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PubMed2001

Telepathology overview: from concept to implementation.

Telepathology is the practice of pathology at a distance by using video imaging and telecommunications. Significant progress has been made in telepathology. To date, 12 classes of telepathology systems have been engineered. Rapid and ultrarapid virtual slide processors may further expand the range of telepathology applications. Next-generation digital imaging light microscopes, such as miniaturized microscope arrays (MMA), may make virtual slide processing a routine laboratory tool. Diagnostic accuracy of telepathology is comparable with that of conventional light microscopy for most diagnoses. Current telepathology applications include intraoperative frozen sections services, routine surgical pathology services, second opinions, and subspecialty consultations. Three telepathology practice models are discussed: the subspecialty practice (SSP) model; the case triage practice (CTP) model; and the virtual group practice (VGP) model. Human factors influence performance with telepathology. Experience with 500 telepathology cases from multiple organs significantly reduces the video viewing time per case (P < .01). Many technology innovations can be represented as S-curves. After long incubation periods, technology use and/or efficiency may accelerate. Telepathology appears to be following an S-curve for a technical innovation.

Diffusion of Innovation↗
PubMedDate not supplied

The contingencies of organizational learning in long-term care: factors that affect innovation adoption.

We apply the theoretical frameworks of knowledge transfer and organizational learning, and findings from studies of clinical practice guideline (CPG) implementation in health care, to develop a contingency model of innovation adoption in long-term care (LTC) facilities. Our focus is on a particular type of innovation, CPGs designed to improve the quality of LTC. Our interest in this area is founded on the premise that the ability of LTC organizations to adopt and sustain the use of innovations like CPGs is contingent on the initial capacity these institutions have to learn about them, and on the presence of factors that contribute to capacity building at each stage of innovation adoption. Based on our review of relevant theory, we develop a set of fifteen testable propositions that relate factors operating at the guideline, individual, organizational, and environmental levels in LTC institutions to stages of guideline adoption/transfer. Our model offers insights into the complexities of adopting and sustaining innovations in LTC facilities particularly, in health care organizations specifically, and in service organizations generally.

Diffusion of Innovation↗
PubMed1982

Managerial innovation and health policy: theoretical perspectives and research implications.

Stimulated by a variety of external pressures, managerial innovation is likely to become more common in health care organizations. Relatively little is known, however, about the phenomenon. This paper develops a framework for the analysis of managerial innovation in health care organizations, based on the premise that control is at the heart of effective managerial practice. Physician control over the production process in health care is likely to be increasingly challenged, partially as a consequence of the ascendency of managerial ideology. Opportunities for managerial innovation will be created, but are likely to be successful only to the extent that physician expertise is incorporated into rather than excluded from the resulting changes.

Communication↗
PubMedDate not supplied

Telemedicine, hospital viability, and community embeddedness: a case study.

Many hospitals today struggle to remain competitive through the adoption of medical technology or expansion of hospital services. This article presents a case study of one hospital's attempt to remain viable through the adoption of telemedicine. Through a 17-year analysis of local hospital-related news reports, it is argued that a hospital's relationship to the local community can affect the success and potential of such innovations. Establishing a pattern of trust and support between the local community and hospital should therefore be an important step in increasing hospital viability.

Community-Institutional Relations↗
PubMed1992

Cancer at the crossroads.

A number of elements are transforming cancer care in hospitals. First is ongoing, rapid technological advance: Experts contend that biotechnology therapies will shift the site of cancer treatment from external, systemic treatments like radiation and chemotherapy, to targeted, tumor-specific drugs that boost the immune system. That change alone holds many implications for oncology management. In addition, an aging population, longer cancer survival rates, reimbursement concerns, and the increasing involvement of patients and their families in treatment decision making, will all have an impact on the way cancer care is designed and delivered. The time to plan, say experts, is now. Meanwhile, innovative treatment plans, patient care approaches, and collaborative efforts among institutions are moving hospital oncology into the 1990s in a dramatic way.

Biotechnology↗
PubMed1990

Innovations in emergency medical services systems.

This article roughly follows the chronology of an EMS call and discusses innovations in prehospital care, including epidemiology and prevention; precall management (system status management and flexible response); intervention during the call (emergency medicine dispatch); finding the scene; and communications.

