Innovation and motivation in public health professionals

Employee-Driven Innovation in Health Organizations: Insights From a Scoping Review

BACKGROUND

Employee-driven innovation (EDI) occurs when frontline actors in health organizations use their firsthand experience to spur new ideas to transform care. Despite its increasing prevalence in health organizations, the organizational conditions under which EDI is operationalized have received little scholarly attention.

METHODS

This scoping review identifies gaps and assembles existing knowledge on four questions: What is EDI in health organizations and which frontline actors are involved? What are the characteristics of the EDI process? What contextual factors enable or impede EDI? And what benefits does EDI bring to health organizations? We searched seven databases with keywords related to EDI in health organizations. After screening 1580 studies by title and abstract, we undertook full-text review of 453 articles, retaining 60 for analysis. We performed a descriptive and an inductive thematic analysis guided by the four questions.

RESULTS

Findings reveal an heterogeneous literature. Most articles are descriptive (n = 41). Few studies are conceptual and empirical (n = 15) and four are conference papers. EDI was often described as a participatory, learning innovation process involving frontline clinical and non-clinical staff and managers. Majority EDI were top-down, often driven by the organization's focus on participatory improvement and innovation and research-based initiatives. Five categories of methods is used in top-down EDI, two thirds of which includes a learning, a team and/or a digital component. Hybrid EDI often involves a team-based component. Bottom-up EDI emerged spontaneously from the work of frontline actors. Enablers, barriers, and benefits of EDI are seen at macro, organizational, team and individual levels; some benefits spread to other health organizations and health systems.

CONCLUSION

This scoping review provides a comprehensive understanding of the organizational conditions under which EDI is operationalized. It offers insights for researchers, health organizations, and policy-makers about how and why frontline actors' involvement is crucial for the transformation of care.

Factors contributing to innovation readiness in health care organizations: a scoping review

Background

Increasing innovation readiness of healthcare organizations is necessary to meet upcoming challenges, including population aging, staff shortages and reduced funding. Health care organizations differ in the extent to which they are innovation ready. This review aims to clarify the concept of innovation readiness and identify which factors contribute to innovation readiness in health care organizations.

Methods

A scoping review was conducted based on the framework from Arksey and O’Malley. PubMed/MEDLINE, CINAHL and Web of Science were searched for studies that (a) aimed to contribute to scientific knowledge about innovation readiness of health care organizations, (b) were peer-reviewed, (c) reported empirical data and (d) were written in English, Dutch or German. Factors researched in the included studies were bundled into 4 overarching main factors and 10 sub-factors.

Results

Of the 6,208 studies identified, 44 were included. The majority (n = 36) of the studies had been conducted since 2011 and almost half of the studies (n = 19) were performed in hospitals. Of the 44 studies, 21 researched factors contributing to innovation readiness in the implementation stage of the innovation process. The authors used a variety of words and descriptions addressing innovation readiness, with hardly any theoretical frameworks for innovation readiness presented. Four main factors and 10 sub-factors contributing to the innovation readiness of health care organizations were summarized: strategic course for innovation, climate for innovation, leadership for innovation and commitment to innovation. Climate for innovation (n = 16) was studied the most and individual commitment to innovation (n = 6) was the least studied.

Conclusion

Our study identified four main factors contributing to the innovation readiness of health care organizations. Research into innovation readiness of health care organizations is a rather new field. Future research could be directed towards defining the concept of innovation readiness and the development of a framework for innovation readiness. More understanding of the interplay of factors contributing to innovation readiness in all stages of the innovation process and in diverse health care settings can support health care managers to structurally embed innovation. This review contributes to the first stage of theory building on factors contributing to innovation readiness of health care organizations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08185-x.

Centralization and innovation: Competing priorities for health systems?

