Innovation in an Evidence Based Culture

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Innovation in an Evidence Based Culture

• Alison Kitson, PHD RN FRCN
• Supernumerary Fellow
• Green College, University of Oxford.
• Formerly Executive Director of Nursing
• Royal College of Nursing UK
• alison.kitson_at_green.ac.uk
• alk23_at_btinternet.com

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Objectives

• Share some of the conceptual challenges around
  the research agenda

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Innovation purposeful and organised search for
changes and systematic analysis of opportunity
such changes offer Drucker 1985
Entrepreneurial Society
Entrepreneurship
Public Sector
Innovation
Profession
Nursing
Profession
Public Sector
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Rogers stages of diffusion of innovations

• Idea
• Development
• Testing
• Adoption
• Distribution

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• Innovation Development and implementation of new
  ideas by people who, over time, engage in
  transactions with others within an institutional
  order. (Van de Ven et al 1999)

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Managing organisational ownership
Managing Processes Structure
Managing People
Innovation
Managing Ideas
IDEA
Implementation
Institution
Managing People
Managing Processes Structure
Managing organisational ownership
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From ideas to implementation Managing IDEAS
Becomes a political imperative gaining influence,
resources, legitimacy
Sloganise them - Emotional Meaning - Energy
Networks - lobbying groups - galvanized around
new ideas
Surface - Energy - Public Consciousness
New Appreciation
Opportunity / problem
Adapted Schon 1971
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Successful Innovation
The Innovation Journey
Implement / Termination period
Development period
B

• Constant Adoption / re-adaptation of old to new
• Visible Culture Change

• Getting Support from top management
• Building Alliances
• Networking Externally

Initiation Period

• Proliferation
• Set backs
• Changing Goal Post
• Team Very Fluid

• Shock

• Planning

• Gestation

Status Quo
A
Key Components of the Innovation Journey
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Van de Ven et al 1999
Context
Divergent Behaviour
Convergent Behaviour

• Launching
• Learning
• Leading
• Relationship building
• Infrastructure development

Context
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Institutional Leadership Roles in Innovation
Responsive Open
Innovator
mentor
Supportive
Risk
Flexible
Group Facilitator
Broker
Co-operative Team
Long-Term Internal
Dynamic competitive
Short- Term External
Producer
Monitor
Control
Co-ordinator
Goal
Cautious
Director
Structured Formal
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Innovation and evidence based practice
Innovation a novel set of behaviours,
routines and ways of working that are directed at
improving health outcomes, administrative
efficiency, cost effectiveness or users
experience and that are implemented by planned
and co-ordinated action
Source Greenhalgh et al 2004
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Context / culture
Medical Sociology
Structure
Rural Sociology
Networks
Organisations
Individuals
K.U
Common Studies
Complexity Studies
Narrative Studies
Marketing
Diffusion of innovations
Individual / Organisation
Evidence base medical studies
Development Studies
Health Promotion
Guidelines
Adapted from Greenhalgh et al, 2004
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User System
Resource System
Innovation
The people who make it happen
Dissemination
Diffusion
Facilitators / Facilitation Process
Adapted from Greenhalgh et al, 2004
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? Facilitators
? Practice Development
Network Structure
Facilitators/ Facilitation Process
Formal Dissemination Processes
Homophily
Opinion Leaders
Boundary Spanners
Champions
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The PARIHS Framework

• SI f (E,C,F)
• Successful implementation is a function of the
  relation between
• the nature of the evidence (E)
• the context (C) or environment in which the
  proposed change is to be implemented
• the way or method by which the change is
  facilitated (F)

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Relation between Evidence Context
(where evidence is high)

• PHY Graphics

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High
Evidence
Low
High
Context

• PHY Graphics

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PARIHS Framework

• Hypothesis to be tested
• The PARIHS Framework is best utilised as a two
  stage process as a preliminary (diagnostic and
  evaluative) measure of the elements and
  sub-elements of E and C and then using the
  aggregated data to determine the most appropriate
  facilitation intervention.

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Evidence (strong)
C4
Ideal position
C2
Context (strong)
Context (weak)
C3
C1
Evidence (weak)
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Getting beneath the black box

• What if we looked for explanations and
  interpretations instead of causal relationships?
• what if the intervention (composite bespoke
  facilitation programme) became its own theory to
  be tested?