Computers↗
PubMed2002

Peer review and innovation.

Two important aspects of the relationship between peer review and innovation includes the acceptance of articles for publication in journals and the assessment of applications for grants for the funding of research work. While there are well-known examples of the rejection by journals of first choice of many papers that have radically changed the way we think about the world outside ourselves, such papers do get published eventually, however tortuous the process required. With grant applications the situation differs in that the refusal of a grant necessarily curtails the possible research that may be attempted. Here there are many reasons for conservatism and reservation as to the ability of a grant allocation process based on peer review to deliver truly innovative investigations. Other methods are needed; although such methods need not be applied across the board, they should constitute the methods whereby some 10-20% of the grant monies are assigned. The nomination of prizes for specific accomplishments is one way of achieving innovation although this presumes that investigators or institution already have available the money necessary to effect the innovations; otherwise it is a question of the selection and funding of particular individuals or institutions and requiring them to solve particular problems that are set in the broadest of terms.

Diffusion of Innovation↗
PubMed2006

Developing a paradigm of drug innovation: an evaluation algorithm.

Assessment of drug innovation is a burning issue because it involves so many different perspectives, mainly those of patients, decision- and policy-makers, regulatory authorities and pharmaceutical companies. Moreover, the innovative value of a new medicine is usually an intrinsic property of the compound, but it also depends on the specific context in which the medicine is introduced and the availability of other medicines for treating the same clinical condition. Thus, a model designed to assess drug innovation should be able to capture the intrinsic properties of a compound (which usually emerge during R&D) and/or modification of its innovative value with time. Here we describe the innovation assessment algorithm (IAA), a simulation model for assessing drug innovation. IAA provides a score of drug innovation by assessing information generated during both the pre-marketing and the post-marketing authorization phase.

Algorithms↗
PubMed1994

Using clinical innovations for research-based practice.

Making choices about patient-care interventions pervades critical care nursing practice. Research utilization activities provide the reasoning by which assessment parameters are established, preventative actions are identified, and interventions are evaluated in the clinical setting for positive effects on patient outcomes. For research results to be directly applicable, they must be transformed into clinical innovations specific to a patient population, clinical situation, or institutional setting. A brief summary of using research findings to design clinical innovations is provided. Examples of selected clinical innovations are included to illustrate the steps of the research utilization process. Clinical innovations are intended to improve or validate patient outcomes and are considered the key to quality patient care.

Clinical Nursing Research↗
PubMedDate not supplied

A new national framework for mental health.

Last year's review of mental health care heralded innovative changes to services for people with mental health problems. But Steve Wood argues that the opportunity to provide adequate care for people with long-term problems has again been missed.

Diffusion of Innovation↗
PubMed1998

Funding information technology: a missed market.

Information technology is driving business and industry into the future. This is the essence of reengineering, process innovation, downsizing, etc. Non-profits, schools, libraries, etc. need to follow or risk efficiency. However, to get their fair share of information technology, they need to help with funding.

Capital Expenditures↗
PubMed1980

What makes a board innovative?

A study of 20 community hospital boards suggests that boards of trustees whose members represent a wide variety of occupational backgrounds are more likely to be innovative and to initiate new programs and services than are more homogeneous boards. The innovative hospital boards also had more women and minority group members, more members under 50, and moe members who lived in their hospital's primary service area.

Communication↗
PubMedDate not supplied

The timing of medical technology acquisition: strategic decision making in turbulent environments.

Healthcare decision makers and researchers have long been interested in the factors behind medical technology acquisition. The rate of environmental change in recent years has dramatically affected technology acquisition decision making in acute care hospitals. This study examines the relative role of decision-maker influence and environmental factors on the timing of MRI acquisition in hospitals operating in three western states with different levels of environmental uncertainty. The results suggest that the relative influence of decision makers and environmental factors on innovation acquisition timing varies depending on environmental turbulence, and that hospitals acquire new technology as one way of controlling the turbulence in their environments.

California↗
PubMedDate not supplied

Will disruptive innovations cure health care?

