Implementation of a Clinical Innovation: The Diffusion of Advanced Clinic Access In VA Authors: Caro

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Implementation of a Clinical Innovation The
Diffusion of Advanced Clinic Access In
VAAuthors Carol VanDeusen Lukas, Mark M.
Meterko, David Mohr, and Marjorie Nealon
SeibertDiscussant Ann Scheck McAlearney,
Sc.D.Division of Health Services Management
Policy, School of Public Health, The Ohio State
UniversityHealth Care Organizations Conference
7Virginia Commonwealth UniversityJune 2005
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A SNOT Analysis

• Strengths
• Needed Improvements
• Opportunities
• Threats

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Strengths

• Well written, clear
• Based on extensive observational study
• Robust prediction models
• Interesting, thorough organizational study

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Needed Improvements

• Additional issues of concern
• Discussion of leadership support, role of leaders
• What is leadership?
• Leadership vs. management
• Discussion of role of physicians
• More specifics about how MDs were/were not
  involved in spread activities
• Suggestions/recommendations for the future?
• Other issues of facility context?
• Disease management activities, triage
  capabilities, others?
• Specifics in discussion of generalizability
• Generalizability of this research question and
  factors
• Local vs. national VA issuescomparison to
  outside VA?

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Opportunities

• Application of Complexity Theory
• Miller, Crabtree, McDaniel, Stange 1998
• Miller, McDaniel, Crabtree, Stange 2001
• Organizational Change Models
• Stages of Change Models e.g., Smith and
  Kaluzny, 1986 (awareness, identification,
  implementation, institutionalization)
• Dynamic Change Management Models e.g.,
  Orlikowski and Hofman, 1997 (anticipated change,
  emergent change, opportunity-based change)
• Longitudinal Perspective
• Factors contributing to sustaining innovative
  clinical practices (e.g., Greenhalgh et al.,
  2004implementation vs. routinization in
  diffusion)

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Threats

• Limits of Outcome Measure
• Extent of ACA implementation
• Connection to actual outcomes?
• Application to Practice?
• VA setting
• Complicated nature of intervention
• Limits of Advanced Clinic Access Model
• Limits of Key Change Principles Matrix
• Implementation of innovation vs. innovativeness?

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Summary

• A very nice paper
• And now what.?

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References

• Miller WL, Crabtree BF, McDaniel RR, Stange KC.
  1998. Understanding Change in Primary Care
  Practice Using Complexity Theory. Journal of
  Family Practice. 46(5) 369-376.
• Miller WL, McDaniel RR, Crabtree BF, Stange KC.
  2001. Practice Jazz Understanding Variation
  in Family Practice Using Complexity Science.
  Journal of Family Practice. 50(10) 872-878.
• Orlikowski, W, and D Hofman. 1997. An
  improvisational model for change management the
  case of groupware technologies. Sloan Management
  Review 38 (2)11-21.
• Smith, D., and A. Kaluzny. 1986. The White
  Labyrinth. Chicago, IL Health Administration
  Press.