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 1,171 records · Page 65Linked to original sources
PubMed2002

Clinical innovation for promoting family care in paediatric intensive care: demonstration, role modelling and reflective practice.

AIM: To explore family caregiving problems in paediatric crisis care and methods that could be applied to move the abstraction of family care to development of specific family interventions. BACKGROUND AND RATIONAL: Family centred care has been accepted as the ideal philosophy for holistic health care of children, but methods for its implementation are not well established. In paediatric health crises, family care requires special sensitivity to family needs and a type of complex nursing care for which many practitioners are not sufficiently prepared. Developing family sensitive models of intervention and finding a strategy for transfer of this knowledge to clinical practice is an important challenge facing family nursing today. Social learning theory provides a rich background to explore these issues. CONCLUSIONS: Specific techniques of role modelling and reflective practice are suggested as effective approaches to teach family sensitive care in clinical settings where families are part of the care environment.

Clinical Competence↗
PubMed1994

Nurses' creativity, tedium and burnout during 1 year of clinical supervision and implementation of individually planned nursing care: comparisons between a ward for severely demented patients and a similar control ward.

The aim of this study was to study creativity and innovative climate, tedium and burnout among the nurses on two wards during 1 year of systematic clinic supervision combined with the implementation of individualized care on an experimental ward (EW) for severely demented patients, as compared with a similar control ward (CW). EW nurses had systematic clinic supervision and each patient had his/her nursing care carefully planned, documented and evaluated. The intervention was evaluated by means of the Creative Climate Questionnaire, Burnout Measure and the Maslach Burnout Inventory. Creativity and innovative climate improved significantly among the EW nurses (n = 19) in eight out of 10 factors during the year of intervention while there was no change on the control ward (n = 20). Tedium and burnout decreased significantly among the EW nurses while no change was seen in this respect among the CW nurses. It seems reasonable to assume that systematic clinical supervision and individualized planned care decreases the negative outcome of stress caused by the psychological burden imposed by nursing care. It also increases nurses' creativity, which, in turn, may benefit patient care. The findings of this study point to the necessity for a support system that focuses on the work itself, i.e. the nursing care. Individualized planned care and systematic clinical supervision may offer this kind of support.

Adult↗
PubMed2006

Innovation and change: shaping district nursing services to meet the needs of primary health care.

BACKGROUND: National Health Service reforms and government directives have placed primary care in the forefront of health care provision. Robust information is needed to inform and direct the district nursing response to these initiatives. AIM: To gain a detailed understanding of the district nursing service in the West Hertfordshire area, determine capacity for development and formulate plans for the 21st century. METHODS: Action research was the supporting methodology. A project group of working professionals led the study, identifying several areas for development, of which two are discussed: workload measurement and caseload profiling. KEY FINDINGS: An understaffed service with unpredictable workload which mitigates against proactive working. The inappropriate use of staff skills prevents efficient, cost-effective care. CONCLUSIONS: Robust caseload management with strict referral and discharge criteria and prioritization of visits offers the possibility of more effective time management. Skill mix review could enable more appropriate use of specialist skills.

Activities of Daily Living↗
PubMed1988

The information age in concept and practice at the National Library of Medicine.

The evolution of today's information age is mirrored in the growth of the National Library of Medicine's bibliographic services: from the pioneering work of the Library in the last century to develop Index Medicus, to developing the innovative computerized MEDLARS system in the early 1960s, to the easily searchable on-line data bases now available to health professionals. The evolution has not come about without controversy, however, as tension developed between the public sector, where the information was viewed as a social benefit, and the private sector, where it was viewed as a source of profit. The Library has fostered research and development in biomedical communications in the laboratories of its Lister Hill Center and through grants to assist in establishing the field of medical informatics. The future of biomedical communications will be profoundly affected by work now being carried out by the Library: in fields such as biotechnology, through integrative methodologies such as the Unified Medical Language System now under development, and by a grant program to improve the infrastructure for information within academic health science centers.

Diffusion of Innovation↗
PubMed2005

The implementation of electronic services: planned or organic growth?

The literature on innovation suggests that projects are successful when rigorous project management is mixed judiciously with 'organic' development. This paper argues that organic growth can play a substantial role in the implementation of electronic services in healthcare settings. Evidence for organic growth is presented, based on a study of email use. Methods are presented for investigating email use in health service settings in the National Health Service (NHS) in Bradford, England. Geographical information systems (GIS) outputs and social network analyses are presented. The results demonstrate a fivefold increase in the use of email over a 13-month period, which is shown to be largely independent of the growth in the number of organisations using the network. They also demonstrate a marked increase in the complexity of the patterns of email use over the period.

