Health Care Organizations Require Different Tactics To Implement Change

MedicaIngrid Nembhard, PhD, MS Associate Professor, Yale School of Public Health & Yale School of Management Associate Director, Health Care Management Program Interview with:
Ingrid M. Nembhard PhD MS
Yale University
New Haven, CT

Medical Research: What is the background for this study? What are the main findings?

Dr. Nembhard: Many health care organizations (hospital, medical groups,  etc.) have sought to address well-documented quality problems by implementing evidence-based innovations, that is, practices, policies, or technologies that have been proven to work in other organizations. The benefits of these innovations are often not realized because adopting organizations experience implementation failure—lack of skillful and consistent use of innovations by intended users (e.g., clinicians). Past research estimates that implementation failure occurs at rates greater than 50% in health care. The past work also shows organizational factors expected to be facilitators of implementation are not always helpful.

In this work, we examined a possible explanation for the mixed results: different innovation types have distinct enabling factors. Based on observation and statistical analyses, we differentiated role-changing innovations, altering what workers do, from time-changing innovations, altering when tasks are performed or for how long. We then examined 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 of 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.

Medical Research: What should clinicians and patients take away from your report?

Dr. Nembhard: For clinicians, patients, and others leading implementation efforts, our results indicate the importance of considering the nature of the innovation to be implemented, and specifically the change that it brings for workers, when selecting organizational factors to leverage in service of implementation. Some factors will be more effective than others because of the type of innovation. Our findings provide insights that can help health care organizations to implement innovations successfully, resulting in better quality of care for patients.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Nembhard: Given our findings, implementation research should consider innovations’ change for workers as it moves forward. It should also examine the interaction of organizational factors, as we found that the effectiveness of senior management engagement and network membership for the implementation of time-changing practices was influenced by the presence of the other. Providing additional insight about strategies for implementing different types of innovations is the next stage of implementation and improvement research.


Implementing Role-Changing Versus Time-Changing Innovations in Health Care

Differences in Helpfulness of Staff Improvement Teams, Management, and Network for Learning

Nembhard IM1, Morrow CT2, Bradley EH2.
Med Care Res Rev. 2015 Jun 26. pii: 1077558715592315.

[wysija_form id=”3″]


Ingrid M. Nembhard PhD MS Yale University (2015). Health Care Organizations Require Different Tactics To Implement Change 

Last Updated on July 1, 2015 by Marie Benz MD FAAD