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PubMedDate not supplied

A life cycle model of continuous clinical process innovation.

The changing healthcare environment has created a sense of urgency for continuous innovation in clinical care processes. Managers and clinicians are investing unprecedented funds and energy in the development of various clinical process innovations (CPI) such as clinical pathways, electronic workstations, and various forms of information technology. While increasing attention has been paid to the development of such initiatives, our understanding of how best to disseminate and ensure their use is limited. In this first of two articles dealing with the dissemination and use of CPI in integrated delivery systems, we present a "life cycle" model of the dissemination process and suggest opportunities for managing CPI. The management of CPI requires more than just an understanding of the factors that may facilitate or impede its implementation and use. Managers require an understanding of the actual process so that they can assess the specific implementation stage at which the organization is presently operating, and design appropriate interventions that can affect the process. A future article will identify the factors that facilitate and inhibit the process and suggest some intervention strategies.

Critical Pathways↗
PubMed2005

Costing the ambulatory episode: implications of total or partial substitution of hospital care.

The Macarthur Health Service introduced an innovative Acute Ambulatory Care Service (MACS) in 2000. The service was designed to substitute patient care previously provided in hospital beds with care in the patient's home. The financial implications of complete or partial substitution of hospital care were explored using local data sources from the introduction of the service in 2001-2002. These data were analysed using the NSW Department of Health cost of care methodology. This study determined that episodes of care in MACS were less costly than equivalent episodes of inpatient care for selected diagnoses. The Macarthur cost of care data confirmed substantial savings (63%) in cases in certain diagnostic groups (cellulitis, pneumonia) with complete substitution, and lower savings (50%) for partial substitution of care when compared with hospital admission. Savings are likely to be greater as the level of substitution increases and are dependent on the choice of ambulatory sensitive diagnoses.

Ambulatory Care↗
PubMed2006

E-service learning: A pedagogic innovation for healthcare management education.

This paper proposes an innovation in service learning that we identify as e-service learning. By adding the "e" to service learning, we create a service learning model that is dynamic, mediated by technology, and delivered online. This paper begins by examining service learning, which is a distinct learning concept. Service learning furnishes students with opportunities for applied learning through participation in projects and activities in community organizations. The authors then define and conceptualize e-service learning, including the anticipated outcomes of implementation such as enhanced access, quality, and cost effectiveness of healthcare management education. Because e-service learning is mediated by technology, we identify state of the art technologies that support e-service learning activities. In addition, possible e-service learning projects and activities that may be included in healthcare management courses such as finance, human resources, quality, service management/marketing and strategy are identified. Finally, opportunities for future research are suggested.

Curriculum↗
PubMed1988

The proliferation of medical papers in several countries after discoveries in cardiology.

The numbers of papers on the Medline database concerning seven innovations in cardiology in the last 20 years were ascertained by year from the time of their discovery until the present. They were further divided into three geographical regions. The proliferation of papers in medical journals regarding new discoveries is initially exponential, with a plateau phase which is unrelated in magnitude to the constants in the model for the exponential phase. The magnitude of the plateau phase in the case of drugs is related to the number of indications for use of the drug. The proliferation of papers on a particular subject in English journals lags behind journals from the United States of America and the rest of the world. Eventually there are a larger number of papers published per year, per head of the population or per doctor in England than in the U.S.A. Current computer databases are not satisfactory for research audit. The department within an institution and an assessment of the quality of the research should be available.

Cardiology↗
PubMed2005

Sticking to the knitting: CIHR, innovation and Canadian biotech.

