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In this report the authors describe how bringing together nurses from different specialties to share innovations and developments can enhance personal, professional and practice development on a much wider scale.
An analysis of the present-day status of the innovation system in public health services is submitted together with prospects of its development. Results are presented of the sociological investigation designed to study efficiency of use of innovations in health system.
As well as the expanding diabetes market for glucose-monitoring devices, there are other applications for these products and opportunities for companies with the will to innovate. One area that is explored here is the intensive care unit.
Fourteen nursing research findings that meet the Conduct and Utilization of Research in Nursing (CURN) Project (1982) criteria for clinical use were identified from research journals and CURN publications. Data collected from 216 practicing nurses in small, medium, and large hospitals were analyzed to determine their awareness of, persuasion about, and use of the findings. The majority of nurses were aware of the average innovation, were persuaded about it, and used the average innovation at least sometimes. Use of the innovations had no relationship to hospital policies or procedures concerning the nursing research findings.
Nursing research development has long been viewed by practicing nurses as an activity for those in academia with the "thinking time" and resources to support scientific investigation. This view is being challenged by nurses in one hospital and its affiliated university. They are setting the pace for research activities by establishing a consortium to enhance collaborative research development and utilization. The author describes the model and how its goals have been operationalized through establishing an innovative collaborative structure. Suggestions for implementing such programs are described. Programmatic outcomes achieved in the first 3 years are also described.
In this study, the authors investigate the effects of efficacy and cooperativeness on willingness to adopt an innovation at the individual and nursing-unit levels. The results of a field report showed that efficacy was significantly associated with willingness to adopt an innovation at both the individual and nursing-unit levels, whereas cooperativeness was significant only at the individual level. These results suggest that examining innovation adoption at multiple levels provides more valid information than does examining it at a single level.
This paper discusses five innovative programmes in medical education with the view of giving a glimpse of the new approaches to the education of physicians. Each one of them has unique features and provides useful lessons. The School of Medicine, McMaster University, Hamilton (Canada), pioneered the use of interdisciplinary problem based learning. The programme obliterates the basic science and clinical science dichotomy, and involves self-directed, small group (tutorial) learning as the principal educational method. Faculty of Medicine, University of Sherbrooke (Canada) shows the way for introduction of innovative problem-based curriculum in a traditional medical school. The University Centre for Health Sciences, Ben Gurion University of the Negev, Beersheva (Israel), serves as the nodal point of the health care system in the region. Merging of the service and the educational systems has not only succeeded in better community orientation of graduates, but also in improving the health care availability in the region. The University of Philippines, College of Medicine, Institute of Health Sciences, Tacloban (Philippines), trains grassroot workers as well as physicians. Through a ladder-type curriculum, a health worker can rise to become a doctor of medicine. The Chulalongkorn University Medical School, Bangkok, Thailand, has successfully run a parallel innovative track for students of rural background. The students are identified from the underserved areas, and are given a large part of their clinical training at the provincial/district hospitals. The programme has succeeded in inculcating favourable attitudes towards working in rural areas, and in improving the care at provincial/district hospitals. These innovative programmes have emerged as role-models for bold experimentation in medical education.
Cryosurgery is the in situ ablation of a target tissue by application of extreme cold temperature. The ability of cryosurgery to ablate tissue is unquestioned. It is the controlled application of a cryoinjury in a manner to minimize morbidity that is problematic. Prostate cryosurgery is complicated by the proximity of the prostate to adjacent structures that are sensitive to a freeze injury, namely the urethra, rectal wall, and neurovascular bundles. Several recent technological advances have led to the development of an effective treatment protocol with acceptable morbidity. These include the advent of real-time transrectal ultrasound, cryomachines with almost instant freeze-thaw control through the use of the Joule-Thompson effect, and warming catheters to effectively preserve the integrity of the urethra and external sphincter. Further, temperature monitoring at the posterior margin of the prostate sometimes combined with an injection of saline solution into Denonvilliers fascia has reduced the occurrence of urethrorectal fistula formation to 0% to 0.5% in modern series. We review the key innovations of prostate cryosurgery that differentiate this state-of-the-art procedure from that used by early investigators to even that of the early 1990s. Potential future innovations, specifically related to image guidance of the procedure, are also addressed.
