Abstract
BackgroundThe implementation of innovations (i.e., new tools and practices) in healthcare organizations remains a significant challenge. The objective of this study was to examine the key interpersonal, organizational, and system level factors that influenced the implementation and use of synoptic reporting tools in three specific areas of cancer care.MethodsUsing case study methodology, we studied three cases in Nova Scotia, Canada, wherein synoptic reporting tools were implemented within clinical departments/programs. Synoptic reporting tools capture and present information about a medical or surgical procedure in a structured, checklist-like format and typically report only items critical for understanding the disease and subsequent impacts on patient care. Data were collected through semi-structured interviews with key informants, document analysis, nonparticipant observation, and tool use/examination. Analysis involved production of case histories, in-depth analysis of each case, and a cross-case analysis. Numerous techniques were used during the research design, data collection, and data analysis stages to increase the rigour of this study.ResultsThe analysis revealed five common factors that were particularly influential to implementation and use of synoptic reporting tools across the three cases: stakeholder involvement, managing the change process (e.g., building demand, communication, training and support), champions and respected colleagues, administrative and managerial support, and innovation attributes (e.g., complexity, compatibility with interests and values). The direction of influence (facilitating or impeding) of each of these factors differed across and within cases.ConclusionsThe findings demonstrate the importance of a multi-level contextual analysis to gaining both breadth and depth to our understanding of innovation implementation and use in health care. They also provide new insights into several important issues under-reported in the literature on moving innovations into healthcare practice, including the role of middle managers in implementation efforts and the importance of attending to the interpersonal aspects of implementation.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-014-0121-0) contains supplementary material, which is available to authorized users.
Highlights
The implementation of innovations in healthcare organizations remains a significant challenge
Synoptic reporting tools (SRTs) result in health system efficiencies [24,25,26] and provide an effective mechanism to generate real-time data [20,25,27,28]. They have been widely endorsed as a means of standardizing cancer reporting, and improving the availability and quality of clinical information for persons diagnosed with cancer [29,30,31,32,33]
Six individuals invited to partake in the mammography case did not respond; one individual invited in the endoscopy case did not respond; and no individuals invited in the cancer surgery case did not respond
Summary
The implementation of innovations (i.e., new tools and practices) in healthcare organizations remains a significant challenge. Across settings and diseases, these types of reports inconsistently and incompletely provide the information required to understand the disease and make informed care decisions [2,3,4,5,6,7]. Synoptic reporting tools (SRTs) result in health system efficiencies [24,25,26] and provide an effective mechanism to generate real-time data [20,25,27,28] They have been widely endorsed as a means of standardizing cancer reporting, and improving the availability and quality of clinical information for persons diagnosed with cancer [29,30,31,32,33]. SRTs represent complex innovations (i.e., new knowledge, tools, or practices), with their implementation and use requiring changes in clinical practice [34] and support from the organization and larger healthcare system
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