Over the last 15 years, there has been a trend in Canada to centralise the provision of health services that were previously administratively and fiscally decentralised. Canadian policy rhetoric on centralisation often identifies improved innovation as an anticipated outcome. This paper challenges the assumed relationship between centralisation and innovation. We incorporate evidence from the management literature into the debate on the structure of health systems to explore the effects that centralisation is likely to have on innovation in health systems. The findings of this paper will be of interest to international policymakers, who are currently grappling with the prospect of maintaining a decentralised approach or adopting a more centralised health system structure in the future.

Health system policy rhetoric often assumes centralisation promotes innovation.

Management research suggests centralisation negatively influences innovation.

Innovation requires front‐line and middle manager input in decision‐making.

Policy goals should be informed by interdisciplinary evidence.

Creativity in the South Korean Workplace: Procedural Justice, Abusive Supervision, and Competence

Innovation is now a feature of daily life. In a rapidly changing market environment and amid fierce competition, organizations pursue survival and growth through innovation, and the key driver of innovation is the creativity of employees. Because the value of creativity has been emphasized, many organizations are looking for effective ways to encourage employees to be creative at work. From a resource perspective, creativity at work can be viewed as a high-intensity job demand, and organizations should encourage it by providing and managing employee resources. This study is an attempt to empirically investigate how competence and abusive supervision affect the relationship between procedural justice and creativity from the conservation of resources perspective. Findings from two-wave time-lagged survey data from 377 South Korean employees indicate that procedural justice increases creativity through the mediation of competence. Furthermore, abusive supervision has a negative moderating effect on the relationship between procedural justice and competence. The findings show that competence moderates the relationship between procedural justice and creativity and that the lower the level of abusive supervision, the greater the effect of procedural justice on competence and creativity.

Innovative Behavior in the Workplace: An Empirical Study of Moderated Mediation Model of Self-Efficacy, Perceived Organizational Support, and Leader-Member Exchange

Recently, most organizations, from for-profit organizations to nonprofit organizations, are facing a rapidly changing environment and increased uncertainty. Organizational performance now depends on quickly responding and overcoming change through employees’ innovative behavior. As the importance of innovative behavior has been highlighted, many organizations are looking for effective ways to encourage employees to adopt innovative behavior. From the resource perspective, innovative behavior can be regarded as high-intensity job demand, and organizations should support innovative behavior by providing and managing employees’ resources. Based on the conservation of resource perspective, this study attempted to empirically explore how self-efficacy and perceived organizational support affect the relationship between leader–member exchange (LMX) and innovative behavior. Using two-wave, time-lagged survey data from 337 employees in South Korea, we found that leader–member exchange enhances innovative behavior via the mediation of self-efficacy. Additionally, perceived organizational support positively moderates the relationship between leader–member exchange and self-efficacy. Our findings demonstrate that self-efficacy is a mediating mechanism in the relationship between leader–member exchange and innovative behavior. Furthermore, this study suggests that the higher the level of perceived organizational support, the greater the effect of leader–member exchange on innovative behavior affected by self-efficacy.

Conceptualising employee involvement in service innovation: an integrative review

Purpose

Employees are considered as important contributors to service innovation, but the literature is not unanimous about what employee involvement in service innovation entails. To advance theoretical understanding of the topic, this paper develops a conceptual framework for analysing employee involvement in service innovations, reviews existing research on the topic and proposes a research agenda.

Design/methodology/approach

Different modes of employee involvement in service innovation are distinguished based on two dimensions: (1) the intensity of employee influence on service innovation and (2) the breadth of the innovation activity in which employees are involved. This conceptual framework is abductively developed through a literature review of empirical service innovation studies to identify and analyse whether and how these modes of employee involvement are manifested in the service innovation literature.

Findings

The findings delineate six modes of employee involvement in the reviewed service innovation studies. Employees are primarily seen as having a strong influence on situated innovation activities but a limited influence on systemic innovation activities. The findings show that more research is needed to assess the connections between different modes of employee involvement.

Practical implications

The findings can be used by practitioners to assess the possibilities different modes of employee involvement may bring to service innovation activities.

