Academy Health Annual Research Meeting 2010
28 June 2010, Boston USA
‘Innovation in the NHS: Insights from
C
Case
Studies
S di on Technology
T h l
Adoption
Ad i
to fight Healthcare Associated
Infections’
Dr Yiannis Kyratsis
Research Fellow
Imperial
p
College
g London
Co-authors: Dr Raleelah Ahmad, Professor Alison Holmes
12 NHS Trusts across all 10 SHAs in England
Definitions




Innovation ((Creative ideas applied)
pp )
Technology (Hardware / Software)
Ad ti (th
Adoption
(the d
decision
i i to
t use))
Implementation (technology in use)
Methodology





Comparative
C
i C
Case studies
di – 12 NHS Trusts
T
Qualitative - semi-structured interviews: 90
Secondary data
Follow up through to implementation phase
Sample: Multi-level, multi-stakeholder, management
and
d practice:
i CEO
CEO, DIPC  microbiologists,
i bi l i
biomedical scientists, nurses (IP & specialities),
estates
Framework for Analysing the Adoption
off Health Innovations
Macro-Context
Communication
Individual
Innovation
Adopter
Organisation
Health System
Kyratsis
K
t i & Atun,
At
2005
Atun, Kyratsis et al, 2007
Findings: Selected Technologies
1 technology
t h l
2 technologies
t h l i
3 or more
technologies
g
Total = 39 technology
selections
3 HPA RRP1
technologies were
selected by 6 trusts
Technologies by Priority Area
0
Areas o
of priority
y
Environmental Hygiene
ICT
Patient Hygiene
Training
Diagnostics
Hand Hygiene
Medical Devices Hygiene
Antibiotic Prescribing
Catheter Care
2
4
6
8
10
12
14
16
18
20
Factors important in decision making






Information, Knowledge and Communication of the
Information
innovation
‘E id
‘Evidence’
’
Attributes of the innovation
Organisation type
The decision making process
Institutional Conditions
Innovation Knowledge
Awareness
knowledge
Professional networks
Principles /theory
knowledge
Professional networks / Peer
expertise
Rapid Review Panel (RRP1)
How to
knowledge
Suppliers
Other Trusts
Peer review journals
Trust Staff
Showcase
S
Suppliers
li
Patients
RRP1
S
Supplier
li marketing
k ti
Showcase hospitals
(Rogers, 2003)
Previous experience
(success/failure)
‘How
How to’
to knowledge gap
Technology
‘How to’ knowledge gap
Ultrasonic cleaning tanks
Extent of time savings on manual
cleaning; process of re-filling tanks;
situating tanks; power supply
1-2 hour PCR testing for MRSA
Training and quality control for ward
based V restricted service with a lab
based
Hydrogen Peroxide Vapour System
Decant facilities
Sources & Types of ‘evidence’
Types of
Evidence
Theoretical
Key Questions
Sources of Evidence
How and Why does it work?
What is the logic/underlying
theory & principles?
Peer review journals / Literature
Professional Networks / Expert opinion
Suppliers
Rapid Review Panel (RRP1)
Empirical
When, for Whom and How Well
does it work? What does it cost?
Professional networks
Suppliers
Other Trusts
Previous experience
p
(success/failure)
(
/
)
Showcase Hospitals
Experiential
What is it like to use? What has
been learnt from its application
across settings/contexts?
Previous Experience of Staff/Trust with
the same or similar technology
Other Trusts
Trial / Pilot
Showcase Hospitals
p
(Glasby, 2006; Walshe, 2009)
Innovation Attributes






Costs (Initial – Ongoing)
Sustainability
Compatibility (structural)
Scope to evaluate
Strength of evidence
Scope of intervention – i.e. trust wide or speciality
specific
Organisational Type and Decision Making
Teaching trusts perceived selves as innovation
leaders – however they also perceived the NHS
innovation field as ‘confusing’ and felt ‘excluded’
Constraints of PFI Trusts – early engagement was
required barrier to adoption of certain technologies
required,
Size and
S
d Complexity
C
l
– Trust
T
2
2: contrast btw.
b two
sites
Process of Decision Making
Predetermined
Inclusive
Exclusive
Emergent
Extreme Cases: Selected Technologies
& Trust IPC Strategy
1.
Formal and highly inclusive decision making
process - Trust 3 - addressed 4 priority areas with 6
technologies. Mix of pre-determined and emergent
t h l i
technologies
2.
Formal and highly exclusive decision making
process – Trust 4 – addressed 1 priority area with 1
technology. Predetermined technology.
Multi-level
Multi
level Dynamics
IInter-organisational:
i i
l
Policy, legislation, mandatory surveillance, reporting
framework national targets,
framework,
targets professional associations
• Organisational:
pro-innovation culture,, academic rigour,
p
g , leaders,, ‘transforming
g
IPC role: from narrow technical to general and strategic’,
organisational tradition, Trust policies/strategies, profile and
membership of IPC team, departmental budgets
• Individual:
g IPC role: from narrow technical to general
g
and
‘Transforming
strategic’, ‘champion’, ‘resident expert’, ‘boffin’, ‘clinical
leader’, ‘pro-scientific evidence’ Vs ‘technology in use’
attitudes
•
Interactions & Multi-level Dynamics –
Trust 3
Macro-Context
Ergonomics,
h lth & safety
health
f t
Endoscopy
sinks
Communication
Users: Nurses
Nurses,
nurse auxiliaries
/
Endoscopy Unit
Clinical
governance
lead –
project lead
Individual
Innovation
Adopter
PFI
Foundation
Organisation
Accreditation
A
dit ti
Requirements
Health System
Kyratsis & Atun, 2005
Atun, Kyratsis et al, 2007
Procurement
Methods
Management
NHS supply chain
Trust wide clinical procurement
specialist
Local procurement office
Procurement Action Groups
Direct to supplier
o
o
o
Understanding of the procurement process
Early engagement of procurement team is important
Emerging models
Implications
Challenges
Enablers
Trust type
g
y framework
Regulatory
Performance targets
g of funding
g
Nature and timing
Procurement support & engagement
g & ‘past
p experience’
p
with
‘Trust learning’
innovations is important for future
p
decisions
adoption
Implications


Innovation adoption – A holistic picture of innovation
adoption
d
drivers
d
and
d barriers
b
taking
k into account
multiple interactions and multi-level influences
When Introducing Innovations - Broad and Detailed
A l
Analysis
off M
Multilevel
l l l Dynamics is needed
d d ((in contrast to
initiatives informed by simplistic situational analysis)
References



Atun, R.A. Kyratsis,I., Jelic,G., Rados-Malicbegovic, D & Gurol-Urganci, I. (2007) Diffusion of
complex health innovations - implementation of primary health care reforms in Bosnia and
Herzegovina, Health Policy and Planning (22), 28-39
Glasby, J. and Beresford, P. (2006) Who knows best? Evidence-based practice and the
service user contribution, Critical Social Policy, 26(1), 268-284
Kyratsis, Y. & Atun, R. (2005), Discussion Paper Centre for Health Management Imperial
College Business School

Rogers, E (2003) Diffusion of Innovations 5th Edition, Free Press

Walshe, K., (2009), International Journal for Quality in Health Care, 21(3): 153
Acknowledgments
The project has been funded by the
Department of Health
We are
a e also
a so deeply
deep y grateful
g a e u too all
a those
ose
who voluntarily participated in the study
across the
th 12 NHS Trusts
T t