Data Collection↗
PubMed2003

ESID, dissemination, and community psychology: a case of partial implementation?

Dissemination, the second stage of Experimental Social Innovation and Dissemination (ESID) is a critical, if not defining, element of this social change model. This paper attempts to assess the extent to which community psychology has adopted and implemented ESID's dissemination focus in its training and publications. We identify four levels of commitment to dissemination: dissemination advocate, dissemination activist, dissemination researcher, and experimental dissemination researcher. Content analyses of textbooks, journal publications, and conference papers and a brief survey of doctoral training in the field were conducted. Findings suggest that the dissemination aspects of ESID have been modestly and partially implemented within the field. That is, although there is some evidence of a commitment to dissemination practice (advocate, activist), there is much less evidence of a commitment to dissemination research. The implications of these findings for the effectiveness of the ESID model and for training and practice in community psychology are discussed.

Diffusion of Innovation↗
PubMed2006

Hospital organization culture, capacity to innovate and success in technology adoption.

PURPOSE: Absorptive capacity has been defined as an organization's ability to recognize the value of new information, assimilate it, and apply it to productive ends. This study aims to examine the type of organization culture that influences the capacity of hospital organizations to innovate by absorbing new technology and the importance of this absorptive capacity in information technology (IT) implementation success. DESIGN/METHODOLOGY/APPROACH: Based on previous research, this study proposes a measure of absorptive capacity that includes managerial IT knowledge and communication channels and tests its relationship to the level of success implementing new systems. A sample of 192 hospital administrators shared their opinions about their organizations culture, ability to absorb new technology, and the extent to which their latest IT implementation operational for at least one year has been a success. FINDINGS: The results show the importance of organization culture as an important factor in developing absorptive capacity, and the latter's influence in the implementation of new technologies. ORIGINALITY/VALUE: The study provides insights into the types of activities that management should undertake in order to enhance absorptive hospital capacity.

Computer Communication Networks↗
PubMed1998

Reflection: a reflex action?

Nursing appears to be regularly subjected to new and 'fashionable' ideas and practices, many of which come from the USA. Examples of these include the nursing process and models of nursing. In the pursuit of professionalization of nursing, the need for such innovations is supported by the author. What cannot be supported, however, is the haphazard way in which some of these initiatives are often badly introduced and accepted into the profession in the absence of any research supporting their benefits. This article seeks to explore the notion of reflective practice, some of the reasons it has been introduced, as well as some of the problems associated with investigating its benefits. The different types of reflective practice are discussed along with their implications for professional practice. Attempts are made to explain the difference between reflection and the mere recall of events, as well as some possible explanations as to why reflective practice has not been embraced by clinical nurses in the way it should or could have. Finally, the subject of how reflective practice could be practically implemented in clinical areas is discussed and an example for a model of reflection given.

Clinical Competence↗
PubMed1994

The challenge of the 21st century: innovating and adapting Social Security systems to economic, social, and demographic changes in the English-speaking Americans.

The Social Security Programs in the United States are complex and have evolved over a long span of years. However, it is possible to categorize much of this experience into two different eras in which Social Security functioned in a distinctive environment, and a third era that is now beginning. The middle third of this century was an "age of invention," in which the programs grew rapidly under favorable social and economic conditions. Since then, the programs have experienced an "age of accommodation," in which growing financial constraints have permitted only limited changes in the program. We can look forward to an "age of maturation" in the decades to come, as most persons reaching retirement will have been covered by Social Security during their entire working careers. The declining ratio of workers to beneficiaries and a wide range of demographic and social changes will present significant challenges. The Social Security programs must change considerably to respond to the demands of a new era, and vigorous efforts to do so are underway.

Cost Control↗
PubMedDate not supplied

Inquiry-driven strategies for innovation in medical education: experiences in India.