Originality/value

The proposed conceptual framework and the analysis of current research and research gaps in service innovation studies provide a clear research agenda for progressing multidimensional understanding of employee involvement in service innovation.

Workplace cyberbullying and creativity: examining the roles of psychological distress and psychological capital

Purpose

This study aims to investigate the effects of workplace cyberbullying on creativity directly and through psychological distress. Furthermore, this study proposes that psychological capital (PsyCap) buffers the harmful effects of workplace cyberbullying on psychological distress and creativity.

Design/methodology/approach

The data were collected in two waves from 329 nurses working in four large public hospitals located in a metropolitan city of Pakistan. The data were analyzed through PROCESS (Model 8) using SPSS.

Findings

The results demonstrate that cyberbullying negatively affects creativity through increased psychological distress. The findings also explicate that PsyCap moderates the effects of cyberbullying on psychological distress such that the link was weak (vs strong) for those (victims) who had high (vs low) PsyCap.

Practical implications

This study recommends management to develop and promote PsyCap among employees because these positive resources help them to regulate their emotions and cognition to overcome negative consequences of cyberbullying and other workplace stressors.

Originality/value

Psychological distress as an underlying mechanism between cyberbullying and creativity as well as buffering effect of PsyCap is the novelty of the study.

Fostering innovation through stakeholders' engagement at the healthcare industry: Tapping the right key

In this paper we investigate to which point each of the healthcare industry's stakeholders are influencing the final innovation outputs. We propose and test a model that puts together stakeholders' engagement, innovation objectives and innovation outputs. We analyze data from 400+ healthcare Spanish companies using Partial Least Squared modelling technique. Results show that stakeholders' engagement is crucial to orientate innovation objectives that are directly and positively related to innovation outputs. Also, results push to a higher implication of society in the co-creation and participation in innovation activities in the healthcare industry highlighting its importance as, both, triggers and the most benefited recipients. This paper uncovers the relationship among healthcare stakeholders and innovation outputs and also answers another research question-which stakeholders have a stronger relationship with innovation outputs. Implications suggest that healthcare industry managers and policy makers should build on the relationship with clients/customers/patients/final users as innovation-related information inputs as an effective way to improve their innovation outputs.

Humor Styles as New Resources in a Primary Preventive Perspective: Reducing Resistance to Change for Negotiation

Reducing resistance to change is fundamental to dealing with the rapid and continuous changes of the 21st century labor market. Personality traits have been widely studied in relation to resistance to change. However, personality is not completely suitable for primary prevention intervention, since it does not change over time. Instead, humor styles appear to be a promising preventive resource to facilitate the negotiation process by enabling individuals to cope with the current work environment. Using a sample of 149 university students, this study analyzed the relationship between personality traits, such as extraversion and emotionality, humor styles, and resistance to change. The mediation analysis highlighted that both affiliative and self-enhancing humor styles could promote integrative negotiations within organizations in relation to change, due to their negative relationships with resistance to change. Thus, implementing dedicated interventions to increase the usage of affiliative and self-enhancing humor styles could help in lowering the failure risk in negotiation processes, supporting changes.

When ethical leadership and LMX are more effective in prompting creativity

Purpose

Despite the immense amount of literature on ethical leadership and leader‒member exchange (LMX), little is known about how and when ethical leadership and LMX are more/less effective in prompting employee creativity. It is proposed that ethical leadership affects creativity through LMX. Furthermore, the authors draw upon an interactionist perspective and suggest that employee psychological capital is a dispositional boundary condition that influences the effectiveness of LMX in promoting employee creativity. The paper aims to discuss these issues.

Design/methodology/approach

Using a survey questionnaire, data were collected from 557 nurses and their supervisors working in public sector hospitals. The data were collected in two phases (time lagged) to avoid common method bias. Moderated mediation analysis was performed, using model 14 of PROCESS, to probe hypothesized relationships.