The novel proposal outlined by Glenn Brimacombe suggests that the federal government directly participate in funding incremental venture capital investment in Canadian biotechnology, with the goal of facilitating commercialization of Canadian biotechnology and health sciences intellectual property. In this way, they suggest, the economic development benefits of the Canadian current investment in health sciences will be increased. The proposal is based on two premises that need further evaluation: (1) the biotechnology sector in Canada presently underperforms in terms of value creation; (2) this underperformance is due to inadequate venture capital investment. It is the author's view that, although several measures do suggest relative system underperformance, this is likely due to structural differences rather than inadequate venture capital investment. The absence of large, integrated, global biopharmaceutical firms based in Canada, the large number of very small biotech firms and the absence of a clear federal policy mandate supporting technology transfer and underinvestment in public sector funded basic research may all be contributory factors. Given the Canadian biotech sector's current efficiency at creating value from limited public investment in basic science, increasing the core CIHR budget might be an even better investment opportunity for limited incremental funding.

Biotechnology↗
PubMedDate not supplied

The Nursing Extern Program: innovative strategies for students in transition.

Within the present context of a shortage of nursing personnel, it seems crucial for organizations to find strategies that facilitate the transition from the student to the nurse role in order to recruit and retain caring and competent professionals. Early exposure to clinical nursing practice can (1) promote an appreciation of the organization and functioning of the clinical unit, (2) facilitate the application of knowledge and acquisition of nursing interventions, and (3) engage motivated nursing students in the learning process. L'Ordre des Infirmières et Infirmiers du Québec initiated the Nursing Extern Program (the Program) to ease the severe nursing shortage, which was expected to worsen over the summer. The Program was seen as a way for students to consolidate the learning acquired during clinical rotations. Nursing students were employed as externs over the summer period. Within the confines of the Program, nursing students had the opportunity to practice 21 nursing care activities while under the direct supervision of an expert nurse. This article describes the L'Ordre des Infirmières et Infirmiers du Québec Program and identifies the key elements of a hospital-based program. In the first 2 years of implementation, the Program retained 62% of the externs as graduates.

Diffusion of Innovation↗
PubMed1994

Change champions at the grassroots level: practice innovation using team process.

A nursing administrative group recognized the critical value of staff participation in the formulation of a restructuring project and guidance throughout the project. Using a team approach, a task force of three staff nurses, two assistant nurse managers, a nurse clinician, a nursing practice specialist, and a representative from nursing administration came together. They were given responsibility for researching and setting the course for restructuring change. A unit-based team including a unit secretary, a nursing attendant, licensed practical nurse (LPN), and six staff nurses was formed from volunteers from the 40-bed medicine unit to develop that unit's plan for restructuring. The unit-based team analyzed patient care needs and staff member roles. They created a new patient care technician role as well as a nurse care coordinator role. The role of the LPN was envisioned as providing technical support. Staffing mix was also determined by the unit-based team. Both the task force and the unit-based team continue to evaluate, troubleshoot, and take every opportunity to sell their vision to solidify it further as the foundation for the future of patient care services at the hospital. The process will soon move forward to a large surgical unit.

Communication↗
PubMedDate not supplied

Dissemination of a continuing education program in diabetes to health care professionals.

A goal of the Diabetes Research and Training Centers (DRTCs) is to translate advances in diabetes research into improved patient care by providing innovative, state-of-the-art training for health care professionals. This paper is a report on a collaborative DRTC-AADE training project. A 2-day diabetes program developed by the Chicago DRTC was packaged as a Workshop Instructor's Guide with accompanying slides and materials. AADE faculty observed the workshop presented by DRTC faculty and subsequently presented the workshop themselves. The evaluation design involved comparing a workshop presented by the DRTC faculty with a workshop presented by faculty from AADE. Three components were included in the evaluation: the participants' evaluation, a commitment-to-change evaluation, and the faculty observations. When comparing workshops, few differences were observed in participants' or faculty observers' evaluations. Moreover, participants at both workshops were equally successful at meeting goals related to improving their diabetes education practice behaviors. Dissemination of the program has been expanded and the workshop has become part of AADE's national continuing education efforts.

Allied Health Personnel↗
PubMed1998

The NHS as a learning organization: aspirations beyond the rainbow?

