this. The top priority was the provision of a community nursing service. This contribution consists of the analysis of the structure of provisions for care of patients with AIDS in the German Federal Republic (BRD). It deals with the reaction of the nursing services and asks to what extent the objectives have been achieved. Three different ways to adapt to the situation in the BRD are described and analysed. Data are based on qualitative interviews with members of the nursing service. It is shown that AIDS has led, in the BRD, to numerous innovations in community nursing care, the relevance of which far transcends the treatment of AIDS. In spite of this success, the care of patients is unsatisfactory. Many promising attempts to change came to grief as a result of resistance and obstacles to implementation. Others proved to be insufficiently robust or inappropriate in view of the multiplicity of problems encountered in AIDS. Reasons are to be found in the defective structure of the service, in the fact that management difficulties concerned with implementation of innovations were underestimated and that there is a "crisis" in nursing in the BRD. There have been criticisms for a long time, pointing out that the basic qualification is insufficient, that it does not prepare nurses adequately to deal with new social and health problems. If no change is introduced to training, community nursing is unlikely to be able to cope innovatively and flexibly with new challenges in the future.

Acquired Immunodeficiency Syndrome↗
PubMed1990

The changing pattern of medical activity in a major Belgian university hospital.

To evaluate the changes in the pattern of clinical activity in a 1900-bed Belgian teaching hospital in the period 1979-1987, we extracted data from the historical files of the hospital's central invoicing system. The total charge for a day of hospitalization, care and treatment increased by 83%. In this total per diem charge the share of hospital charges in the strict sense declined from 60 to 53%; the shares of charges for services and for pharmaceuticals rose, respectively, from 29 to 32, and from 10 to 15%. Within charges for services the share for diagnostic services declined by 22%; the share for surgery rose by 16%, and that for miscellaneous other services by 89%. For diagnostic services the decline was particularly clear for laboratory medicine (-32%) and for conventional imaging services (-22%), while cardiac and endoscopic investigations show a prominent expansion (+78 and +83%, respectively). In surgery the growth is quite homogeneous with the charges for urology, ophthalmology and orthopedics as the most important growers. In a group of miscellaneous, not diagnostic nor surgical services, which grows faster than all other groups, there is a marked shift from rather simple to technologically more advanced services. The increase in the pharmacy's bill results from increases in charge for both drugs (+49%) and materials (+95%). We conclude that the observed changes in charges reflect an intensification of care and an impact of technological innovation on clinical practice, including a phenomenon of substitution of old technologies for newer ones.

Belgium↗
PubMed2006

The ethics of innovation in pediatric surgery.

Ethical issues in pediatric research have long been debated, and experimentation in pediatric surgery is under intense scrutiny. Extensive legislation and institutional systems that attempt to protect children while supporting necessary research are at times ineffective. Pediatric surgery has less funding and resources for innovation than fields with higher clinical volume. Not unlike pediatrics in general, innovation in pediatric surgery must be beyond criticism. And yet, for the sake of patients, innovation should not only be maintained, but must be encouraged.

Child↗
PubMed2006

Personality and self-reported use of mobile phones for games.

Mobile phones are popular devices that may generate problems for a section of the community. A previous study using the Eysenck Personality Questionnaire found that extraverts with low self-esteem reported more problems with their mobile phone use. The present study used the NEO FI and Coopersmith Self-Esteem Inventory to predict the self reported mobile phone use of 112 participants. Multiple regression found that people low on agreeableness were more likely to use their mobile phones to play games. The findings imply an interplay between personality traits and excessive or problematic use on mobile phones that is relevant to proposed innovations such as gambling on mobile phones.

Adolescent↗
PubMed1993

The medical school curriculum committee revisited.

Numerous study commissions have contended that departmental territoriality and lack of coordinated planning are stagnating contemporary medical education. As a cure, these commissions have recommended the creation of centralized academic management units empowered to oversee revitalization of the curriculum through a series of reforms, including better definition of graduation competencies, community-based training, interdisciplinary courses, problem-based learning, and modernization of evaluation strategies. To determine the extent to which these recommendations were being adopted, in 1990 the authors sent a questionnaire on curriculum committee functions, current innovation efforts, and future priorities to academic administrators and members of medical school curriculum committees at 143 North American medical schools. Responses were received from administrators (primarily associate deans for academic affairs) at 118 schools and committee members (primarily faculty) at 111 schools. Recommendations for enhancing curriculum committee effectiveness were also elicited. The authors conclude that centralization of curricular management has occurred at very few institutions, and that the commonly mentioned reforms are being adopted at a modest pace. The results are analyzed in light of theories of the institutional change process and strategies for introducing educational innovations into established institutions.

Administrative Personnel↗
PubMed2006

[An innovative proposal for health insurance policies based on research results: the case of unemployed in Medellin, Colombia].

In recent decades there has been an important academic debate on how to transfer research-based knowledge to the health policy-making process. Despite an intensive controversy and various approaches to the problem, there is basic consensus concerning both the academic relevance and the usefulness of further evaluation of concrete experiences that allow conclusions and clarification of what are still confusing issues. The current article discusses a joint research experience by professors and local and regional health policy-makers. The research focused on the socioeconomic conditions, duration of the employment/unemployment cycle, and features of health insurance for workers that lost their jobs in the Greater Metropolitan "Valle de Aburrá" Area (Antioquia, Colombia) in 2005, as the basis for a proposal to guarantee the maintenance of health insurance for these workers. The potentialities and difficulties of the interactive process are analyzed. The article is also intended to elucidate how scientific outcomes influence policymaking in health, as well as the difficulties imposed by concrete reality and the political process for implementing the innovative proposal.

Administrative Personnel↗
PubMed2004

What drives change? Barriers to and incentives for achieving evidence-based practice.

To bridge the gap between scientific evidence and patient care we need an in-depth understanding of the barriers and incentives to achieving change in practice. Various theories and models for change point to a multitude of factors that may affect the successful implementation of evidence. However, the evidence for their value in the field is still limited. When planning complex changes in practice, potential barriers at various levels need to be addressed. Planning needs to take into account the nature of the innovation; characteristics of the professionals and patients involved; and the social, organisational, economic and political context.

Diffusion of Innovation↗