Diffusion of Innovations in Health Service Organisations A Systematic Literature Review

by Greenhalgh, Trisha; Robert, Glenn; Bate, Paul; Macfarlane, Fraser; Kyriakidou, Olivia; Donaldson, Liam

• ISBN13: 9780727918697
• ISBN10: 0727918699
• Edition: 1st
• Format: Hardcover
• Copyright: 2007-03-12
• Publisher: BMJ Books

Summary

This is a systematic review on how innovations in health service practice and organisation can be disseminated and implemented. This is an academic text, originally commissioned by the Department of Health from University College London and University of Surrey, using a variety of research methods. The results of the review are discussed in detail in separate chapters covering particular innovations and the relevant contexts. The book is intended as a resource for health care researchers and academics.

Author Biography

Trisha Greenhalgh, Professor of Primary Health Care, University College London, UK

Table of Contents

Acknowledgements	viii
Foreword	ix
How to read this book	x
Summary overview	1	(19)
Introduction	20	(12)
What is diffusion of innovations theory?	20	(2)
Why did the UK Department of Health want to research the diffusion of innovations?	22	(3)
Scope of this research	25	(1)
Definitions	26	(5)
Structure of this book	31	(1)
Method	32	(16)
Outline of method	32	(2)
Planning phase	34	(1)
Search phase	35	(2)
Mapping phase	37	(1)
Appraisal phase	38	(2)
Synthesis phase	40	(2)
Meta-narrative review: philosophical origins and links with other approaches to the synthesis of complex evidence	42	(6)
The research traditions	48	(35)
The origins of diffusion of innovations research	49	(2)
Rural sociology	51	(2)
Medical sociology	53	(2)
Communication studies	55	(1)
Marketing and economics	56	(2)
Limitations of early diffusion research	58	(2)
Development studies	60	(2)
Health promotion	62	(2)
Evidence-based medicine and guideline implementation	64	(2)
Structural determinants of organisational innovativeness	66	(2)
Studies of organisational process, context and culture	68	(2)
Interorganisational studies: networks and influence	70	(1)
Knowledge-based approaches to diffusion in organisations	70	(7)
Narrative organisational studies	77	(2)
Complexity and general systems theory	79	(1)
Conclusion	80	(3)
Innovations	83	(17)
Background literature on attributes of innovations	83	(4)
The Tornatzky and Klein meta-analysis of innovation attributes	87	(3)
Empirical studies of innovation attributes	90	(4)
Limitations of conventional attribution constructs for studying adoption in organisational settings	94	(3)
Attributes of innovations in the organisational context	97	(3)
Adopters and adoption	100	(14)
Characteristics of adopters: background literature	100	(3)
Adoption as a process: background literature	103	(3)
Assimilation of innovations in organisations	106	(8)
Diffusion and dissemination	114	(20)
Communication and influence through interpersonal networks	114	(4)
Opinion leaders	118	(8)
Champions and advocates	126	(3)
Boundary spanners	129	(1)
Change agents	130	(1)
The process of spread	130	(4)
The inner context	134	(23)
The inner context: background literature	134	(1)
Organisational determinants of innovativeness: meta-analyses	135	(5)
Organisational determinants of innovativeness: overview of primary studies in the service sector	140	(1)
Empirical studies on organisational size	141	(5)
Empirical studies on structural complexity	146	(2)
Empirical studies on leadership and locus of decision-making	148	(2)
Empirical studies on organisational climate and receptive context	150	(4)
Empirical studies on supporting knowledge utilisation and manipulation	154	(3)
The outer context	157	(18)
Interorganisational influence through informal social networks	157	(6)
Interorganisational influence through intentional spread strategies	163	(7)
Empirical studies of environmental impact on organisational innovativeness	170	(2)
Empirical studies of impact of politics and policymaking on organisational innovativeness	172	(3)
Implementation and institutionalisation	175	(24)
Overview of the implementation literature	176	(2)
Measuring institutionalisation and related concepts	178	(2)
Implementation and institutionalisation: systematic reviews and other high-quality overviews	180	(6)
