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An interview with Karlene M. Kerfoot. Interview by Connie R. Curran.

Innovation is the key to achieving higher levels of quality and productivity and reducing turnover. Karlene M. Kerfoot, PhD, RN, CNAA, believes the future of nursing in hospitals is a unit-based shared governance structure. Dr. Kerfoot is a member of the Nursing Economic$ Editorial Board and authors the journal's "Nursing Management Considerations' column. In this interview, she outlines her programs, experiences, and philosophies for attaining her goals.

Communication↗

Exceptionalism as the rule? U.S. health policy innovation and cross-national learning.

American health care reformers, who often look to other nations for models of desirable health systems, are often surprised nowadays by cross-national infatuation with health policy innovations minted in the United States. American innovations appeal to policy makers abroad as they struggle with cost pressures, distinguish knowledge about how health systems work, and deal with changing images of what constitutes good public policy. These strategems are adapted, not adopted; however, the premises and practices with which other nations follow American directions differ deeply from those in the United States. Ironically, even cross-national experiments may end up offering instructive policy "rules" to the exceptionalist United States.

Cost Control↗

A review of the functional electrical stimulation equipment market.

The market for functional electrical stimulation (FES) equipment for use in rehabilitation is growing as increasingly sophisticated products enter the market each year. Factors that impact the availability of FES equipment include technological limitations, government regulation, reimbursement status, and clinician training. New products have become available in the last decade with many innovative applications available under investigational status. The current availability of FES equipment for selected applications such as therapeutic muscle stimulation, cardiovascular exercise, restoration of function in the lower and upper extremities, respiratory assist, restoration of bladder function, electroejaculation, and scoliosis correction is reviewed. A review of FES equipment for nonneuromuscular applications such as control of epilepsy, cochlear implants, electrotactile stimulation, and systems to enhance wound healing and bone growth is also included. Key manufacturers are identified.

Diffusion of Innovation↗

Eager sellers and stony buyers: understanding the psychology of new-product adoption.

Companies that introduce new innovations are the most likely to flourish, so they spend billions of dollars making better products. But studies show that new innovations fail at a staggering rate. While many blame these misses on lackluster products, the reality isn't so simple. The goods that consumers dismiss often do offer improvements over existing ones. So why don't people purchase them? And why do companies keep peddling products that buyers are likely to reject? The answer, says the author, can be found in the brain. New products force consumers to change their behavior, and that has a psychological cost. Many products fail because people irrationally over-value the benefits of the goods they own over those they don't possess. Executives, meanwhile, overvalue their own innovations. This leads to a serious clash. Studies show, in fact, that there is a mismatch of nine to one, or 9x, between what innovators think consumers want and what consumers truly desire. Fortunately, companies can overcome this disconnect. To start, they can determine where their products fall in a matrix with four categories: easy sells, sure failures, long hauls, and smash hits. Each has a different ratio of product improvement to change required from the consumer. Once businesses know where their products fit into this grid, they can manage the resistance to change. For some innovations, major behavior change is a given. In those cases, companies can either wait for consumers to warm to the product, make the improvement so great that buyers get past their apprehension, or try to eliminate the incumbent product. Firms can also try to minimize buyer resistance by making products that are compatible with incumbent goods, seeking out those who are not yet users of the existing product, or finding true believers.

Choice Behavior↗

Innovation, ideology and innocence.

Innovative solutions are required to deal with the inadequacies of existing medical education programmes, in both the developed and developing countries, if we are to promote the evolution of more acceptable, more efficient and more effective health care. The newly formed Network of Community-oriented Educational Institutions for Health Sciences is attempting to promote a series of educational and organisational innovations, aimed at the preparation of health professionals who will be better equipped and better motivated to meet the real health needs of the populations they are to serve. Such innovations encounter many obstacles, of which ideologically-based inflexibility of thought is the most important. Ideologies are here defined, in Barnett's words, as "patterns of belief ... quasi-conceptual, quasi-affective sets assumed to be true", having the power to prohibit "rigorous or experimental examination of novel experience." Such systems of thought have 'negative, restrictive and pathological effects' on the development of innovative solutions to complex problems. A particularly destructive and inhibiting stereotype has flowed from an ideological commitment to the achievement of 'international excellence'. A state of what in this paper is called 'innocence' is regarded as mandatory for the implementation of studies based on a commitment to the empirical approach, to the null hypothesis and above all to the evaluation of the process and outcome of educational and other interventions in the health care system.

