When the user is not the chooser: learning from stakeholder involvement in technology adoption decisions in infection control
When the user is not the chooser: learning from stakeholder involvement in technology adoption decisions in infection control
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DOI：
10.1016/j.jhin.2012.04.014
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发表时间：
2012-07-01
影响因子：
6.9
通讯作者：
Holmes, A.
中科院分区：
文献类型：
--
作者：
Ahmad, R.;Kyratsis, Y.;Holmes, A.
背景：卫生系统需要高效和有效的创新决策来为患者提供最大利益，特别是在财政紧张的环境下。虽然存在循证创新来帮助解决医疗保健相关感染，但这些创新的接受和实施是高度可变的，在某些情况下非常缓慢。目的：从组织的角度调查创新采用决策和实施过程，重点关注创新过程中利益相关者参与的影响。方法：通过121次定性访谈，对英国12个国家医疗服务机构的38项技术采用决策和实施过程进行了审查。结果：不同组织的利益相关者参与程度不同，决策高度排他于感染预防和控制(IPC)团队，组织成员高度包容。背景，包括组织文化、以前的经验和后勤因素，影响了利益相关者的参与程度。利益攸关方参与这一进程的时机影响到：(1)所考虑的创新的范围；(2)选定的技术；(3)技术实施的成功。不采用、不再采用和成功实施的案例被提出，以分享学习。提出了利益相关者参与的潜在好处，包括一个面向目标的参与框架。结论：关键利益相关者参与可以导致与结构和文化背景兼容的创新采用和实施，特别是当参与跨越启动、决策和实施阶段时。让更广泛的医疗保健组织的成员参与进来可以提高IPC的知名度，并加强使IPC成为每个人的业务的努力。(C)2012年医疗感染学会。爱思唯尔有限公司出版。保留所有权利。
Background: Health systems need efficient and effective innovation decisions to provide maximum benefit to patients, particularly in a climate of financial constraints. Although evidence-based innovations exist for helping to address healthcare-associated infections, the uptake and implementation of these is highly variable and in some cases very slow.Aim: To investigate innovation adoption decisions and implementation processes from an organizational perspective, focusing on the implications of stakeholder involvement during the innovation process.Methods: Thirty-eight technology adoption decisions and implementation processes were examined through 121 qualitative interviews in 12 National Health Service healthcare organizations across England.Findings: Stakeholder involvement varied across organizations with decisions highly exclusive to the infection prevention and control (IPC) team, to highly inclusive of wider organizational members. The context, including organizational culture, previous experience, and logistical factors influenced the level of stakeholder engagement. The timing of stakeholder involvement in the process impacted on: (i) the range of innovations considered; (ii) the technologies selected, and (iii) the success of technology implementation. Cases of non-adoption, discontinued adoption, and of successful implementation are presented to share learning. The potential benefits of stakeholder involvement for 'successful' innovation adoption are presented including a goal-oriented framework for involvement.Conclusions: Key stakeholder involvement can lead to innovation adoption and implementation compatible with structural and cultural contexts, particularly when involvement crosses the phases of initiation, decision-making and implementation. Involving members of the wider healthcare organization can raise the profile of IPC and reinforce efforts to make IPC everybody's business. (C) 2012 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.