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The authors report on innovative approaches to the organization of health services and the delivery of patient care in 19 U.S. hospitals and hospital networks. Strengthening patient care is the focus of this initiative. Hospital-wide interdisciplinary planning and the subsequent trial of new human service technologies are explored.
Increasing interest in linking high-quality and cost-effective clinical practice processes to patient outcomes has enhanced interest in computerizing clinical practice guidelines to support clinician decision making. This article describes a Clinical Information Technology Innovation Model (CITIM) that was used to assess health care setting readiness for a clinical decision support system (CDSS) to decrease innovation risk and enhance the potential for innovation success. A case illustration shows CITIM application in the assessment of a hospital's readiness for a computerized knowledge-based system to support RN acute pain management decision making with patients who had coronary artery bypass graft surgery.
Lower limb orthotics is in the process of a default transformation because of its association with lower limb prosthetics, a mechanical discipline that has translated component and material innovations into balance and velocity function gains to achieve a level of ambulation not possible a generation ago. This article discusses the fundamental mechanical similarities and differences of lower limb orthotics to prosthetics and their application to orthoses designed to improve the gait outcome of patients requiring orthotic intervention.
This article describes the methods that one academic nursing unit used to move from receiving no National Institutes of Health funding to a top-20 ranking. A 1995 school task force recommended changes to move toward greater research productivity, including increased external funding. The school created a research infrastructure to support both the scientific development of research studies and the production of high-quality external grant applications. Barriers to research productivity were successfully managed. The research culture dramatically changed to emphasize innovation, autonomy, peer support and review, long-term investment in research productivity, penetration of research throughout school activities, and public display of research accomplishments. Academic nursing units can develop research cultures to support meaningful research that secures major external funding.
Technical innovations have enormous potential for enhancing the lives of people with disabilities, often providing means for substantial independence and contributing to their dignity. This paper uses a framework related to the personal needs of individuals throughout the hours of waking and rest. Examples of various potentialities are provided and discussed.
Storytelling and innovative organizational structures are distinct but complementary approaches to tackling the problem of providing evidence-based healthcare in hospitals. Both appear to have a great deal of merit. In this paper I have used storytelling as a method to expose and analyze three messages in the paper by Browman and colleagues: 1) it is possible to create a negotiating environment by changing the formal decision-making structure; 2) evidence-based healthcare costs more money; and 3) allowing a trial period for an innovation increases the likelihood that it will be adopted. Two major challenges are, first, to ensure that evidence-based healthcare is valued within both the informal and formal organization; and second, to actively involve the most important stakeholders--patients--at all levels of policy setting in hospitals.
The past 20-25 years have seen innovations in equipment and drugs that have allowed infusion services to move from institutions to the home. The home care industry moved into the HDIT field, considering this a natural direction in which to develop. High-tech home care is now a substantial aspect of the industry.
Identifying which business ideas have real commercial potential is fraught with uncertainty, and even the most admired companies have stumbled. It's not as if they don't know what the challenges of innovation are. A new product has to offer customers exceptional utility at an attractive price, and the company must be able to deliver it at a tidy profit. But the uncertainties surrounding innovation are so great that even the most insightful managers have a hard time evaluating the commercial readiness of new business ideas. In this article, W. Chan Kim and Renée Mauborgne introduce three tools that managers can use to help strip away some of that uncertainty. The first tool, "the buyer utility map," indicates how likely it is that customers will be attracted to a new business idea. The second, "the price corridor of the mass," identifies what price will unlock the greatest number of customers. And the third tool, "the business model guide," offers a framework for figuring out whether and how a company can profitably deliver the new idea at the targeted price. Applying the tools, though, is not the end of the story. Many innovations have to overcome adoption hurdles--strong resistance from stakeholders inside and outside the company. Often overlooked in the planning process, adoption hurdles can make or break the commercial viability of even the most powerful new ideas. The authors conclude by discussing how managers can head off negative reactions from stakeholders.
