Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Diffusion of Innovation”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 829 records · Page 46Linked to original sources

Accelerating acceptance.

Innovations are either accepted or rejected in large part because of their implementation--sometimes without regard to improvements over existing techniques. By understanding the dynamics of how innovations are adopted and by whom, physician executives will have insight into influencing others. All adopters are not created equal. They fall into five categories, beginning with those who embrace innovation, even seek it out. In any given organization, or the population in general, there are: (1) innovators (2.5 percent); (2) early adopters (13.5 percent); (3) early majority (34 percent); (4) late majority (34 percent); and (5) laggards (16 percent). As these categories imply, each group has specific personalities related to adopting innovations that can be identified and used to implement new policies and procedures. By identifying and encouraging innovators and early adopters to think outside the box and then gaining critical mass through the early majority, who also act as opinion leaders, organizations can accelerate the pace of adopting innovations. New processes are adopted when opinion leaders initiate new practices, whose results can be tangibly discerned by the majority of adopters.

Behavior↗

Should general practitioners purchase health care for their patients? The total purchasing experiment in Britain.

Until relatively recently, general practitioners (GPs) have been allowed to work independently, with no requirement to consider the resource implications of their referral and prescribing decisions. In order to align the interests of GPs with the overall objectives of health systems a number of countries have introduced primary care based capitation, funds pooling and budget holding either as experiments or as an overall policy. Are these experiments and policies likely to work? This paper presents evidence from the UK total purchasing experiment, which was the first major quasi-market development in the NHS to be independently evaluated from the outset. Total purchasing gave volunteer groups of practices freedom to purchase all hospital and community health services for their patients. The evidence suggests that whilst GPs have great potential as purchasers, they also have considerable limitations. The expectation that they will be able to improve the quality of patient experience of care, or to alter the use of resources, may not be generally realised. GP-based purchasing may be more appropriate where the task is to alter the balance or location of care between hospital and extramural settings. However, budgetary incentives are not 'magic potions' which have similar effects on behaviour wherever they are introduced. Holding budgets and having independent contracts, while important pre-requisites for being taken seriously in a quasi-market, were not sufficient for effective total purchasing. The paper concludes that health systems should not only value innovation and experimentation and encourage learning from evaluative research; they should also recognise the importance of supportive circumstances for any innovation to effect real and sustained change.

Budgets↗

Implementation of an innovation in the ophthalmic operating room: the Memory lens.

I have participated in the evolution of the cataract procedure for the last 23 years. This year, as nursing director for an eye surgery center, I was responsible for the implementation of a new prerolled intraocular lens: The Memory lens. I review 5 implementation strategies, which are: Be open to recently approved products Utilize all company resources Introduce, train, train, train Evaluate, review, review, review Enjoy the questions and attention from others considering the innovation The implementation of this innovation confirmed both my and the operating room staff's ability to change and reaffirmed their commitment to achieve the resultant patient benefits.

Cataract Extraction↗

The adoption of innovation in collective action organizations.

This study used a quantitative/qualitative methodology to explore how collective action organizations (CAOs) remain open to organizational change and innovation. It examined the adoption of inclusion--a recent innovation in the field of disabilities--by local chapters of The Arc Michigan (a disabilities CAO). We found considerable variability in the adoption of inclusion by local Arc chapters. This variability was significantly related to the ecology surrounding these chapters. Local Arc chapters that had adopted an inclusion philosophy had significantly different internal and external environments from those that had not adopted inclusion. Our qualitative findings make it clear, however, that innovative Arc chapters were not the passive recipients of these internal and external influences. These chapters were proactive players in defining and shaping the nature of their internal and external environments. Strategies that were related to a chapter's ability to remain open to innovation included (a) a change orientation, (b) a conscious philosophy or vision, (c) a proactive strategy for achieving chapter goals and overcoming barriers to change, (d) the creation of a supportive organizational network, and (e) avoidance of resource dependencies that required them to engage in activities that were inconsistent with the innovation. These findings provide a framework by which CAOs can maintain an openness to innovation and remain on the forefront of social change.

Child↗

Programme approach to managing informed commissioning.

The objective of this paper is to examine possible organizational reasons for why UK NHS commissioners have not adopted programme budgeting and marginal analysis (PBMA). This is despite increasing evidence of discontent with current commissioning and priority-setting processes, increasing research evidence demonstrating the potential of PBMA and support for the principles of PBMA. Two separate semistructured surveys of the views of commissioning decision-makers on the use of PBMA were carried out at Grampian Health Board and Newcastle & North Tyneside Health Authority. Twenty-nine decision-makers were interviewed. Both surveys found common barriers to implementation of PBMA, described by respondents as 'institutional inertia'. These were the reactive rather than proactive environment; the fear of 'unnecessary' explicitness; an aversion to unilateral innovation in the current NHS environment; and the demand for concrete evaluation evidence. It is concluded that these qualitative surveys have small samples and cannot claim to be representative. It may be significant that many issues were common to both surveys carried out separately in organizations. It is unlikely that NHS commissioning will independently adopt techniques such as PBMA, given the current commissioning environment and organizational structures. Implementation strategies and future research on such commissioning innovations may need to focus on institutions as well as the interventions.