Four medical institutes, viz, AIIMS, New Delhi; CMC, Vellore; JIPMER, Pondicherry and IMS-BHU, Varanasi formed a consortium to introduce reforms in undergraduate medical education. A detailed inquiry was conducted by administering questionnaires to the faculty, recent graduates and patients to identify the deficiencies in the present system. Morbidity patterns prevalent in the community at primary, secondary and tertiary care levels were determined. These were matched with the actual curricula being followed and the assessment patterns. The main findings were: inadequate emphasis on practical skills (including communication), insufficient coverage of common diseases; and neglect of behavioral, social and ethical aspects in the curriculum. Based on these findings certain corrective programmes are being introduced. The content areas in the curriculum have been classified in to 'must know', 'good to know' and 'need not know'. A list of essential skills have been identified. Steps are on to ensure that these skills are acquired by the graduates. A modular approach to the teaching was suggested and modules on some of these topics are under preparation.

Child↗
PubMed1997

Innovations in community health nursing: examples from practice.

The Ottawa Charter for Health Promotion is cited internationally as an appropriate conceptual framework for healthcare service delivery yet the literature reveals minimal evidence of nursing services interpreting and applying the Ottawa Charter strategies into nursing practice. Nurses with the community services of Noarlunga Health Services and the Drug and Alcohol Services Council of South Australia, however, do use the strategies to plan and implement their services. The Ottawa Charter strategies of developing personal skills; creating supportive environments; strengthening community action; building healthy public policy; and re-orienting services in the interest of health can be used as a tool to assist nurses to identify the purpose of their interventions and select a comprehensive range of nursing actions which address the needs of individuals while acknowledging the broader determinants of health. This article presents a nursing analysis of the Charter and provides examples of how the strategies are used to influence nursing practice in both organizations. The examples provided from the two different nursing services also demonstrate the adaptability and relevance of the strategies to diverse community nursing practice settings.

Community Health Nursing↗
PubMed1990

Innovations in clinical practice through hospital-funded grants.

Improving patient outcomes while controlling the costs of care requires a partnership between clinical researchers and hospital management. To this end, Strong Memorial Hospital in Rochester, New York, dedicated hospital operating funds to a program of small grants designed to align the patient care and academic interests of clinicians with the goals of efficient hospital management. The grants gave clinicians an opportunity to test the efficacy of specific patient care maneuvers. These studies resulted in improved guidelines for the use of diagnostic and therapeutic modalities, new technology, and length of hospitalization. Annual marginal cost savings from implementing the first-year study results are projected to be $587,255, an 8 to 1 return on the first year's expenses. The authors conclude that a hospital-funded applied research program encourages those delivering patient care to identify inefficiencies and introduce change while ensuring quality patient care. This joint faculty-management effort can augment the hospital's quality-assurance, utilization management, and technology assessment programs while advancing the scholarship of faculty members.

Cost-Benefit Analysis↗
PubMed2001

Quality vascular surgical care: the importance of innovation and change in an era of dwindling reimbursement.

BACKGROUND: Reductions in vascular surgery reimbursement emphasize the need to decrease cost while maintaining quality. Hospital solvency is essential if we are to preserve acceptable levels of nursing/support personnel and acquire new diagnostic and treatment programs. METHODS: Care processes for patients undergoing carotid, aortic, or dialysis access surgery were retrospectively analyzed and new quality- and cost-oriented treatment algorithms and clinical pathways were developed and implemented using case management principles. Preoperative risk stratification, length of stay, costs, complications, outcomes, and patient satisfaction were compared before and after these revisions in the care process. Statistical analyses were done using the Wilcoxon Rank sum test and Fisher exact test. RESULTS: Significant reductions in length of stay, intensive care use, and cost of treatment and diagnosis were achieved without adversely affecting morbidity, mortality, or patient satisfaction. CONCLUSION: Use of algorithm, clinical pathway, and case management principles resulted in a marked improvement in the "bottom line" for vascular surgical procedures in our academic medical center.

Academic Medical Centers↗
PubMed2004

Patient access to medical technology across Europe.

Access to medical technology differs across Europe. Differences in funding and reimbursement systems create barriers for the adoption of new and innovative medical technology. It is obvious that a joint effort between representatives from the industry and the profession has great potential to emphasise inequitable discrepancies and thereby improve the availability of accepted innovations in cardiovascular medicine. It is equally obvious that future efforts to overcome such restrictions to availability must be directed at the individual country level. The involvement of the profession, perhaps best accomplished by activation of National Cardiac Societies, will be mandatory for success. Collaboration with the industry is then a likely key factor for success. Presently there seems to be a great lack of knowledge and interest for this important aspect of a well functioning health care system and the responsibility to improve it remains with the professional societies. They need to allocate time and resources for this purpose, educate their members and lobby within their countries with the ambition to create better, more uniform and transparent procedures, and to become natural partners in the funding and reimbursement processes.