AIM: It is the intention of this paper to review the issues and challenges organizations face when aspiring to embrace and enact the tenets of a learning organization; and in particular the perceived impact on management strategy, structure and leadership styles. The paper is predicated on the premise that learning and knowledge act as vital strategic resources, crucial not only to organizations in terms of competitive advantage but to ethical enterprise per se. BACKGROUND: Modern life is characterized by change, against the backdrop of this continual turmoil, organizational learning has emerged as a dominant theme within contemporary management theory, with many commentators increasingly locating the capacity of an aspiring organization to accommodate the ethos of organizational learning, as the vital component in ensuring enduring efficiency, innovation and competitiveness. However, the utility of such learning needs to be scrutinized and evaluated in terms of service need and expectation. ORIGINS OF INFORMATION: The paper will expand upon wider theoretical debates extant within the literature, by considering the concept and utility of the learning organization with specific reference to management reform extant within the British National Health Service (NHS). DATA ANALYSIS: During the course of the review the various the theoretical positions contributing to the notion of the learning organization will be analysed, the practical ramifications of which will be examined in the context of reflective practice, clinical supervision and the wider cultural background of nursing and the NHS. CONCLUSIONS: The paper concludes that the NHS needs to reorientate management perspectives to focus attention more acutely on systems which are deliberately designed to facilitate shared learning, to unravel the ambiguities of organizational life, to affirm management belief in the nursing contribution and to achieve an as yet unrealized potential in terms of patient care and advanced nursing practice.

Clinical Competence↗
PubMed2003

Indications of coronary artery bypass graft in 2003.

UNLABELLED: During the last 3 decades, coronary artery bypass grafting (CABG) emerged, was developed and has progressed. Additionally, recent surgical innovations have been introduced aimed at reducing the trauma without deviating from the efficiency of conventional procedure. At the same time significant evolution in preventive, medical treatment and percutaneous procedures has been observed. The introduction of new treatment has improved the result in medically treated patients. Percutaneous procedures emerged and were developed. New technologies and advances available to adjunctive medical therapies have appeared and have impacted the effectiveness initially established for percutaneous coronary intervention (PCI). Larger use of stent permits a significant decrease in restenosis and the introduction of coated stent will probably improve the RESULTS: Indication is a moving field. Continuing improvement in medical treatment, technical procedure and development of less invasive surgery modifies the place of each treatment and continuing evaluation and comparison are necessary. Introduction of new treatment, aimed at treating ischemic cardiomyopathy like transmyocardial revascularization, cell transplantation or gene therapy will probably modify indications in the future.

Angioplasty, Balloon, Coronary↗
PubMed2004

UME-21 local evaluation initiatives: contributions and challenges.

BACKGROUND AND OBJECTIVES: The 18 medical schools involved in the UME-21 initiative developed innovative curricula and evaluation strategies. While there was significant variation in how schools approached the evaluation process, there were common methodological issues and challenges affecting the reliability of scores and validity of interpretations regarding outcomes. This paper explores these issues and challenges, using experiences from selected UME-21 schools. METHODS: Four evaluation issues and strategies are discussed: instrument development, study design, process evaluation using formative evaluation methods, and qualitative strategies. Within each discussion, examples from a UME-21 school are presented. RESULTS: The four evaluation strategies offered the flexibility to match local evaluation needs with an effective approach to evaluations. CONCLUSIONS/IMPLICATIONS: The school-level evaluation requirements by the UME-21 initiative provided schools the flexibility to design individualized evaluation strategies, yet also encouraged collaboration among evaluators. While this strategy resulted in many successes at the school level, it also served to identify common methodological challenges that can be used as a guide for other schools in implementing and evaluating curricula.

Clinical Clerkship↗
PubMed1996

Doctors and the health industry: a case study of transcutaneous oxygen monitoring in neonatal intensive care.

