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PubMed1981

Implementing comprehensive health education: educational innovations and social change.

The effectiveness of health education is ultimately determined by whether it is implemented, and how it is implemented. Although a given health education innovation may be designed and experimentally assessed to promote well-being with some measure of effectiveness and efficiency, the actual impact of the innovation will depend upon the manner in which it is disseminated, initiated, and maintained. The implementation of health education programs in schools or elsewhere is a function of the types of innovations available, certain characteristics of those innovations that influence their use, and the manner in which the innovations are brought into practice. This paper has been prepared to review, synthesize, and apply current and relevant information about educational innovations and social change to provide a conceptual base for the design, execution, and analysis of efforts to implement health education in schools. The American system of public and private schools could be an agent vitally important to the realization of a second public health revolution. Indeed, in a democratic society, the implementation of health education in schools seems a condition necessary for such a revolution. By analyzing and learning from our own health education efforts, as well as the efforts of those experienced with implementing other types of educational innovations in schools, we might ensure that future populations are informed sufficiently about factors that influence their health and well-being.

Adolescent↗
PubMed1986

Coexistence, conflict, and cooperation: public policies toward medical devices.

Medical devices include thousands of products, many of which have greatly contributed to the quality of health care. As devices have proliferated, so have public policies that affect them. The federal government intervened to promote three fundamental values: safety by federal regulation, innovation through federal funding of research and development, and access by providing services under Medicare. The policies generally coexisted without conflict. However, two recent developments--the advent of cost containment and the expansion of the tort liability system--present a potentially disruptive influence on these policies, and threaten to undermine the values they serve. Because cost restraints are inevitable and the tort system provides consumer protection, the challenge for policymakers is to reconcile them with the values of safety, innovation, and access. The proposals presented here seek to promote coordination to protect those values without imposing unacceptable costs on the health care system.

Cost Control↗
PubMedDate not supplied

Nursing management innovations: a need for systematic evaluation.

While emphasis in nursing is placed on research on clinical interventions, there has been little attention to the equally important management interventions. The concept of a management intervention or innovation is introduced here and five types of management innovations in nursing are identified. An overview of the research base for four of the innovations demonstrates the need for systematic evaluation.

Diffusion of Innovation↗
PubMed1989

Differences in the approaches of the doctor, manager, politician and social scientist in health care controversies--hospital case-mix management methods: an illustration of the manager's approach in health care controversies.

Resource allocation methods in health care are one of the major sources of controversies between managers, doctors, politicians and social scientists. In the past 10 years, an important innovation has appeared in hospital management and payment methods: case based systems, the most well known being the Diagnostic Related Group (DRG), that have been used for 5 years by Medicare in the U.S.A. to pay for hospital care. Through the analysis of the diffusion of DRGs in the U.S.A. and in France, we support the idea that DRGs are a typical illustration of the managerial approach to health care. They represent a significant breach in professional autonomy through the introduction of bureaucratic rationality. We also show how scientific controversies are structured by the dynamics of the diffusion of case based management systems.

Analysis of Variance↗
PubMed1999

Ethical problems in surgery: innovation leading to unforeseen complications.

A hypothetical case that involves a surgical innovation is used to illustrate three ethical issues in surgery: the profound trust that vulnerable patients feel toward their surgeons, even when they innovate; the disequilibrating effect of new procedures on traditional safeguards of surgical competence; and the need for a systematic approach to the evaluation of new surgical procedures.

Diffusion of Innovation↗
PubMed2005

Towards a wireless patient: chronic illness, scarce care and technological innovation in the United Kingdom.