Budgets↗

Commentary: obstacles to scientific discovery.

Over the last two centuries, obstacles to scientific discovery frequently have been encountered by visionary scientists. From Semmelweis to Marshall, many scientists have faced rigid and nonintellectual academic environments that refused to recognize innovative advances. Their heroic journeys should be a constant reminder to us to create an academic environment that fosters intellectual freedom.

Diffusion of Innovation↗

Most wired 2003.

A record number of health care organizations are represented in H&HN's fifth Most Wired Survey and Benchmarking Study. This year's survey reveals numerous trends in IT strategies among the 100 Most Wired, and the winners of the Innovator, Most Improved and Most Wireless awards. New this year: the Most Wired Small and Rural Award.

Awards and Prizes↗

Diffusion of new technologies: rational and irrational.

The diffusion of medical technology, the process by which new clinical procedures and devices come into use in the health care system, is an historical topic, as old as medicine itself. Hospitals, physicians, manufacturers, third-party payers, and patients all are factors in the demand for, and adoption and diffusion of, new medical technologies. The federal government also plays a role both in furthering technology diffusion through federally financed health programs and in attempting to control diffusion by stimulating state certificate of need and other regulatory programs. The history of the CT scanner's diffusion illustrates the problems that can result from the lack of a coherent strategy to control the diffusion of major medical technologies. Some of these same problems are now appearing in the diffusion of magnetic resonance imaging (MRI) devices. In the current health care environment, prospective payment and the continuing period of remarkable technological innovation are major influences on technology diffusion and on initiatives for technology assessment. The diffusion of technology can be made more rational by instituting a formal process to identify technologies (both old and new) that require assessment, by financial support for assessment efforts, by selective reimbursement for clinical trials, and by regionalization of costly procedures.

Certificate of Need↗

Patterns of preference for information sources in the adoption of new drugs by specialists.

The present study investigated the adoption of new prescription drugs by specialists who treat serious disorders using relatively high risk drugs with potentially serious side effects. One-hundred and fifty-six specialists, primarily practicing in medical specialties, evaluated a number of drug information sources and reported their use of these sources both in their general drug adoption procedures and in the adoption of one of a number of target drugs. As predicted, the pattern of drug adoption among specialists is substantially different from that generally reported in earlier studies, which are usually based on samples of general practitioners or of general practitioners and specialists combined. Professional sources of information predominate throughout the process, both in adoption procedures generally used and in the adoption of target drugs. The majority of specialists reported contact with commercial sources at some stage in the adoption process for the target drugs, but these sources were not, as is often reported in the literature, the main sources of first news of a new drug, nor did they exert much influence at the prescribing stage. It is clear from these results that in future research on drug innovation, different classes of medical practitioners, such as specialists vs general practitioners, will need to be distinguished.

Attitude of Health Personnel↗

Long-term implementation of the teenage health teaching modules by trained teachers: a case study.

This evaluation addressed long-term implementation of the Teenage Health Teaching Modules (THTM) by trained teachers in Indiana. Structured random sample telephone interviews and cross-sectional written surveys determined the extent to which teachers implemented THTM and factors related to its implementation. Although most schools and teachers continued to use THTM, many teachers failed to maintain implementation fidelity. Barriers to THTM implementation included insufficient time for health instruction, reassignment of THTM teachers to other instructional areas, and the need for revised middle school modules. ANOVA and Mann-Whitney U tests revealed more favorable THTM perceptions and implementation practices among teachers without implementation difficulties and among teachers who intended to attend a reconvening workshop. Evaluation of the long-term implementation of THTM revealed the impact of environmental barriers on the use of innovative health education curricula by trained teachers.

Adolescent↗

Telemedicine: a new health care delivery system.

The resurgence of telemedicine can be attributed to its potential for addressing intransigent problems in health care, including limited accessibility, cost inflation, and uneven quality. After discussing definitions and the genesis of telemedicine, this review focuses on conceptual issues and an assessment of past research. The scope and methodological rigor necessary for sustained development and policy making have been limited in this area of research, owing to the nature of extant telemedicine projects and the lack of a comprehensive research strategy that specifies the objectives of telemedicine research regarding accessibility, cost, and quality. Research strategies and a framework for analysis are discussed. Without a commitment to the types of research objectives, framework, and strategy presented here, the considerable promise of telemedicine, as an innovative system of care, may not be fully realized.

Cost Control↗

Institutional and economic influences on the adoption and extensiveness of managerial innovation in hospitals: The case of reengineering.

In the recent past, a number of managerial innovations--including product line management, total quality management, and reengineering--have swept through the hospital industry. Given their pervasiveness and their cost, understanding the mix of factors that influences their adoption is of theoretical interest and practical relevance. The research reported here focuses on this general question by examining influences on the adoption and extensiveness of a particular managerial innovation, hospital reengineering. The results suggest that while economic and institutional factors have influenced the adoption and extensiveness of hospital reengineering, institutional forces play a more important role. The greater influence of institutional forces may be attributed to the high degree of uncertainty in health care, the causal ambiguity of the innovation, and the anticipatory actions of hospitals attempting to position themselves in a rapidly changing environment.