Empirical studies of interventions aimed at strengthening predisposition and capacity of the user system	186	(4)
Empirical studies of interventions aimed at strengthening the resource system and change agency	190	(1)
Empirical studies of linkage activities to support implementation	191	(4)
Empirical studies that have investigated `whole-systems' approaches to implementation	195	(4)
Case studies	199	(20)
Developing and applying a unifying conceptual model	199	(3)
Case study 1: integrated care pathways ('the steady success story')	202	(2)
Case study 2: GP fundholding ('the clash')	204	(2)
Case study 3: telemedicine ('the maverick initiative')	206	(2)
Case study 4: the electronic health record ('the big roll-out')	208	(2)
Conclusion	210	(9)
Discussion	219	(13)
Overview and commentary on main findings	219	(1)
A framework for applying the model in a service context	220	(5)
Recommendations for further research	225	(6)
Conclusion	231	(1)
Appendix 1: Data extraction form	232	(2)
Appendix 2: Critical appraisal checklists	234	(11)
Box A.1 Quality checklist for experimental (randomised and non-randomised controlled trial) designs	234	(1)
Box A.2 Quality checklist for quasi-experimental (interrupted time series) designs	235	(1)
Box A.3 Quality checklist for attribution studies	236	(1)
Box A.4 Quality checklist for questionnaire surveys	237	(1)
Box A.5 Quality checklist for qualitative studies	238	(1)
Box A.6 Quality checklist for mixed-methodology case studies and other in-depth complex designs	239	(1)
Box A.7 Quality checklist for comparison of `real-world' implementation studies	240	(2)
Box A.8 Quality checklist for action research designs	242	(3)
Appendix 3: Descriptive statistics on included studies	245	(10)
Table A.1 Main sources and yield of papers, books and book chapters	247	(1)
Table A.2 Breakdown of studies included in the book	248	(1)
Table A.3 Yield from hand search of journals	249	(3)
Table A.4 Yield from search of electronic databases	252	(2)
Table A.5 Yield from electronic citation tracking	254	(1)
Appendix 4: Tables of included studies	255	(38)
Table A.6 Narrative overviews used as key sources in this review	255	(2)
Table A.7 Empirical studies of attributes of health care innovations in the organisational setting	257	(3)
Table A.8 Empirical studies that focused on the process of adoption in health care organisations	260	(2)
Table A.9 Network analyses of interpersonal influence in health care organisations	262	(1)
Table A.10 Empirical studies of opinion leadership in health care organisations	263	(2)
Table A.11 Controlled trials of opinion leaders as an intervention in health care organisations	265	(2)
Table A.12 Empirical studies of impact of champions in health care organisations and selected other examples	267	(2)
Table A.13 Meta-analyses that addressed the impact of the organisational context on adoption of innovations	269	(2)
Table A.14 Empirical studies of `inner' context determinants of innovation in health care organisations and selected other examples	271	(3)
Table A.15 Empirical studies from health care that looked at the organisational context for innovation from a knowledge utilisation perspective	274	(2)
Table A.16 Empirical studies of informal inter-organisational influence amongst health care organisations and selected other examples	276	(2)
Table A.17 Empirical studies on health care quality improvement collaboratives	278	(2)
Table A.18 Empirical studies of impact of environmental factors on innovation in health care organisations and selected other examples	280	(3)
Table A.19 Empirical studies of impact of political and policymaking forces on organisational innovation	283	(2)
Table A.20 Systematic reviews relevant to the question of dissemination, implementation and sustainability of innovations in service delivery and organisation	285	(2)
Table A.21 Surveys of perceptions about capacity or of association between capacity and implementation in health care organisations	287	(2)
Table A.22 Empirical studies of interventions to enhance user system capacity in health care organisations	289	(2)
Table A.23 `Whole-systems' approaches to implementation and sustainability of innovations in health care organisations and selected other examples	291	(2)
Glossary	293	(3)
References	296	(17)
Index	313