Innovation adoption and diffusion in nursing: a comparative case study design
Creators: name: Othman, Shokri
Publisher: name: Imperial College London
Year: 2021

description: Background: Innovation adoption and diffusion (IAD) in healthcare refers to the essential process of integrating novel practices into systems’ critical functions. IAD is often slow and unsuccessful, leading to patients not receiving optimal care in a timely manner. IAD research has been dominated by descriptive or prescriptive theories with limited benefit to practice applications; these theories are often simplistic and assume IAD to follow a linear and predictable pathway despite emerging evidence portraying healthcare organisations as complex adaptive systems. Therefore, contemporary IAD research is increasingly shifting in favour of complexity theory replacing linear theories. Nonetheless, nursing research in the field is still trailing behind other disciplines on this shift. Aim: This study applied complexity theory to evaluate the process of innovation adoption and diffusion in frontline nursing practice. Objectives: The study explored why some nursing units succeed in innovation adoption and diffusion while others, within the same organisation, fail. Methodology: Drawing on constructivism, this study applied a theoretical framework built on complexity theory as the grand theory, complex adaptive system (CAS) as the middle-range theory, and Atun’s framework at the micro level. The theoretical framework requires a systems thinking approach capable of exploring the system as a whole rather than a collection of isolated, separate individual components. Design: A Comparative case study design was adopted, forming a 2x2 matrix incorporating two cases with four units of investigation. The two cases were two innovations selected as representatives for the phenomenon of IAD in frontline nursing: WHO 5 Moments for Hand Hygiene (5MHH) and Intentional Nursing Rounding (INR). Each innovation (case) was evaluated through its adoption and diffusion into two comparable units of investigation (wards); a ward of successful adoption and diffusion and an unsuccessful comparator ward. The study deployed multiple data collection methods incorporating non-participatory observation for thirty hours in each unit, and semi-structured interviews with nurses across the nursing hierarchy. Results: The study was able to identify several manifestations of complexity in frontline nursing and demonstrate how these impact adoption and diffusion behaviours. Manifestations of complexity were identified in attributing clinical outcomes to staff compliance; in the discrepancy between evidence, policy, performed, practice, and records; and through the disparity in staff values and priorities across the hierarchy. Existing organisational arrangements of clinical governance (policy design, dissemination, monitoring and clinical documentation) did not facilitate IAD at the frontline. Conclusion: Complexity offers an explanation for the variation in frontline innovation behaviours. Future strategies are recommended to improve IAD in frontline nursing through enhancing the adaptability of the innovation, engaging the informal social communication network, recognising frontline priorities, acknowledging staged and gradual improvement in compliance over time, and maintaining patient interest at the core of all frontline practice innovations.