Disseminating Health Care Innovations

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Disseminating Health Care Innovations

• Pamela Kiser MS, RN

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Research Base and Health Care

• Best Drugs
• Best Surgical strategies
• Best Diagnostic strategies
• Proven Clinical Guidelines

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The Majority of this Scientific Knowledge remains
unused!

• As stated in the Institute of Medicine report
  Crossing the Quality Chasm
• Between the health care we have and the care we
  could have lies not just a gap, but a chasm.

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Failing to use available science is

• Costly and harmful
• Leads to overuse of unhelpful care
• Under use of effective care
• and, errors in execution of care

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Results in Patient Safety

• Serious medication errors occur in 7 out of 100
  hospitalizations
• 80,000 unnecessary hysterectomies/year
• 500,000 unnecessary Cesarean deliveries/year
• 1 in 5 elderly myocardial infarction survivors
  receives appropriate medications to prevent a
  reoccurance.

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Patient Safety NEJM/June 26, 2003

• Patients received half of the recommended
  processes involved in the care of their chronic
  conditions.
• These processes where closely correlated to
  preventable death or disability. For example,
  64 of the elderly participants received a
  pneumococcal vaccine. Nearly 10,000 deaths could
  be avoided annually with this vaccine.

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Diffusions of InnovationsEverett Rogers

• Perceptions of the innovation
• Characteristics of the people who adopt the
  innovation
• Contextual factors, especially involving
  communication, incentives, leadership, and
  management.

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Perceived benefits of the change.

• Most likely to adopt if it benefits me
• Risk vs. gain
• To diffuse rapidly, it must be compatible with
  values, beliefs, past history/ training.
• Why reduce C-section rates if they are clinically
  acceptable and they reduced malpractice exposure?
• The rate of diffusion is directly correlated to
  the complexity of the proposed innovation.

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Adopters of change

• Innovators in healthcare are considered weird
  or incautious, or may be heavily invested in a
  specialized topic.
• Early adopters leaders of clinical groups, very
  social, watched by others.
• Early Majority they need innovations to meet
  their immediate needs, not just be interesting.
• Late Majority Is it safe yet? Adopted only
  after local adoption.
• Laggards I have always done it like that.

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Rule 1 Find Sound Innovations

• Health care is well published. Use it.
• (but who is paying attention?)
• Restraint Reduction Initiative

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Rule 2 Find and Support Innovators

• Novel ideas most frequently come from those not
  imbedded in the system.
• Warning! They can be abrasive, not invested in
  the local networks, and demanding of latitude.

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Rule 3 Invest in Early Adopters

• Internal nurse/champions
• Need slack time and resources to try out new
  things and to reduce their uncertainty through
  small scale trails

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Rule 4 Make it possible to observe the early
adopters.

• Case presentation (how to apply the innovations,
  how did it work, let the early majority learn
  from their mistakes.

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Rule 5 Trust and enable Reinvention

• Take this great idea and make it work here!
  Recognize it will not look the same at the
  implementation point.

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Rule 6 Create room for change

• Time
• Money
• Energy
• Emotional support

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What do we need?

• Easy retrieval of patient information
• IT systems that integrate patient data and are
  constantly updated, minute by minute.
• Health information report cards available and
  readable to the public.
• Establishing a national baseline for performance
  of health care and
• Hold providers of care accountable.

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