title: Implementing Role-Changing Versus Time-Changing Innovations in Health Care: Differences in Helpfulness of Staff Improvement Teams, Management, and Network for Learning.
abstract: Health care organizations often fail in their effort to implement care-improving innovations. This article differentiates role-changing innovations, altering what workers do, from time-changing innovations, altering when tasks are performed or for how long. We examine our hypothesis that the degree to which access to groups that can alter organizational learning--staff, management, and external network--facilitates implementation depends on innovation type. Our longitudinal study using ordinal logistic regression and survey data on 517 hospitals' implementation of evidence-based practices for treating heart attack confirmed our thesis for factors granting access to each group: improvement team's representativeness (of affected staff), senior management engagement, and network membership. Although team representativeness and network membership were positively associated with implementing role-changing practices, senior management engagement was not. In contrast, senior management engagement was positively associated with implementing time-changing practices, whereas team representativeness was not, and network membership was not unless there was limited management engagement. These findings advance implementation science by explaining mixed results across past studies: Nature of change for workers alters potential facilitators' effects on implementation.
authors.affiliation: Yale University, New Haven, CT, USA Yale School of Management, New Haven, CT, USA ingrid.nembhard@yale.edu.
authors.forename: Ingrid M
authors.initials: IM
authors.lastname: Nembhard
authors.affiliation: Yale University, New Haven, CT, USA.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Morrow
authors.affiliation: Yale University, New Haven, CT, USA.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Bradley
mesh_terms: D003695:Delivery of Health Care / Q000592:standards*; D004059:Diffusion of Innovation; D058016:Health Facility Administration; D006801:Humans; D008137:Longitudinal Studies; D015279:Organizational Culture; D058996:Quality Improvement; D013192:Staff Development
keywords: frontline staff; hospitals; implementation; networks; organizational change; organizational learning; quality improvement team; roles; senior management