Decision Making, Organizational↗

Harnessing the power of new technologies.

So far, the human experience comprises about 40,000 years--a period, as the historian Arthur Schlesinger points out, of approximately 800 generations. One of the most striking realities of our collective experience is that the development of what we would consider new technologies has all been essentially within the most recent 10 or so generations. Not surprisingly, the speed and scope of technological innovation has led to struggles in learning to understand and then harness the capabilities we have developed and will continue to develop.

Computer Communication Networks↗

[The economic and sociomedical efficiency of innovations in the practice of health protection].

The article discusses techniques for assessing the economic and medico-social efficiency of innovations introduced into health care practice starting from the example of a new procedure (prodigiosin inhalations) in prevention of ENT disorders and of influenza in preschool children. The analysis bears on the role and importance of evaluations of this type in the implementation of scientific findings, as well as in restructuring the health care sector and reorienting biomedical research. The authors contend that the expanding area of innovation use does not trigger more than insignificant rises in costs (costs allocated to scientific research, for instance), whereas cost containment is almost directly proportional to the expanding applications. It can, therefore, be concluded that imposing limitations and delays in the implementation of efficient innovations bars cost savings and diminishes the actual economic efficiency of biomedical research.

Child, Preschool↗

Community psychology into the 1990s: capitalizing opportunity and promoting innovation.

Political and social changes during the last decade and their implications for community psychology research and practice are discussed. Shifting responsibility for social problems, economic considerations, and levels of citizen concern and involvement in community problem solution are considered stimuli for new opportunities for innovation and change. The discipline is challenged to renew efforts in the promotion of innovation and to develop and disseminate interventions that result in modification in the role relationships characterizing the ecology of social problems.

Communication↗

Introducing a complex health innovation--primary health care reforms in Estonia (multimethods evaluation).

All post-Soviet countries are trying to reform their primary health care (PHC) systems. The success to date has been uneven. We evaluated PHC reforms in Estonia, using multimethods evaluation: comprising retrospective analysis of routine health service data from Estonian Health Insurance Fund and health-related surveys; documentary analysis of policy reports, laws and regulations; key informant interviews. We analysed changes in organisational structure, regulations, financing and service provision in Estonian PHC system as well as key informant perceptions on factors influencing introduction of reforms. Estonia has successfully implemented and scaled-up multifaceted PHC reforms, including new organisational structures, user choice of family physicians (FPs), new payment methods, specialist training for family medicine, service contracts for FPs, broadened scope of services and evidence-based guidelines. These changes have been institutionalised. PHC effectiveness has been enhanced, as evidenced by improved management of key chronic conditions by FPs in PHC setting and reduced hospital admissions for these conditions. Introduction of PHC reforms - a complex innovation - was enhanced by strong leadership, good co-ordination between policy and operational level, practical approach to implementation emphasizing simplicity of interventions to be easily understood by potential adopters, an encircling strategy to roll-out which avoided direct confrontations with narrow specialists and opposing stakeholders in capital Tallinn, careful change-management strategy to avoid health reforms being politicized too early in the process, and early investment in training to establish a critical mass of health professionals to enable rapid operationalisation of policies. Most importantly, a multifaceted and coordinated approach to reform - with changes in laws; organisational restructuring; modifications to financing and provider payment systems; creation of incentives to enhance service innovations; investment in human resource development - was critical to the reform success.

Attitude of Health Personnel↗

The decision to adopt evidence-based and other innovative mental health practices: risky business?

OBJECTIVE: A risk-based decision-making framework was used to examine the decision to adopt innovative mental health practices, including both evidence-based and other research-guided practices. METHODS: Seventy-eight projects involving decisions to adopt one of four innovative mental health practices were the focus of this study. Key informants with direct knowledge about the adoption decision provided data for hypothesis testing. RESULTS: As predicted, the propensity to adopt an innovative practice-as measured by decision stage-was negatively related to the perceived risk of adopting the practice, positively related to expected capacity to manage risk, and positively related to an organization's past propensity to take risks. Further, perceived risk, anticipated resource availability, and exposure to field-based evidence explained a substantial part of what differentiated adopters from nonadopters. Finally, several features of innovations known to influence innovation adoption decisions were found to be related in expected ways to perceived risk, capacity to manage risk, and risk propensity. CONCLUSIONS: This research supports the view that the decision to adopt an innovative mental health practice is a decision made in consideration of risk. Contrary to popular views that early adopters of innovations are willing to take enormous risks, these data offer the novel idea that early adopters act because they see the risks associated with adopting as lower than their nonadopter counterparts, partly because the risks are seen as more manageable. Implications of results are discussed for organizations considering adoption of innovative health care practices and for state or local mental health authorities hoping for a higher level of adoption in their areas.

Decision Making↗