This case study presents an industry perspective on medical innovation. Introduced as a scientific breakthrough in the late 1970s, transcutaneous oxygen monitoring was rapidly adopted for routine use in neonatal intensive care. But plagued by technical problems, it was within a decade being replaced by pulse oximetry, a still more recent technology. Its use in efforts to prevent retinopathy of prematurity, an eye disease of preterm newborns often leading to blindness, proved disappointing. The project included interviews with executives and design engineers of companies marketing the device, with investigators who had pioneered the technology, and with senior practicing neonatologists. The findings, reflecting complexity and uncertainty, are relevant to issues concerning health care in the United States and other developed nations. They centre on the key role and ultimate responsibility of the medical profession, with a need for greater attention to the scientific training of health care workers, as perceived by members of the medical device industry. The views of senior investigators are integrated into the picture, with discussion of major challenges faced by the medical community.

Blood Gas Monitoring, Transcutaneous↗
PubMed2004

Introducing the Learning Practice--I. The characteristics of Learning Organizations in Primary Care.

RATIONALE, AIMS AND OBJECTIVES: This paper is the first of three related papers exploring the ways in which the principles of Learning Organizations (LOs) could be applied in Primary Care settings at the point of service delivery. Here we introduce the notion of the Learning Practice (LP) and outline the characteristics and nature of an LP, exploring cultural and structural factors in detail. METHODS: Drawing upon both theoretical concepts and empirical research into LOs in health care settings, the format, focus and feasibility of an LP is explored. RESULTS AND CONCLUSIONS: Characteristics of LPs include flatter team-based structures that prioritize learning and empowered change, involve staff and are open to suggestions and innovation. Potential benefits include: timely changes in service provision that are realistic, acceptable, sustainable, and owned at practitioner level; smoother interprofessional working; and fast flowing informal communication backed up by records of key decisions to facilitate permanent learning. Critical comment on potential pitfalls and practical difficulties highlights features of the present system that hinder development: tightly defined roles; political behaviours and individual-oriented support systems; plus the ongoing difficulties involved in tolerating errors (whilst people learn). This paper contributes to the wider quality improvement debate in the area in three main ways. First, by locating Government's desires to create health systems capable of learning within the theoretical and empirical evidence on LOs. Second, it suggests what an LP could be like and how its culture and structures might benefit both staff and patients in addition to meeting externally driven reforms and health priorities. Third, it extends the application of LO concepts to the health care sector locating the principles in bottom-up change.

Diffusion of Innovation↗
PubMedDate not supplied

Innovations in community-based nursing education: transitioning faculty.

The health-care climate is changing rapidly and in ways that challenge the abilities of professionals who provide health care. Nursing educators are preparing professional nurses who can think critically, use sound clinical judgment, and participate as full partners in shaping health-care delivery and policy. Therefore, many schools of nursing, including five schools of nursing whose experiences are synthesized in this article, are revising their curricula to a community-based nursing perspective. Strategies to assist faculty in the transition to a community-based nursing curriculum include using change theory, creating a supportive environment, reducing tension and isolation, and evaluating. Potential challenges during transition include addressing grief and loss, overcoming the tedium of curricular development, moving the revision along while allowing opportunities for faculty input and consensus building, exploring alternative pedagogies, managing faculty workload and qualification issues, and preparing for transition. Outcomes include a more complete understanding of the community client as a partner in the delivery of health care, increased visibility and role modeling to potential future candidates for health careers, cultural transformations within a university, and promotion of the overall health of a community.

Adaptation, Psychological↗
PubMed1995

Innovations in patient care: changing clinical practice and improving quality.

BACKGROUND: In the traditional hospital organization, administrators supply the resources while physicians determine their use. Given this dichotomy, a partnership between clinicians and hospital management is essential for efforts to enhance the quality of care while controlling costs. To foster this partnership, in 1986 the University of Rochester's Strong Memorial Hospital developed its Innovations in Patient Care (IPC) program, which several other medical centers have duplicated. CURRENT STATUS AND LOGISTICS: Hospital operating revenues of approximately $175,000 per year are provided to both fund proposals and support core IPC staff. Clinical staff submit proposals to study innovations to promote higher quality care and/or the efficient and appropriate use of diagnostic and therapeutic services. Many of the 77 projects funded to date have led to important changes in clinical practice. CASE STUDIES: One study, whose principal investigator was assistant director of emergency medicine, showed that structured, condition-specific (for example, asthma, pharyngitis, lacerations, and isolated closed-head injury) quicksheets improved documentation of clinical findings, resource use, and clinical practice. A study organized by the leadership of surgical nursing revealed that a nursing case management model led to reductions in patient length of stay and increases in nurse satisfaction. Another study, designed by a fellow in neonatalogy, developed and tested guidelines for the use of head ultrasounds in screening very-low-birthweight infants for intraventricular hemorrhage. CONCLUSIONS: IPC programs, which integrate well with initiatives in total quality management, can be effectively used to change clinical practice and improve the quality and efficiency of patient care.