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As in the market in North America, major barriers to private investment in the development and production of vaccines exist for markets in developing countries. These include the risks of uncertain funding and demand and the difficulties created by historically low pricing. A number of promising and innovative approaches nonetheless are being explored to increase the incentives and reduce the risks of investing in vaccines for developing countries. These innovations are fueled by the growing recognition of powerful stakeholders that vaccines are a critical technology for ensuring global health.
Health care reform in the United States is on a collision course with economic reality. Most proposals focus on measures that will produce one-time cost savings by eliminating waste and inefficiency. But the right question to ask is how to achieve dramatic and sustained cost reductions over time. What will it take to foster entirely new approaches to disease prevention and treatment, whole new ways to deliver services, and more cost-effective facilities? The answer lies in the powerful lessons business has learned over the past two decades about the imperatives of competition. In industry after industry, the underlying dynamic is the same: competition compels companies to deliver constantly increasing value to customers. The fundamental driver of this continuous quality improvement and cost reduction is innovation. Without incentives to sustain innovation in health care, short-term cost savings will soon be overwhelmed by the desire to widen access, the growing health needs of an aging population, and the unwillingness of Americans to settle for anything less than the best treatments available. The misguided assumption underlying much of the debate about health care is that technology is the enemy. By assuming that technology drives up costs, reformers neglect the central importance of innovation or, worse yet, attempt to slow its pace. In fact, innovation, driven by rigorous competition, is the key to successful reform.
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This essay characterizes the nature of the technologically current dental office and identifies challenges to be overcome in accelerating the introduction of technology. These challenges include dentists' preference for serial introduction of incremental change, lack of a network for communicating information on technology, the dental market of small and independent offices that make it difficult for manufacturers to finance innovative products, and the need to integrate technological change in dental education.
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Our rapidly changing health care environment requires critical care nurses to develop creative and innovative approaches to patient care. Empowering and enabling these nurses are the only ways that health care institutions will be able to meet the challenges of the future. This article describes two examples of innovations that have contributed to cost containment within a coronary care unit.
Both federal and state governments have mandates to collect, analyze, and disseminate health care information. The federal government is the single largest payer for health care and health services research. Its agencies, the Healthcare Finance Administration (HCFA) and the Agency for Healthcare Policy Research (AHCPR) play a major role in shaping information strategies for all health care stakeholders. State governments are among those stakeholders and are fertile grounds for experimentation, change, and learning. Building effective federal-state partnerships and public-private partnerships can help foster innovation in health data collection and analysis, as well as identify new strategies for information dissemination.
Innovative surgical procedures in the office setting have increased in the practice of otolaryngology. Laser-assisted uvulopalatoplasty (LAUP), middle ear endoscopy, powered nasal surgery, and endoscopic lipodebridement are frequently performed in the office. This paper focuses on some innovative procedures, the office environment, safety guidelines, and emergency preparations required for successfully implementing office-based surgery.
What are physicians waiting for? What will it take to stimulate widespread adoption of Internet medical systems? How can health care leaders and physicians help the technology innovators and the executives of technology firms understand the components necessary to assure physician acceptance and utilization of new tools? (1) Don't underestimate the personal nature of a physician's practice. It really isn't a "business." (2) Most physicians are not Luddites; they are just extremely pragmatic and practical. (3) For the majority of physicians to adopt a new technology in their private office practice, it must address three major issues: money, hassle, and patient care. There are many obstacles to adopting the new technologies that are the result of physician training and expectations and the current models of payment and revenue generation. Some technological innovations are presented to physicians without sufficient respect for their knowledge of how medical practices really work. The benefits promised often don't match with the needs structure of the physicians. As a consequence, the cycle of diffusion of these new systems is extended and delayed.