Patient-centered innovation in health care organizations: a conceptual framework and case study application.
BACKGROUND
Patient-centered innovation is spreading at the federal and state levels. A conceptual framework can help frame real-world examples and extract systematic learning from an array of innovative applications currently underway. The statutory, economic, and political environment in Washington State offers a special contextual laboratory for observing the interplay of these factors.


OBJECTIVE
We propose a framework for understanding the process of initiating patient-centered innovations-particularly innovations addressing patient-centered goals of improved access, continuity, communication and coordination, cultural competency, and family- and person-focused care over time. The framework to a case study of a provider organization in Washington State actively engaged in such innovations was applied in this article.


METHODS
We conducted a selective review of peer-reviewed evidence and theory regarding determinants of organizational change. On the basis of the literature review and the particular examples of patient-centric innovation, we developed a conceptual framework. Semistructured key informant interviews were conducted to illustrate the framework with concrete examples of patient-centered innovation.


RESULTS
The primary determinants of initiating patient-centered innovation are (a) effective leadership, with the necessary technical and professional expertise and creative skills; (b) strong internal and external motivation to change; (c) clear and internally consistent organizational mission; (d) aligned organizational strategy; (e) robust organizational capability; and (f) continuous feedback and organizational learning. The internal hierarchy of actors is important in shaping patient-centered innovation. External financial incentives and government regulations also significantly shape innovation.


CONCLUSIONS
Patient-centered care innovation is a complex process. A general framework that could help managers and executives organize their thoughts around innovation within their organization is presented.
Department of Health Services, School of Public Health, University of Washington, Seattle, USA. seh315@uw.edu
Susan E
SE
Hernandez
Douglas A
DA
Conrad
Miriam S
MS
Marcus-Smith
Peter
P
Reed
Carolyn
C
Watts
D001291:Attitude of Health Personnel; D017598:Efficiency, Organizational; D006801:Humans; D007857:Leadership; D017146:Models, Organizational; D019982:Organizational Case Studies; D015279:Organizational Culture; D009936:Organizational Innovation; D009937:Organizational Objectives; D018802:Patient-Centered Care / Q000592:standards*; D011361:Professional Competence; D011785:Quality Assurance, Health Care / Q000592:standards*; D013192:Staff Development; D014861:Washington