It's no secret that health care delivery is convoluted, expensive, and often deeply dissatisfying to consumers. But what is less obvious is that a way out of this crisis exists. Simpler alternatives to expensive care are already here--everything from $5 eyeglasses that people can use to correct their own vision to angioplasty instead of open-heart surgery. Just as the PC replaced the mainframe and the telephone replaced the telegraph operator, disruptive innovations are changing the landscape of health care. Nurse practitioners, general practitioners, and even patients can do things in less-expensive, decentralized settings that could once be performed only by expensive specialists in centralized, inconvenient locations. But established institutions--teaching hospitals, medical schools, insurance companies, and managed care facilities--are fighting these innovations tooth and nail. Instead of embracing change, they're turning the thumbscrews on their old processes--laying off workers, delaying payments, merging, and adding layers of overhead workers. Not only is this at the root of consumer dissatisfaction with the present system, it sows the seeds of its own destruction. The history of disruptive innovations tells us that incumbent institutions will be replaced with ones whose business models are appropriate to the new technologies and markets. Instead of working to preserve the existing systems, regulators, physicians, and pharmaceutical companies need to ask how they can enable more disruptive innovations to emerge. If the natural process of disruption is allowed to proceed, the result will be higher quality, lower cost, more convenient health care for everyone.

Diffusion of Innovation↗
PubMed2006

Factors affecting innovation in pediatric surgery: hospital type and appendectomies.

BACKGROUND: There are little data on whether patient or hospital characteristics affect utilization of innovative surgical techniques in children, especially with respect to laparoscopic appendectomy (LA), whose benefit over existing treatment remains unproven. This study examines the patterns of LA using a national database, focusing on variations in care between children's and general hospitals. METHODS: Using data from the 2000 Healthcare Costs and Utilization Project Kid's Inpatient Database for patients aged 5 to 20 years with a discharge diagnosis of appendectomy, we analyzed the relationship between LA and patient demographic and hospital characteristic variables. RESULTS: The Healthcare Costs and Utilization Project Kid's Inpatient Database included 50,825 pediatric appendectomies (26% LA) representing 97,205 cases in the nation. Children's hospitals and children's units were significantly more likely to provide LA (36% and 28%, respectively) than general hospitals (25%). Higher LA rates were also associated with greater patient age, female sex, nonperforated appendicitis, private insurance, and white patient race. The children's hospital effect compared to general hospitals (adjusted odds ratio, 2.11; 95% confidence interval, 1.88-2.38) and all other relationships remained significant in the multivariate model. CONCLUSION: Utilization of LA is significantly higher in children's hospitals. Children's hospitals appear more likely to adopt innovative surgical procedures, such as LA, even when clear benefit over standard treatment has not yet emerged.

Adolescent↗
PubMed2006

[Health research in Brazil: context and challenges].

The deficiencies in Brazilian science and technology policies with regard to the challenges of the twenty-first century are discussed, while acknowledging that these policies have in some respects been very successful. The importance of health research within the framework of general endeavors in science, technology and innovation in this country is also demonstrated. The distribution of research around the world is then summarized, and a specific position is claimed for Brazil, along with some other countries, within the global panorama. Some elements needed for maturation of the sectoral system for health innovation are discussed. Finally, the need for the presence of the Ministry of Health within the panorama of health research, for this maturation process to take place adequately, is discussed.

Biomedical Research↗
PubMed2005

Children's nursing in Ireland: barriers to, and facilitators of, research utilisation.

A random sample of 200 RSCNs on the An Bord Altranais Live Register Nurses were surveyed in this study that aimed to provide a better understanding of barriers to, and facilitators of, research utilisation among RSCNs in the Republic of Ireland. The data collection instrument was a questionnaire 1 using the Barriers Scale (Funk et al I991), adapted from the Conduct and Utilisation of Research in Nursing (CURN) Project Research Utilisation Questionnaire (Crane et al 1977). The scale consists of structured items that measure barriers to research utilisation under four headings; the adopter (RSCN)--eight variiables; the organisation (setting)--eight variables; the innovation (research utilisation)--six variables; and communication (presentation)--six variables. The most frequently cited barrier was lack of time to implement new ideas. All eight characteristics of the organisation feature in the ten highest barriers, with characteristics of adopter and innovation ranking among the five lowest barriers. No significant impact of demographic detail was noted for respondents in relation to each of the subscales.

Adult↗