What Is the Innovation?
Why This Matters
Assessing the feasibility of adopting a particular innovation begins with an understanding of how the innovation works and the scope of the innovation. Decisionmakers should also examine other organizations’ experiences with the innovation. What may work effectively in one setting may not work as well in another, so it is important to consider factors such as context, setting, and circumstances, along with evidence of success.
Key Questions to Consider
- How does the innovation work?
- What is the scope of the innovation?
- Where has the innovation been implemented?
- What is the evidence that the innovation worked?
You have heard about a new practice adopted by another health care organization. It sounds intriguing, and you want to learn more. The first step is to find out the answers to these questions:
- What was done?
- By whom?
- For whom?
The Agency for Healthcare Research and Quality (AHRQ) Health Care Innovations Exchange has a searchable repository of profiles of innovative activities and tools. See examples of complete innovation descriptions at https://innovations.ahrq.gov.
A logic model can be a valuable tool to capture which key areas the innovation addresses and how it accomplishes its intended goals. A logic model shows how inputs and activities are expected to lead to intended outcomes. It can help clarify assumptions, specify related activities that may shape the innovation and its impacts, and detail contextual factors that might affect the innovation. It can also help to identify the parts of the innovation that might be adaptable to a particular situation.
The W.K. Kellogg Foundation has developed a handbook to guide the development of logic models: http://www.wkkf.org/knowledge-center/resources/2006/02/wk-kellogg-foundation-logic-model-development-guide.aspx (If you don’t have the software to open this PDF, download free Adobe Acrobat Reader® software.)
Golisano Children’s Hospital benefited from learning about Cincinnati Children’s experiences implementing family-centered rounding. Please refer toSection 3 of the case studies in the Appendix for information.
Innovations vary in scope. The magnitude of change that will be required to adopt the innovation will depend on the scope of the innovation. Ask yourself the following questions:
- Will the innovation require organizationwide change, or is the innovation limited to a single subsystem?
- Will the innovation require transformational change such as a shift in organizational culture, or incremental change?
- Is the change required by the innovation a natural progression from current practice?
Mt. Carmel Health System implemented Six Sigma, an organization-wide process improvement strategy to increase efficiency and improve its financial standing. To learn more about the scope of this effort, please refer to Sections 2.1 and 2.2 of the case studies in the Appendix.
A description of key types of organizational change can be found in a handout provided by the Free Management Library:http://www.managementhelp.org/misc/types-of-orgl-change.pdf
Understanding where the innovation has been implemented may provide insights about how well it will fit in your setting. Dimensions to consider include:
- Inpatient versus ambulatory settings
- Independent versus multisite organizations
- Fee-for-service versus capitated payment
- Primary care versus specialty care services
- Acute versus postacute versus long-term care services
- Urban versus suburban versus rural settings
- Diverse versus homogeneous patient population
- Commercial versus safety-net patient population
Before you decide to adopt an innovation, consider the evidence that the innovation is likely to achieve its goals. To embark on evidence-based decisionmaking, you will need to:
- Find the evidence. Searches of the Web, databases of research articles and syntheses, and networking with professional colleagues are common methods for unearthing evidence.
- Evaluate the evidence. Consider how credible the evidence is in terms of rigor of the analysis, trustworthiness of the source, and applicability to your situation. For example, consider for how long and in how many places the innovation had been implemented when judging the relevance of evaluation data.
- Judge whether there is sufficient evidence. Is the information complete? Are there important perspectives that are not represented?
- Assess the alternatives. Is there more than one viable option? What tradeoffs are associated with each alternative?
For a series of tools designed to support informed managerial decisionmaking, visit the Informed Decisions Toolbox. It includes modules on how to assess the accuracy, applicability, and actionability of the available evidence: http://toolbox.berkeley.edu/tools/
Evidence that an innovation did not work is as important as evidence it did work. For an example of evidence on a failed innovation, look at Faxed Physician Reminders Fail to Improve Antidepressant Adherence on AHRQ’s Health Care Innovation Exchange:http://www.innovations.ahrq.gov/node/5152
Organizations should be clear about what will be gained by adopting an innovation prior to making an adoption decision. Whether decisionmakers are actively searching for an innovation to solve a particular problem, or just happen upon an attractive innovation, they have to determine whether the innovation is congruent with the organization’s goals.
Key Questions to Consider
- Will the innovation address our problems?
- Will the innovation help us achieve our goals?
- What is our vision of success for the innovation?
If you have been looking for a solution to an organizational problem, an innovation may appear to be just what the doctor ordered. But is it the right prescription? To answer that question, you need to define the problem and ascertain whether the innovation will address it. Key questions to ask include the following:
- What kind of problem is it?
- What is the nature of the problem (e.g., efficiency, quality, safety, workforce, patient satisfaction, public relations, financial)?
- How is the problem defined? By whom?
- When and where does the problem occur?
- What causes the problem?
- Whom does the problem affect?