Biomedical Technology↗
PubMed1994

Methodological challenges and innovations in patient outcomes research.

Between 1989 and 1992, the Agency for Health Care Policy and Research (AHCPR) awarded funding to 14 special projects known as Patient Outcomes Research Teams (PORTs). These large, complex projects form the centerpiece of the first generation of research under the Medical Treatment Effectiveness Program. In carrying out their individual 5-year research plans, and through collaborative work of six Inter-PORT Work Groups, PORTs have contributed to methodological advances related to their specific clinical focus and to outcomes research in general. Each of the PORTs has followed a standard research model, involving the application of: systematic literature review, measurement of outcomes, analysis of cost and claims data, decision analysis, and strategies for disseminating findings. This article reports what has been learned by individual PORTs, and by AHCPR, regarding the usefulness of each of these methodologies, both for the ongoing projects and for the next generation of effectiveness research. Example from individual PORTs and work groups illustrate some of the methodological gains that have been made in effectiveness research and provide a glimpse of the work that remains to be done.

Analysis of Variance↗
PubMed2005

Implementing the CanMEDS physician roles in rural specialist education: the multi-specialty community training network.

CONTEXT: Changing medical education to realign it with societal needs has become a renewed priority in many countries. Advanced training in rural settings to prepare physicians to better serve rural areas has received particular attention around the world. Such initiatives are usually targeted at primary care practitioners. Few initiatives have been designed to enhance specialist training in a rural setting, let alone adapt specialist competency frameworks such as the CanMEDS roles of the Royal College of Physicians and Surgeons of Canada to non-urban medical education. ISSUE: We describe an innovation in medical training for rural competence for specialist physicians using the CanMEDS framework near London, Ontario, Canada. Since 1997, the University of Western Ontario has established its Multi-Specialty Community Training Network (MSCTN) to provide rural and regional training opportunities for specialty residents in anaesthesia, general surgery, internal medicine, paediatrics, obstetrics and psychiatry. It became the first program in Canada to fully adapt the new CanMEDS roles into learning objectives and evaluations. LESSONS LEARNED: Competency-based frameworks like CanMEDS are important because they provide a comprehensive tool to organize outcome-based curricula. The CanMEDS roles framework has been very useful in developing educational goals for rural/regional specialty resident rotations as well as forming a constructive basis for resident, preceptor, and program evaluations. Our experiences with this program may provide lessons for others planning training for specialists in rural settings, and those adopting the CanMEDS competency framework.

Community Networks↗
PubMed1994

Utilization review for Medicaid diagnosis-related group systems: practice, innovation, and lessons of experience.

Utilization review practices, innovations and trends for the 21 states using diagnosis-related groups for Medicaid during 1992 are described. According to this descriptive survey, Medicaid inpatient utilization review programs vary widely in authority, approach and focus, reflecting state payment system incentives, health and hospital system characteristics, and provider practice norms. More than half of the states with Medicaid diagnosis-related group systems contract with a Medicare Peer Review Organization. State programs are developing complementary clinical and data analytic approaches, advised by multidisciplinary utilization review committees, and are moving from random review to strategies that focus on specific types of admissions/procedures, and shift as provider practices and utilization patterns change. Utilization review strategies also support payment incentives and system features, e.g., by targeting outliers, readmissions and transfers, and short stays. Overall, programs are becoming more flexible, targeted, and interactive. Trends and suggestions for refining utilization review programs for diagnosis-related group systems are presented.

Data Collection↗
PubMed1995

A model for estimating the impact of changes in children's vaccines.

OBJECTIVES: To assist in strategic planning for the improvement of vaccines and vaccine programs, an economic model was developed and tested that estimates the potential impact of vaccine innovations on health outcomes and costs associated with vaccination and illness. METHODS: A multistep, iterative process of data extraction/integration was used to develop the model and the scenarios. Parameter replication, sensitivity analysis, and expert review were used to validate the model. RESULTS: The greatest impact on the improvement of health is expected to result from the production of less reactogenic vaccines that require fewer inoculations for immunity. The greatest economic impact is predicted from improvements that decrease the number of inoculations required. CONCLUSIONS: Scenario analysis may be useful for integrating health outcomes and economic data into decision making. For childhood infections, this analysis indicates that large cost savings can be achieved in the future if we can improve vaccine efficacy so that the number of required inoculations is reduced. Such an improvement represents a large potential "payback" for the United States and might benefit other countries.

Child, Preschool↗