title: Determining the predictors of innovation implementation in healthcare: a quantitative analysis of implementation effectiveness.
abstract: BACKGROUND
  The failure rates for implementing complex innovations in healthcare organizations are high. Estimates range from 30% to 90% depending on the scope of the organizational change involved, the definition of failure, and the criteria to judge it. The innovation implementation framework offers a promising approach to examine the organizational factors that determine effective implementation. To date, the utility of this framework in a healthcare setting has been limited to qualitative studies and/or group level analyses. Therefore, the goal of this study was to quantitatively examine this framework among individual participants in the National Cancer Institute's Community Clinical Oncology Program using structural equation modeling.
  
  
  METHODS
  We examined the innovation implementation framework using structural equation modeling (SEM) among 481 physician participants in the National Cancer Institute's Community Clinical Oncology Program (CCOP). The data sources included the CCOP Annual Progress Reports, surveys of CCOP physician participants and administrators, and the American Medical Association Physician Masterfile.
  
  
  RESULTS
  Overall the final model fit well. Our results demonstrated that not only did perceptions of implementation climate have a statistically significant direct effect on implementation effectiveness, but physicians' perceptions of implementation climate also mediated the relationship between organizational implementation policies and practices (IPP) and enrollment (p <0.05). In addition, physician factors such as CCOP PI status, age, radiological oncologists, and non-oncologist specialists significantly influenced enrollment as well as CCOP organizational size and structure, which had indirect effects on implementation effectiveness through IPP and implementation climate.
  
  
  CONCLUSIONS
  Overall, our results quantitatively confirmed the main relationship postulated in the innovation implementation framework between IPP, implementation climate, and implementation effectiveness among individual physicians. This finding is important, as although the model has been discussed within healthcare organizations before, the studies have been predominately qualitative in nature and/or at the organizational level. In addition, our findings have practical applications. Managers looking to increase implementation effectiveness of an innovation should focus on creating an environment that physicians perceive as encouraging implementation. In addition, managers should consider instituting specific organizational IPP aimed at increasing positive perceptions of implementation climate. For example, IPP should include specific expectations, support, and rewards for innovation use.
authors.affiliation: Public Health Research Division, RTI International, 3040 East Cornwallis Road, Post Office Box 12194, Research Triangle Park, NC, 27709-2194, USA. sjacobs@rti.org.
authors.forename: Sara R
authors.initials: SR
authors.lastname: Jacobs
authors.affiliation: Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. weiner@email.unc.edu.|Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. weiner@email.unc.edu.
authors.forename: Bryan J
authors.initials: BJ
authors.lastname: Weiner
authors.affiliation: Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. bbreeve@email.unc.edu.|Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. bbreeve@email.unc.edu.
authors.forename: Bryce B
authors.initials: BB
authors.lastname: Reeve
authors.affiliation: Department of Organizational Behavior, Kenan-Flagler Business School, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. bbreeve@email.unc.edu.
authors.forename: David A
authors.initials: DA
authors.lastname: Hofmann
authors.affiliation: Department of Organizational Behavior, Kenan-Flagler Business School, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. Mike_Christian@kenan-flagler.unc.edu.
authors.forename: Michael
authors.initials: M
authors.lastname: Christian
authors.affiliation: Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. mweinber@email.unc.edu.|Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. mweinber@email.unc.edu.|Center for Health Services Research in Primary Care, Durham Department of Veterans Affairs, Durham, North Carolina, USA. mweinber@email.unc.edu.
authors.forename: Morris
authors.initials: M
authors.lastname: Weinberger
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D003627:Data Interpretation, Statistical; D017598:Efficiency, Organizational / Q000592:standards* / Q000706:statistics & numerical data*; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D054547:National Cancer Institute (U.S.) / Q000592:standards* / Q000706:statistics & numerical data*; D016522:Oncology Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data*; D009936:Organizational Innovation; D010820:Physicians / Q000523:psychology*; D036301:Qualitative Research; D014481:United States