'Modernization' is a key health policy objective in the UK. It extends across a range of public service delivery and organizational contexts, and also means there are radical changes in perspective on professional behaviour and practice. New information and communications technologies have been seen as one of the key mechanisms by which these changes can be engendered. In particular, massive investment in information technologies promises the rapid distribution and deployment of patient-centred information across internal organizational boundaries. While the National Health Service (NHS) sits on the edge of a pound sterling 6 billion investment in electronic patient records, other technologies find their status as innovative vehicles for professional behaviour change and service delivery in question. In this paper, we consider the ways that telemedicine and telehealthcare systems have been constructed first as a field of technological innovation, and more recently, as management solutions to problems around the distribution of health care. We use NHS responses to chronic illness as a medium for understanding these shifts. In particular, we draw attention to the shifting definitions of 'innovation' and to the ways that these shifts define a move away from notions of technological advance towards management control.

Chronic Disease↗
PubMedDate not supplied

Care of the elderly as a global nursing issue.

The size of the world's elderly population is growing at a rapid rate, with the 60 and older population of Europe and North America outpacing total population growth in recent decades. As life expectancy lengthens, the quality of that life becomes an issue of importance to nursing practitioners and nursing educators. Developed countries and developing countries will be faced with different challenges when determining service delivery models for their aging populations. Innovation in delivery models and comprehensive and longitudinal data are needed if the goal of aging in place is to be achieved.

Aged↗
PubMed2000

From theory to practice: community health nursing in a public health neighborhood team.

An interdisciplinary team in a local public health district tested its ability to implement the core public health functions of assessment, policy development, and assurance by changing its practice to a community-driven model of building partnerships for health with groups and communities in a designated locale. Evaluation of this innovation revealed that the public health nurse members of the team enacted their community health nursing knowledge to strengthen agency to cocreate health. Interdisciplinary collaboration was essential to the team's community mobilization efforts. Additional findings suggested that this organizational innovation was associated with developing a more participatory organizational climate, increasing system effectiveness, and building community capacity.

Community Health Nursing↗
PubMedDate not supplied

Knowledge utilization among experienced staff nurses.

The purpose of this descriptive exploratory study was to describe the processes staff nurses use to select and transfer new knowledge to practice. Eleven experienced staff nurses shared 29 examples in which gaining new knowledge resulted in changes in thinking or acting in a clinical situation. Findings indicated that knowledge utilization originated with the nurse who was active in selecting and using new knowledge. Nurses used multiple knowledge utilization processes primarily involving factual knowledge and instrumental utilization. Often, the decision to move knowledge to practice was based on comparison by similarity. There were no variations in utilization processes as nurses floated across units. Sources of new knowledge were primarily informal and unit based. Implications for staff development focus on developing unit-based resources and resource personnel, using innovative ways to introduce new knowledge on the unit, and providing time in formal classes for exchange of ideas on using new knowledge in practice.

Clinical Competence↗
PubMed2002

Quality collaboratives: lessons from research.

Quality improvement collaboratives are increasingly being used in many countries to achieve rapid improvements in health care. However, there is little independent evidence that they are more cost effective than other methods, and little knowledge about how they could be made more effective. A number of systematic evaluations are being performed by researchers in North America, the UK, and Sweden. This paper presents the shared ideas from two meetings of these researchers. The evidence to date is that some collaboratives have stimulated improvements in patient care and organisational performance, but there are significant differences between collaboratives and teams. The researchers agreed on the possible reasons why some were less successful than others, and identified 10 challenges which organisers and teams need to address to achieve improvement. In the absence of more conclusive evidence, these guidelines are likely to be useful for collaborative organisers, teams and their managers and may also contribute to further research into collaboratives and the spread of innovations in health care.

Cooperative Behavior↗
PubMed2003

A better way to innovate.

Harvard professor Henry Chesbrough takes a look at leading-edge companies' latest moves to harvest ideas from outside and to benefit from sharing their own R&D with others--even with competitors.

Commerce↗
PubMed2004

Translating research into practice: speeding the adoption of innovative health care programs.

For this study, the authors conducted case studies of four varied clinical programs to learn key factors influencing the diffusion and adoption of evidence-based innovations in health care. They found that the success and speed of the adoption/diffusion process depend on: the roles of senior management and clinical leadership; the generation of credible supportive data; an infrastructure dedicated to translating the innovation from research into practice; the extent to which changes in organizational culture are required; and the amount of coordination needed across departments or disciplines. The translation process also depends on the characteristics and resources of the adopting organization, and on the degree to which people believe that the innovation responds to immediate and significant pressures in their environment.

