title: Multi-level factors influence the implementation and use of complex innovations in cancer care: a multiple case study of synoptic reporting.
abstract: BACKGROUND
  The implementation of innovations (i.e., new tools and practices) in healthcare organizations remains a significant challenge. The objective of this study was to examine the key interpersonal, organizational, and system level factors that influenced the implementation and use of synoptic reporting tools in three specific areas of cancer care.
  
  
  METHODS
  Using case study methodology, we studied three cases in Nova Scotia, Canada, wherein synoptic reporting tools were implemented within clinical departments/programs. Synoptic reporting tools capture and present information about a medical or surgical procedure in a structured, checklist-like format and typically report only items critical for understanding the disease and subsequent impacts on patient care. Data were collected through semi-structured interviews with key informants, document analysis, nonparticipant observation, and tool use/examination. Analysis involved production of case histories, in-depth analysis of each case, and a cross-case analysis. Numerous techniques were used during the research design, data collection, and data analysis stages to increase the rigour of this study.
  
  
  RESULTS
  The analysis revealed five common factors that were particularly influential to implementation and use of synoptic reporting tools across the three cases: stakeholder involvement, managing the change process (e.g., building demand, communication, training and support), champions and respected colleagues, administrative and managerial support, and innovation attributes (e.g., complexity, compatibility with interests and values). The direction of influence (facilitating or impeding) of each of these factors differed across and within cases.
  
  
  CONCLUSIONS
  The findings demonstrate the importance of a multi-level contextual analysis to gaining both breadth and depth to our understanding of innovation implementation and use in health care. They also provide new insights into several important issues under-reported in the literature on moving innovations into healthcare practice, including the role of middle managers in implementation efforts and the importance of attending to the interpersonal aspects of implementation.
authors.affiliation: Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada. urquhartr@cdha.nshealth.ca.
authors.forename: Robin
authors.initials: R
authors.lastname: Urquhart
authors.forename: Geoffrey A
authors.initials: GA
authors.lastname: Porter
authors.forename: Joan
authors.initials: J
authors.lastname: Sargeant
authors.forename: Lois
authors.initials: L
authors.lastname: Jackson
authors.forename: Eva
authors.initials: E
authors.lastname: Grunfeld
mesh_terms: D003625:Data Collection; D004059:Diffusion of Innovation; D006801:Humans; D007407:Interviews as Topic; D008495:Medical Oncology / Q000379:methods / Q000458:organization & administration; D009369:Neoplasms / Q000628:therapy*; D009674:Nova Scotia; D019982:Organizational Case Studies; D009936:Organizational Innovation; D012107:Research Design; D057170:Translational Research, Biomedical / Q000379:methods