title: Health System-Level Factors Influence the Implementation of Complex Innovations in Cancer Care.
abstract: BACKGROUND
  The movement of new knowledge and tools into healthcare settings continues to be a slow, complex and poorly understood process. In this paper, we present the system-level factors important to the implementation of synoptic reporting tools in two initiatives (or cases) in Nova Scotia, Canada.
  
  
  METHODS
  This study used case study methodology. Data were collected through interviews with key informants, document analysis, non-participant observation and tool use/examination. Analysis involved production of case histories, analysis of each case and a cross-case analysis.
  
  
  RESULTS
  The healthcare system's delivery and support structure, information technology infrastructure, policy environment and history of collaboration and inter-organizational relationships influenced tool implementation in the two cases.
  
  
  CONCLUSIONS
  The findings provide an in-depth, nuanced understanding of how healthcare system components can influence the implementation of a new tool in clinical practice.
authors.affiliation: Assistant Professor, Department of Surgery, Dalhousie University, Halifax, NS.
authors.forename: Robin
authors.initials: R
authors.lastname: Urquhart
authors.affiliation: Professor, School of Health and Human Performance, Dalhousie University, Halifax, NS.
authors.forename: Lois
authors.initials: L
authors.lastname: Jackson
authors.affiliation: Acting Head and Professor, Division of Medical Education Dalhousie University, Halifax, NS.
authors.forename: Joan
authors.initials: J
authors.lastname: Sargeant
authors.affiliation: Professor, Department of Surgery, Dalhousie University, Halifax, NS.
authors.forename: Geoffrey A
authors.initials: GA
authors.lastname: Porter
authors.affiliation: Giblon Professor and Vice Chair, Research, Department of Family and Community Medicine, University of Toronto Toronto, ON.
authors.forename: Eva
authors.initials: E
authors.lastname: Grunfeld
mesh_terms: D002173:Cancer Care Facilities / Q000458:organization & administration*; D003299:Cooperative Behavior; D003695:Delivery of Health Care / Q000458:organization & administration*; D006801:Humans; D017146:Models, Organizational; D009369:Neoplasms / Q000628:therapy*; D009674:Nova Scotia; D019982:Organizational Case Studies; D009936:Organizational Innovation; D018581:Technology Transfer