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Determining the predictors of innovation implementation in healthcare: a quantitative analysis of implementation effectiveness.

Jacobs SR, Weiner BJ, Reeve BB, Hofmann DA, Christian M, Weinberger M - BMC Health Serv Res (2015)

Bottom Line: Our results demonstrated that not only did perceptions of implementation climate have a statistically significant direct effect on implementation effectiveness, but physicians' perceptions of implementation climate also mediated the relationship between organizational implementation policies and practices (IPP) and enrollment (p <0.05).In addition, physician factors such as CCOP PI status, age, radiological oncologists, and non-oncologist specialists significantly influenced enrollment as well as CCOP organizational size and structure, which had indirect effects on implementation effectiveness through IPP and implementation climate.Overall, our results quantitatively confirmed the main relationship postulated in the innovation implementation framework between IPP, implementation climate, and implementation effectiveness among individual physicians.

View Article: PubMed Central - PubMed

Affiliation: Public Health Research Division, RTI International, 3040 East Cornwallis Road, Post Office Box 12194, Research Triangle Park, NC, 27709-2194, USA. sjacobs@rti.org.

ABSTRACT

Background: The failure rates for implementing complex innovations in healthcare organizations are high. Estimates range from 30% to 90% depending on the scope of the organizational change involved, the definition of failure, and the criteria to judge it. The innovation implementation framework offers a promising approach to examine the organizational factors that determine effective implementation. To date, the utility of this framework in a healthcare setting has been limited to qualitative studies and/or group level analyses. Therefore, the goal of this study was to quantitatively examine this framework among individual participants in the National Cancer Institute's Community Clinical Oncology Program using structural equation modeling.

Methods: We examined the innovation implementation framework using structural equation modeling (SEM) among 481 physician participants in the National Cancer Institute's Community Clinical Oncology Program (CCOP). The data sources included the CCOP Annual Progress Reports, surveys of CCOP physician participants and administrators, and the American Medical Association Physician Masterfile.

Results: Overall the final model fit well. Our results demonstrated that not only did perceptions of implementation climate have a statistically significant direct effect on implementation effectiveness, but physicians' perceptions of implementation climate also mediated the relationship between organizational implementation policies and practices (IPP) and enrollment (p <0.05). In addition, physician factors such as CCOP PI status, age, radiological oncologists, and non-oncologist specialists significantly influenced enrollment as well as CCOP organizational size and structure, which had indirect effects on implementation effectiveness through IPP and implementation climate.

Conclusions: Overall, our results quantitatively confirmed the main relationship postulated in the innovation implementation framework between IPP, implementation climate, and implementation effectiveness among individual physicians. This finding is important, as although the model has been discussed within healthcare organizations before, the studies have been predominately qualitative in nature and/or at the organizational level. In addition, our findings have practical applications. Managers looking to increase implementation effectiveness of an innovation should focus on creating an environment that physicians perceive as encouraging implementation. In addition, managers should consider instituting specific organizational IPP aimed at increasing positive perceptions of implementation climate. For example, IPP should include specific expectations, support, and rewards for innovation use.

No MeSH data available.


Related in: MedlinePlus

The impact of implementation climate on physician enrollment.
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Related In: Results  -  Collection

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Fig1: The impact of implementation climate on physician enrollment.

Mentions: The conceptual model for this study is based on Klein and colleagues’ innovation implementation framework which specifics the antecedents of complex innovation implementation [7,16]. The framework postulates that implementation effectiveness, or the consistency and quality of innovation use, results from both organizational implementation policies and practices (IPP) and individual climate perceptions (Figure 1). IPP are the formal strategies organizations utilize to put the innovation into use, while implementation climate is the extent to which organizational members perceive that an innovation is expected, supported, and rewarded by their organization [7,9,16]. Specifically, the authors suggest that IPP are the antecedents of climate, while individuals’ interpretive perceptions of climate ascribe meaning to the policies and practices [23]. Therefore, how physicians view their organization in terms of encouraging innovation implementation is determined by IPP. In addition, these perceptions predict the number of patients each physician will enroll in a cancer clinical trial (i.e., implementation effectiveness). Therefore, our first hypothesis is as follows:Figure 1


Determining the predictors of innovation implementation in healthcare: a quantitative analysis of implementation effectiveness.