Communication↗

Health innovation networks to help developing countries address neglected diseases.

Gross inequities in disease burden between developed and developing countries are now the subject of intense global attention. Public and private donors have marshaled resources and created organizational structures to accelerate the development of new health products and to procure and distribute drugs and vaccines for the poor. Despite these encouraging efforts directed primarily from and funded by industrialized countries, sufficiency and sustainability remain enormous challenges because of the sheer magnitude of the problem. Here we highlight a complementary and increasingly important means to improve health equity: the growing ability of some developing countries to undertake health innovation.

Biomedical Research↗

The dynamics of technological change in medicine.

This paper contrasts a dynamic and interactive view of technological change with the linear model of medical innovation that is still so deeply ingrained in many policy discussions. In particular, it focuses on the role of feedback mechanisms between the users and the developers of medical technology and the demand and supply forces (including competition among medical specialties) determining this feedback. It explores three distinct mechanisms by which technological change may contribute to rising health care spending: intensity of use of existing technology, introduction of new technologies, and expanded application of these new technologies.

Diffusion of Innovation↗

Biomedical research councils. Their role and function in transferring information.

Biomedical research plays a great part in promoting not only advances in scientific knowledge but also in the continuous flow of technological innovations in health care. One of the first conditions for the successful transformation of research into an innovation is overcoming the divisions between science and technology, between the researchers and their partners in the innovation process. Biomedical Research Councils (BMRCs) have an important role in the transfer of information. To improve the chances of successful developments and transfers of scientific breakthroughs, the BMRCs must adopt new, comprehensive strategies for such transfer. They must learn to recognize as early as possible which new opportunities hold promise, at which stage of development information should be transferred to other areas of expertise, and which target groups in which fields should be made partners in the research.

Communication↗

Investigating innovation in complex health care supply networks: an initial conceptual framework.

This paper explores the constraints and enablers of the process of innovation within the context of UK health care supply networks. Building on a comprehensive literature review of established and recent innovation and supply network research, the paper presents three levels of supply network analysis: sector level supply networks, focal organization supply networks and dyadic supply relationships. The paper reports on the first round of fieldwork conducted with 12 different health care organizations. The three different levels are applied during analysis and the findings are considered in terms of the key themes that have emerged and the practical and theoretical challenges that they represent.

Diffusion of Innovation↗

Innovation and creativity in a new age for health care.

The world of healthcare is changing. If nursing is to remain relevant in this transforming environment, nurses must be able to see past current conditions and circumstances and prepare a different world for nursing practice. In order to do this well, nursing leaders must embrace innovation and engage newer strategies for responding to the changing demands for nursing practice. Through use of key innovative strategies and techniques, nurses can both visualize a changing context for practice and develop effective strategies to address them. Preparing for the future of practice calls for concerted yet progressive action. Nurses must be willing to challenge the past and write a new and legitimate script for nursing practice that better reflects the highly mobilized and technologically defined health service delivery of the future.

Assertiveness↗

The mini-screen: an innovative device for computer assisted surgery systems.

In this paper we focus on the design of Computer Assisted Surgery (CAS) systems and more generally Augmented Reality (AR) systems that assist a user in performing a task on a physical object. Digital information or new actions are defined by the AR system to facilitate or to enrich the natural way the user would interact with the real environment. We focus on the outputs of such systems, so that additional digital information is smoothly integrated with the real environment of the user, by considering an innovative device for displaying guidance information: the mini-screen. We first motivate the choice of the mini-screen based on the ergonomic property of perceptual continuity and then present a design space useful to create interaction techniques based on a mini-screen. Two versions of a Computer ASsisted PERicardial (CASPER) puncture application, as well as a computer assisted renal puncture application, developed in our teams, are used to illustrate the discussion.

Computer Terminals↗

[Obstacles to innovation].