Decision Making, Organizational↗
PubMed1998

The nursing organization and the transformation of health care delivery for the 21st century.

Market transformations occurring within the health care industry require new patterns of organization and management to meet the increasing complexity of service delivery. A greater understanding of the innovation and entrepreneurial dynamic allows administrators, managers, and leaders to create a new vision of service delivery. Central management and leadership objectives include the development of service technologies that capitalize upon the inherent knowledge of workers to meet consumer needs. A strong sense of innovation and entrepreneurship leading to the introduction of new or improved nursing technologies is a primary component in the evolution of professional nursing practice for the 21st century.

Diffusion of Innovation↗
PubMed2004

What can rural agencies do to address the additional costs of rural services? A typology of rural service innovation.

There is a national commitment to ensuring that, regardless of where patients live, they should be provided with an acceptable level of service in terms of quality, effectiveness and accessibility. Because of differences in the distributions of their populations, rural and urban areas present quite different challenges for the optimal design of health services and social care. However, this has not been fully acknowledged in the development of national policies to unify service standards. The problems of providing services in sparsely populated areas are not new. However, until the case for a rural premium in English health resource allocation is accepted, rural agencies must either tolerate lower levels of services (an option made difficult by the introduction of national service standards) or develop very different approaches to service delivery. To date, there has been little systematic knowledge about the extent of innovative rural practice, a paucity of evaluation of such initiatives and few opportunities to disseminate learning from one area to another. The present paper begins to address this deficit. Drawing upon a review of the formal literature and a comprehensive evaluation of projects developed within a rural Health Action Zone, it presents a typology of innovative responses at the health/social care interface. Examples of service innovations which fall into six broad categories are provided. These not only suggest possibilities for the transfer of good practice, but also the potential for future research.

Diffusion of Innovation↗
PubMed1988

Prospective payment assessment commission. A commissioner's perspective.

The function and priorities of the Prospective Payment Assessment Commission (ProPAC) are discussed. The ProPAC's priorities include (1) safeguarding the quality of care; (2) encouraging hospital productivity and long-term cost-effectiveness; (3) facilitating innovation and appropriate technological change; (4) maintaining stability for providers, consumers, and other payers; and (5) making decisions based on reliable, timely data and information.

Cost-Benefit Analysis↗
PubMed1995

Innovation and the role of the change agent.

The implementation of change is a complex process, which requires a collaborative approach. Change agents need the flexibility to alter their role to suit local circumstances.

Clinical Nursing Research↗
PubMed1997

How Canadian radiologists adopt innovations: a survey.

BACKGROUND AND OBJECTIVE: Innovations and practice changes occur frequently in modern radiologic practice. In this study the authors sought to understand the process of adopting an innovation and to define the characteristics of some innovations and the effect of these characteristics on innovation adoption. METHODS: An anonymous mail survey of the membership of the Canadian Association of Radiologists was undertaken to obtain details about the process of adopting an innovation. Information on the perceived characteristics of the innovation was obtained, as well as the perception of change in practice. RESULTS: The survey was sent to 1005 radiologists and was returned by 372 (37.0%), of whom 278 gave information on an innovation adopted in the preceding year. The respondents reported heavy use of textual and other material resources throughout the process of innovation adoption, as well as consultation with colleagues. Continuing medical education (CME) events, in comparison, were little used as information sources. Compatibility of the innovation with current practice and a relative clinical advantage over existing practices were the most important characteristics of the innovations adopted. The complexity, relative financial gain and ability to try the innovation were all less important. CONCLUSIONS: This study confirms a high rate of change in radiologic practice and documents the number and variety of learning resources used in the adoption of change. It is important for CME providers and educators to recognize the relatively low use of CME events in the process of change. Characterization of the innovations indicates concern with the clinical impact of the change and the individual physician's ability to accomplish the change within his or her practice.

Canada↗