Findings

The results of the moderated mediation suggest that ethical leadership and LMX predict creativity. Ethical leadership indirectly affects creativity through LMX. Employee psychological capital moderates the direct effect of LMX and the indirect effect of ethical leadership on employee creativity.

Research limitations/implications

The study contributes to the extant literature, as the findings suggest that, being a dispositional boundary condition, psychological capital plays a contingent role in explaining LMX and the ethical role of leaders in fostering creativity. Moreover, the results also confirm previous findings, which suggested that ethical leaders promote creativity.

Practical implications

The findings imply that ethical leadership and exchange relationships are important for promoting creativity. Given that creativity is a complex product of an individual’s behavior, high psychological capital employees obtain benefits of quality exchange relationships and utilize them to elicit creativity. Managers are recommended to proactively develop and promote exchange relationships as well as positive psychological resources among employees to achieve creativity.

Originality/value

The study is unique in its scope and contribution, as it tries to develop an understanding of how and when ethical leadership and LMX foster employee creativity. Using an interactionist perspective to theorize psychological capital as a second-stage moderator is, thus, a unique contribution of this study.

Harnessing mobile devices to support the delivery of community-based clinical care: a participatory evaluation

Background

A large provider of community health services (an NHS Trust in England) deployed Apple iPads to its front-line community-based healthcare clinicians (predominantly nurses) to enable them to increase responsiveness to patients’ and their families’ needs. We conducted a participatory formative evaluation of this iPad initiative among different users and the informatics teams implementing it, to establish how such initiatives can sustain adoption and achieve their stated benefits.

Methods

We used a participatory approach involving a partnership between study investigators and key decision-makers of the initiative to engage stakeholders in the study. Methods included focus groups and group discussion, meetings with key personnel and analysis of documents related to the initiative. Using a participatory technique, members of the organisation identified practical challenges to inform the on-going process of implementation and adoption in the Trust.

Results

Healthcare professionals identified many benefits associated with having iPads to support care delivery, including streamlined workflows and accessible information at the point-of-care in the community. However, challenges that interfered with implementation were also reported by both the team implementing the initiative (IT team) and early users. Challenges reported by IT team are: adopter clinicians’ scepticism and suspicion; clinician non-compliance with training and operational guidance procedures; and managing adopter expectations. Challenges reported by users are: setting-up and maintaining the devices on a long-term basis; blurring of personal and professional boundaries; and disconnection from the IT team. Results show that these challenges could be overcome if there were more informal ‘socialised’ interactions between adopters and between adopters and the IT team.

Conclusions

We suggest that similar initiatives require increased ongoing dialogue between different levels of stakeholder groups, in the form of socialised engagements, to avoid common misunderstandings and to promote the processes involved in co-constructing the initiative on a generally-agreed and sustainable basis.

Electronic supplementary material

The online version of this article (10.1186/s12911-019-0869-x) contains supplementary material, which is available to authorized users.

Intrapreneurial Self-Capital: A Primary Preventive Resource for Twenty-First Century Entrepreneurial Contexts

This article discusses the role of intrapreneurial self-capital (ISC) as a possible primary preventive resource to effectively deal with the complexity of the current entrepreneurial environment. The article deepens both the similarities and differences between ISC and psychological capital and thus proceeds to present the most recent empirical evidence that connects ISC to (1) employability and career decision making, (2) innovative behavior, and (3) well-being. The possibilities for further research and interventions are additionally discussed.

Intrapreneurial Self-Capital and Sustainable Innovative Behavior within Organizations

Innovative behavior is necessary to combat the 21st century’s sustainability challenges, as well as to ensure organizations’ longevity and success. Personality traits, such as extraversion, are strongly related to innovative behavior; nevertheless, such traits are not increasable through specific training. Intrapreneurial self-capital is a promising preventive resource to enhance people’s capability to cope with innovations. On this basis, this study analyzed, in an explorative way, the relationship between extraversion, intrapreneurial self-capital, and innovative behavior, using a sample of 120 Italian workers. A mediation model was used to assess the effects of extraversion on innovative behavior and innovative implementation behavior (outcome variables) through intrapreneurial self-capital (conceived as an intervening mediator variable). The mediation analysis highlighted that intrapreneurial self-capital is correlated with both workers’ innovative behavior and innovative implementation behavior. Therefore, implementing dedicated training on intrapreneurial self-capital could help organizations better address sustainability issues and achieve the Sustainable Development Goals introduced by the United Nations.