Jacobs SR, Weiner BJ, Reeve BB, Hofmann DA, Christian M, Weinberger M - BMC Health Serv Res (2015)

The impact of implementation climate on physician enrollment.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4307151&req=5

Fig1: The impact of implementation climate on physician enrollment.
Mentions: The conceptual model for this study is based on Klein and colleagues’ innovation implementation framework which specifics the antecedents of complex innovation implementation [7,16]. The framework postulates that implementation effectiveness, or the consistency and quality of innovation use, results from both organizational implementation policies and practices (IPP) and individual climate perceptions (Figure 1). IPP are the formal strategies organizations utilize to put the innovation into use, while implementation climate is the extent to which organizational members perceive that an innovation is expected, supported, and rewarded by their organization [7,9,16]. Specifically, the authors suggest that IPP are the antecedents of climate, while individuals’ interpretive perceptions of climate ascribe meaning to the policies and practices [23]. Therefore, how physicians view their organization in terms of encouraging innovation implementation is determined by IPP. In addition, these perceptions predict the number of patients each physician will enroll in a cancer clinical trial (i.e., implementation effectiveness). Therefore, our first hypothesis is as follows:Figure 1

Bottom Line: Our results demonstrated that not only did perceptions of implementation climate have a statistically significant direct effect on implementation effectiveness, but physicians' perceptions of implementation climate also mediated the relationship between organizational implementation policies and practices (IPP) and enrollment (p <0.05).In addition, physician factors such as CCOP PI status, age, radiological oncologists, and non-oncologist specialists significantly influenced enrollment as well as CCOP organizational size and structure, which had indirect effects on implementation effectiveness through IPP and implementation climate.Overall, our results quantitatively confirmed the main relationship postulated in the innovation implementation framework between IPP, implementation climate, and implementation effectiveness among individual physicians.

View Article: PubMed Central - PubMed

Affiliation: Public Health Research Division, RTI International, 3040 East Cornwallis Road, Post Office Box 12194, Research Triangle Park, NC, 27709-2194, USA. sjacobs@rti.org.

ABSTRACT

Background: The failure rates for implementing complex innovations in healthcare organizations are high. Estimates range from 30% to 90% depending on the scope of the organizational change involved, the definition of failure, and the criteria to judge it. The innovation implementation framework offers a promising approach to examine the organizational factors that determine effective implementation. To date, the utility of this framework in a healthcare setting has been limited to qualitative studies and/or group level analyses. Therefore, the goal of this study was to quantitatively examine this framework among individual participants in the National Cancer Institute's Community Clinical Oncology Program using structural equation modeling.

Methods: We examined the innovation implementation framework using structural equation modeling (SEM) among 481 physician participants in the National Cancer Institute's Community Clinical Oncology Program (CCOP). The data sources included the CCOP Annual Progress Reports, surveys of CCOP physician participants and administrators, and the American Medical Association Physician Masterfile.

Results: Overall the final model fit well. Our results demonstrated that not only did perceptions of implementation climate have a statistically significant direct effect on implementation effectiveness, but physicians' perceptions of implementation climate also mediated the relationship between organizational implementation policies and practices (IPP) and enrollment (p <0.05). In addition, physician factors such as CCOP PI status, age, radiological oncologists, and non-oncologist specialists significantly influenced enrollment as well as CCOP organizational size and structure, which had indirect effects on implementation effectiveness through IPP and implementation climate.

Conclusions: Overall, our results quantitatively confirmed the main relationship postulated in the innovation implementation framework between IPP, implementation climate, and implementation effectiveness among individual physicians. This finding is important, as although the model has been discussed within healthcare organizations before, the studies have been predominately qualitative in nature and/or at the organizational level. In addition, our findings have practical applications. Managers looking to increase implementation effectiveness of an innovation should focus on creating an environment that physicians perceive as encouraging implementation. In addition, managers should consider instituting specific organizational IPP aimed at increasing positive perceptions of implementation climate. For example, IPP should include specific expectations, support, and rewards for innovation use.

No MeSH data available.


Related in: MedlinePlus