- How big a problem is it?
- What is the perceived importance of the problem to you and to others?
- How frequently does the problem occur?
- What is the severity of the problem?
- What will happen if you don’t fix the problem?
- How will the innovation address the problem?
- Does the innovation address the root cause of the problem?
- Does the innovation provide a longterm solution to the problem?
- Will the innovation spawn other problems?
- Is the innovation congruent with other initiatives?
Your organization may not be facing any particular problems for which you are seeking solutions, but you always have your eyes open for ways to improve quality and efficiency. You’ve come across an innovation, and it sounds promising. But how does it relate to your organization’s goals? Consider the following questions:
- How effective are our current systems for delivering products and services to our patients/clients in helping us meet our goals?
- What can we do differently to improve our systems?
- Is there a perceived need to change?
- Are there opportunities for improvement that we are missing?
- Will the innovation strengthen our ability to confront future challenges?
- How will adopting the innovation help us meet our goals?
- Is there alignment between our strategic goals and the innovation’s intended results?
Golisano Children’s Hospital found that family-centered rounds addressed a number of organizational goals, including meeting accreditation requirements, aligning with Institute of Medicine goals, reducing medication errors, and improving the discharge process. For more information about the goals that this innovation addressed, please refer to Section 3.4 of the case studies in the Appendix.
Before adopting an innovation, you should be clear about what you expect the innovation to achieve. Specifying objectives in a structured manner will guard against adoption of an innovation that holds out only vague promises. It also provides a foundation for future evaluation, which is likely to be critical for the long-term success and sustainability of the innovation. (To learn more about evaluation, see How will we measure the impact of the innovation?.)
A common rubric used in developing objectives is that they be specific, measurable, attainable, relevant, and timely (SMART):
Specific: What are we planning to do?
Measurable: Is it measurable?
Attainable: Can we get it done in the proposed timeframe/in this political climate/for this amount of money?
Relevant: Will this objective lead to the desired results?
Timely: What is the target date for accomplishing this objective?
The following equation may facilitate the objective-writing process:
Objective: To (action verb + key result + target date)
Examples of SMART objectives:
- To increase retention of nurses by 10% within 4 years
- To decrease appointment no-show rate by 40% within 1 year
Additional details regarding SMART objective setting are available on the March of Dimes Web site:
Why This Matters
An innovation’s compatibility with the adopting organization is one of the determinants of successful adoption (Denis et al., 2002; Ferlie et al., 2001). Organizational decisionmakers should assess the extent to which an innovation is consistent with their organization’s mission, values, and culture. Once areas of conflict have been identified, it may be possible to adapt an innovation to make it more compatible.
Key Questions to Consider
- Is the innovation compatible with our mission, values, and culture?
- Can the innovation be adapted to improve compatibility?
A high degree of compatibility between an innovation and the adopting organization’s mission, values, and culture will facilitate both the adoption decision and the implementation process. If an innovation runs counter to your organization’s mission, values, or culture, carefully consider whether these conflicts are likely to cause the innovation to fail. Ask yourself how the innovation fits with your:
- Values (i.e., beliefs and acceptable behaviors)
- Patient-care culture
- Business culture
- Management culture
- Professional culture
- Interpersonal culture
- Quality improvement culture
Organizations can identify areas of incompatibility by recognizing when the innovation might conflict with an aspect of the organization’s mission, values, or culture. For example, mismatches may occur when an organization:
- Encourages experimentation and ad hoc problem solving, but the innovation requires meticulous planning and strict procedural adherence.
- Has a top-down management style, but the innovation requires decisionmaking authority to be widely shared.
- Has divisions that operate independently of each other, but the innovation requires collaboration across divisions.
- Encourages and rewards competitiveness among staff members, but the innovation requires teamwork.
Mismatches do not necessarily mean that the innovation should not be adopted. Innovations may be used as part of a strategy to change organizational culture, or measures can be taken to cushion the culture clash.
A 2003 review of available tools to assess organizational culture in health care can be found at http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1360923.
The decisionmakers at Clinica Campesina gave careful consideration to whether group visits were compatible with their organization’s mission and culture. Please refer to Section 1.2 of the case studies in the Appendix for a discussion of how they assessed compatibility.
At Golisano Children’s Hospital, adoption of family-centered rounding required a change in the paternalistic medical care model. Read about how Golisano effected this cultural shift in Section 3 ofthe case studies in the Appendix.
Often an innovation has to be customized in order to be compatible with an adopting organization. If, however, you do not replicate the innovation exactly, you may not get the same results as the original innovation did. To determine to what extent adaptation is possible, ask:
- What parts of the innovation are essential, and what parts are amenable to alteration?
- How robust is the innovation? Are small adaptations likely to change the results?
- How can the innovation be modified to suit the organization better without sacrificing fidelity to the original innovation?
The Community Tool Box discusses adapting an innovation to fit your situation: http://ctb.ku.edu/en/default.aspx