New Guide Charts Course for Navigating Challenges of Innovation Adoption
The AHRQ Health Care Innovations Exchange (HCIE) aims to “accelerate the development and adoption of innovations in health care delivery” to improve quality and performance. While it is widely acknowledged that developing innovations can be enormously challenging, less attention is paid to the considerable amount of management knowledge, skill, and experience required to decide whether and how to adopt an innovation that has been developed elsewhere.
Not every innovation that works in one organization will succeed in another. Implementing innovations in health care delivery can be particularly difficult. The process is full of risks and typically requires significant organizational change. Health care organizations considering adopting innovations must carefully think through and pay sustained attention to a broad range of internal and external factors that can affect the implementation process.
Given this complexity, the decision about whether to adopt an innovation requires a methodical and comprehensive approach—from the initial information gathering and assessment of organizational fit with the innovation—to anticipating its implementation, refinement, and institutionalization. A growing set of tools designed to assist with these processes are found in HCIE's Articles & Guides section.
AHRQ's new guide to adopting innovations, Will It Work Here? A Decisionmaker's Guide to Adopting Innovations, is an important contribution to these materials. It offers systematic guidance for the full range of considerations required to select appropriate health care delivery innovations and plan for their adoption. Individual sections of the Guide address tasks such as assessing the suitability of innovations and an organization's readiness, and planning and executing implementation. The Guide recognizes the complexity inherent in the adoption process and the large number of factors that influence adoption decisions and the ultimate outcomes achieved.
The unique structure and format of the Guide are particularly well-suited to the challenges of innovation adoption. The Guide contains four separate modules, each encompassing a range of questions and issues that must be addressed when considering adoption of an innovation. While interrelated, the modules are largely independent and can be used in any sequence. In fact, the dynamic nature of the adoption process suggests that each module be used in an iterative manner as the process plays out and the unique outcomes become known from implementing the innovation in a given situation. The effects of most health care delivery innovations are highly dependent on local circumstances, the specific management and implementation processes employed in their adoption, and the unique adaptations and modifications made to the innovation (and the environmental context in which it is implemented) over time.
In fact, changes to the innovation and the environmental context may affect the answers to key questions such as “What are the potential benefits of the innovation?” (Module II). As a result, these questions must be revisited periodically. Answers to many of the questions involved in innovation adoption may depend more on characteristics of the implementation and management processes than on the innovation itself, and therefore will change as adoption processes unfold. An individual stakeholder's support for an innovation (Module III), for example, may depend on that stakeholder's assessment of the expected benefits. Positive attitudes and expectations about benefits can cause stakeholders to support adoption and contribute to success. Similarly, negative expectations can become a self-fulfilling prophecy, as key stakeholders withhold support and intentionally or unintentionally hinder implementation. The Guide offers valuable guidance in identifying key features of the implementation context, and in managing the adoption process to maximize the likelihood of success. The Guide offers valuable guidance in identifying key features of the implementation context, and in managing the adoption process to maximize the likelihood of success.
The Guide also offers valuable advice by advocating time-limited, small-scale, and/or phased implementation of an innovation, as well as continuous monitoring and corrective action whenever needed (Module IV). These strategies are critically important given the significant impact that environmental context has on an innovation's success. Many innovations have achieved success in specific settings but not others. Thus evidence regarding an innovation's impacts in the past may be of limited relevance to would-be adopters. Module IV of the Guide is particularly valuable in guiding incremental decisions based on local evidence and circumstances.
Health care leaders considering the adoption of innovations contained in the HCIE should take the time to thoroughly study the Guide, including the referenced tools and sources and revisit it throughout the adoption process. The Guide is a valuable companion and road map that, together with prior experience and skilled leadership, should increase the benefits realized from the adoption of innovations and help avoid costly mistakes.
About Brian Mittman, PhD
Brian Mittman is the past director of (and current senior adviser to) the VA Center for Implementation Practice and Research Support and a senior scientist at the Kaiser Permanente Southern California Department of Research and Evaluation. He is Editor-in-Chief Emeritus of the journal Implementation Science (http://www.ImplementationScience.com) and has affiliations with the RAND Health Program and UCLA School of Medicine. His research interests include implementation science, health care quality improvement, and health care management.
Disclosure Statement: Dr. Mittman was a consultant to the RTI project team that helped develop the Guide and provided input on a draft.