BACKGROUND AND OBJECTIVES: The Undergraduate Medical Education for the 21st Century (UME-21) project developed and implemented innovations to medical school curricula at medical schools across the country. This report describes the development and implementation of innovative approaches to improving instruction in evidence-based medicine with a population-based perspective. METHODS: Each school participating in the UME-21 project designed, implemented, and evaluated its own unique curriculum initiatives. We examined these initiatives using data abstracted from written reports submitted to the project Executive Committee. Additional data were obtained by personal communication with project directors and evaluators at the various schools, student and preceptor comments, internal program evaluation at each school, and external evaluation by the UME-21 project leadership. The Association of American Medical Colleges Graduation Questionnaire was also used. RESULTS: Fourteen of 18 participating schools implemented a broad range of curricula to facilitate teaching and learning about evidence-based and population-based medicine. Common themes included the application of evidence to patient care, use of clinical practice guidelines and pathways, and the general incorporation of evidence-based techniques (literature searching, critical appraisal, etc) into the teaching of other content, such as clinical science and managed care. Teaching approaches included Web-based and other computer-based education, an emphasis on active and self-directed learning, use of small groups and workshops, and distribution of this content over multiple years. As an alternative to full-length evidence-based medicine courses, many schools incorporated an evidence-based approach into existing courses and clerkships. Data demonstrated an upward trend in student satisfaction with how topics were presented at UME-21 schools. CONCLUSIONS: These innovations successfully demonstrated that evidence-based and population-based medicine content can be introduced into medical school curricula. Introducing these constructs in ways that demonstrate their relevance to patient care facilitates student learning.
The increasing size, growth, and complexity of the health care industry would appear to offer ample opportunity for innovation and entrepreneurship. But is entrepreneurship really on the rise in health care? We performed a sequential cross-sectional analysis of new, rapidly growing health care businesses in the Inc. 500 list to answer this question. We found that, while there appears to be increasing numbers of opportunities for new, privately held businesses, this varies widely by category. In particular, health information management appeared to be an example of emerging industry, characterized by increases in the number of businesses, as well as in the rate of growth and the average revenue. In contrast, the insurance industry seems to have transitioned to maturity. This article argues that companies that introduce disruptive innovations into health care, either through information technology, new ancillary services, or more focused services to the elderly, will likely be good areas for investors who follow the health care industry as well as entrepreneurs who are looking for a niche for market entry.
The Chinese biotech industry is going through a period of fast growth, and with its huge population, China is predicted to be the biggest single-country market in the world. However, the Chinese biotech industry has to tackle the critical issue of innovation, which should be the driving force for China's development into an advanced and responsible country. Here, in this article, the authors review the history of the Chinese biotech industry, exemplified by the development of genetically engineered drugs during the last 20 years, and also point out its the future.
Without culture change, there is little hope of enduring improvement in organizational performance. That's why the Mayo Clinic has launched a grassroots initiative to integrate innovation into employees' daily work. The first step is to diagnose your current culture, then ask what it means to change. As an administrative leader, you may be among the few people-if not the only person-in your organization in the position to diagnose your culture and determine action steps to transform it.
The intent of this article is to provide one company's perspective on the challenging and complex care management of the high-risk neonate. The strategies presented herein should enable and encourage case managers to implement an integrated management process for the frail neonatal population.
The author analyzes the experience of a state public welfare agency in developing a series of changes in social services using participatory techniques to involve frontline staff. Based on a survey of administrators, social service workers and supervisors, the study reveals staff attitudes toward policy innovation in the agency and their role in it. Staff unanimously want more of a voice in shaping the policies and procedures which govern their work, but efforts to secure their involvement are frequently unnoticed or unappreciated. The author identifies a number of constraints to implementing a participatory approach.
Building on previous discussions in graduate health information system (HIS) education, this article focuses on the design of a course in health decision support systems (HDSSs). The goal here is not simply to add to existing prospectives of HIS theories and methodologies, but to prepare these students for changing trends in HIS technologies and applications and for new challenges in HIS administration and impacts arising from these emerging, more advanced, and complex technologies. Specifically, advancing HDSS technology: (1) promises to close the gap between theory and practice, (2) creates a new perspective for the application of information technologies in health care organizations, and (3) enhances innovations in the management and implementation of health information technologies. This paper highlights the need for graduate education in HDSS domain knowledge and how such knowledge can be taught in preparing students for managing change in the future health care environment.
Appropriately used ubiquitous mobile technologies are becoming more important in nursing education because of the scarcity of educators and the increase in the number of first- and second-degree students enrolling in schools of nursing. Podcasting, based on MP3 audio file and Rich Site Summary/Extensible Markup Language technology, is an innovative educational tool that provides experiential learning and network-creation opportunities. Lecture podcasts provide students opportunities to access face-to-face or distance audio presentations/feedback in a convenient manner. Nursing students enrolled in a medical-surgical didactic theory course report high satisfaction with this up-and-coming mobile educational opportunity.
An analysis was performed of the innovatory activities status in Ukraine and in its pharmaceutical sector. Consideration is given to causes of slackening of innovatory processes. Based on the studies made a system of measures is proposed designed to build up a scientific-and-technical potential and activization of innovatory activity in pharmacy.
This paper describes the origin of the Experimental Social Innovation and Dissemination model and its contribution to and intersection with community psychology. It also discusses the challenges presented to ESID by community psychology's growing emphasis on cultural diversity and participatory approaches to research and intervention. It concludes with an overview of the papers presented in the special issue.