Case Management↗
PubMed2006

Impact of CEDIT recommendations: An example of health technology assessment in a hospital network.

OBJECTIVES: The objective of this study is to assess the impact of CEDIT (French Committee for the Assessment and Dissemination of Technological Innovations) recommendations on the introduction of technological innovations within the AP-HP (Assistance Publique-Hôpitaux de Paris), the French hospital network to which this body is attached. METHODS: In 2002, a study based on semidirective interviews of fourteen people affected by these recommendations and a case study relating to thirteen recommendations issued between 1995 and 1998 were conducted. RESULTS: The CEDIT is very scientifically reputable among interviewees. There is generally widespread interest for the recommendations. They are used as decision-making tools by administrative staff and as negotiating instruments by doctors in their dealings with management. Based on the case study, ten of thirteen recommendations had an impact on the introduction of the technology in health establishments. One recommendation appears not to have had an impact. Furthermore, the impact of two technologies was impossible to assess. CONCLUSIONS: This study highlights the significant impact of recommendations arising from a structure that is attached to a hospital network and the good match between CEDIT's objectives and its assignments.

Decision Making↗
PubMed2004

An assessment of the readiness of hospice organizations to accept technological innovation.

We surveyed seven of the 62 certified hospice programmes in the state of Missouri. The survey consisted of 19 questions that covered demographic information, how employees received new information, the current use of various forms of technology, employees' comfort with technology and their perceptions of the use of video-phones. A total of 124 surveys were returned. Respondents were categorized within the following disciplines: nurses (48%), administrators and nurse supervisors (6%), social workers (9%), physicians (3%), home health aids (18%), chaplains (5%) and other staff (e.g. clerical and bereavement staff) (12%). Staff reported using several types of technological device at work but not a video-phone or a Web camera. There were significant differences between hospices in the degree of use of computers at work, the number of devices used at work and the perceived benefits of video-phone technology. There were significant differences between disciplines in the degree of use of computers at work and at home, the number of devices used at work, and their comfort both with the use of new technology and with the idea of introducing new technology to patients and their families. Because there were variations in the perceived usefulness of video-phones for hospice care, the introduction of such equipment would require substantial involvement of the users.

Attitude of Health Personnel↗
PubMed2006

Air quality survey carried out by schoolchildren: an innovative tool for urban planning.

An educational project on biological monitoring of air quality was launched in 2004 to involve about 650 young students (age 6 to 16) from 21 schools of nine municipalities in Tuscany (Central Italy) in active detection of the crucial pollutant ozone with indicator sensitive tobacco seedlings. Results implied the reading of 9,300 raw biological figures and were fortified by the data captured by six photometric analysers. Under the guidance of their teachers, the students had several opportunities to practice with many basic and applied study areas and were initiated into the scientific method in a simple and absorbing manner. Curiosity and involvement were widespread; a sort of emotional and responsible relationship was developed by several pupils. Though primarily an educational exercise, the survey introduced a research element and the regional picture of air pollution that emerged has increased our knowledge of the air quality situation in the area. Biological monitoring of air quality is a powerful tool to improve the awareness and involvement in key topics of environmental education. In addition, it represents a crucial element for improving the awareness of problems and implies the active participation of citizens in the assessment of several indicators of the state of the environment. Its potential as a robust implement in landscape and urban planning is noteworthy.

Adolescent↗