Three publications by K.P. Kisker that appeared in the 'sixties of the present century are milestones along an important path of panoramic changes in the recent history of psychiatry. They are model reflections of the steps or stages towards a new approach to understanding the social system represented by the hospital and the style of working practised therein. A present-day critical assessment is given of the forces that have been acting against this development, as pointed out by Kisker, and especially so of those originating from the dynamics of tension between the nursing and the medical staffs.

Communication↗

Creativity: the fuel of innovation.

Market-leveled changes occurring in the health care industry require new and creative models of organization, management, and service delivery. One of today's primary management challenges is the development of organizational cultures that value innovation, change, and creativity. The adoption of an ethic of innovativeness allows the organization to stretch the limits of individual and collective knowledge, skill, and ability to meet complex consumer needs. Creativity within organizations is influenced by management practices in conjunction with creativity-relevant work group skills. A common wisdom exists that professional nurses are creative in finding solutions for complex patient care needs. The expansion of this creativity within organizational systems will allow for the evolution of professional nursing practice, improvement in care delivery, and organizational performance.

Creativity↗

Curbing the cardiovascular disease epidemic: aligning industry, government, payers, and academics.

Despite decades of progress in the diagnosis, treatment, and prevention of cardiovascular disease, its prevalence continues to grow in both developed and developing countries. We have constructed a model, the "cycle of quality," which connects the innovation of initial scientific discovery with validated methods of translating research into effective delivery. This model can serve as a basis for evaluating proposed efforts to improve interactions among private and public aspects of health care to accelerate development and appropriate adoption of new treatments, and to achieve greater penetration of effective behavioral therapies and established technologies, resulting in major improvements in cardiovascular health.

Cardiovascular Diseases↗

Quality of evidence: usefulness in measuring the quality of health care.

BACKGROUND: In 1998, the Committee on Health Care Quality in America was created and given the charge of devising a strategy to achieve substantial improvement in the quality of health care for all Americans. One strategy to move the quality agenda forward is the use of evidence by both providers of health care and consumers of health care. One feature of this agenda, evidence-based practice, refers to a hierarchy of evidence ranging from individual randomized, controlled trials to expert opinion. OBJECTIVES: The purposes of this article are to describe the evidence base in nursing, discuss the quality and strength of nursing's evidence, illustrate the application of the Quality Health Outcomes Model, and present recommendations for practice, research, and policy to increase nursing's contribution to quality health care. RESULTS AND RECOMMENDATIONS: Nurses everywhere must use innovative solutions to operationalize the "evidence" in evidence-based nursing. The Quality Health Outcomes Model (QHOM) provides a useful way of advancing research and evidence about the quality of health care in America. In concert with the conceptual framework for the National Health Care Quality Report, the QHOM provides a map for identifying evidence gaps and research questions arising from the model and conceptual framework, as well as evidence synthesis (integrating methodologic quality) driven by theoretical understanding.

Diffusion of Innovation↗

Whatever happened to eHealth?

Innovations in information technology will continue to transform the health care system to a system that more closely resembles that envisioned in the 1999 and 2001 IOM reports. Healthcare Leadership & Management Report will continue to report over the next few months on practical use of technology to improve the health care system. We are now researching several systems and providers that are using technology to improve their patient care, productivity, bottom line and host of operational concerns.

Commerce↗

Web-based research: an innovative method for nursing research.

Although still in its infancy, the World Wide Web presents unparalleled opportunities for harnessing the power of the Internet to collect data from populations of interest in an economical and efficient manner. Web-based surveys offer a number of strengths including access to specific populations, speed of data access, and decreased data collection and data entry costs. These advantages are likely to increase as more people begin to use the Web as their primary means of communication. Nurse researchers who embrace this technology will become the pioneers in the new age of nursing research.

Computer User Training↗

Technology assessment in health care: the U.S. perspective.

Formal programs in medical technology assessment in the United States have become increasingly prominent in health care during the last 10 years in large part stimulated by remarkable technologic innovation, expansion in medical knowledge and increasing health care expenditures. The establishment of the Consensus Development Program of the National Institutes of Health initiated a decade of activities in technology assessment in both the public and private sectors and it was intensified by efforts to contain expenditures, particularly the Prospective Payment System. However, in spite of the wide range of evaluation activities, deficiencies remain which will have to be remedied if medical and policy decisions regarding technologies are to be made on sound bases.

Diffusion of Innovation↗