In an Unpredictable and Changing Environment: Intrapreneurial Self-Capital As a Key Resource for Life Satisfaction and Flourishing

The twenty-first century is characterized by an unpredictable and challenging work environment, and the Intrapreneurial Self-Capital (ISC) career and life construct can be seen as a core of individual intrapreneurial resources that enables people to cope with ongoing challenges, changes, and transitions founding innovative solutions when confronted with the constraints imposed by such an environment. The ISC is a challenging construct since it can enhance behavior and attitudes through specific training, unlike personality traits, which are considered substantially stable in the literature. Against this background, the present study examined the relationship between ISC and well-being (hedonic well-being and eudaimonic well-being) controlling for the effects of personality traits. The Big Five Questionnaire (BFQ), the Intrapreneurial Self-Capital Scale (ISCS), the Satisfaction With Life Scale (SWLS), and the Flourishing Scale (FS) were administered to 258 Italian workers. Hierarchical regression analyses showed that ISC explained a percentage of incremental variance beyond that explained by personality traits in relation to both life satisfaction and flourishing. These results indicate that ISC is a key resource for hedonic well-being and eudaimonic well-being and that it offers new research and intervention opportunities.

Motivating factors among Iranian nurses

BACKGROUND

One of the most important challenges of Iranian health care system is "quality of care," and it is assumed that motivated nurses are more ready to provide better care. There are limited studies investigating Iranian nurses' motivations; however, factors which motivate them have not been studied yet. Identifying the motivating factors enables nurse managers to inspire nurses for continuous quality improvement. The aim of this study was to identify motivating factors for Iranian hospital nurses.

MATERIALS AND METHODS

This is a cross-sectional descriptive study in which 310 nurses working at 14 hospitals of Tehran University of Medical Sciences were selected by proportionate stratified random sampling. Data were collected in 2010 by a researcher-developed questionnaire. Descriptive statistics and independent t-test, analysis of variance, Tukey post-hoc test, Chi-Square and Fisher's exact test were used for statistical analysis by Statistical Package for Social Sciences (SPSS) version 16.

RESULTS

The mean score of motivation was 90.53 ± 10.76 (range: 59-121). Four motivating factors including "career development" (22.63 ± 5.66), "job characteristics" (34.29 ± 4), "job authority" (18.48 ± 2.79), and "recognition" (15.12 ± 2.5) were recognized. The least mean of the motivation score, considering the number of items, was 3.23 for career development, while the highest mean was 3.81 for job characteristics.

CONCLUSIONS

The findings showed that motivation of nurses was at a medium level, which calls for improvement. The factors that have the greatest potential to motivate nurses were identified in this study and they can help managers to achieve the goal of continuous quality improvement.

Narrowing the Skills Gap for Innovation: An Empirical Study in the Hospital Sector

Background

The current financial crisis and the increasing burden of chronic diseases are challenging hospitals to enhance their innovation capacity to deliver new and more effective health services. However, the shortage of skills has been widely recognized as a key obstacle for innovation. Ensuring the presence of a skilled workforce has become a priority for the health system in Portugal and across Europe.

Objective

The aim of this study was to examine the demand of new skills and their influence in both investments in innovation and development of skills.

Methods

We used a mixed-methods approach combining statistical analysis of data survey and content analysis of semistructured interviews with the Administration Boards of hospitals, using a nominal group technique.

Results

The results illustrate an increasing demand of a broad range of skills for innovation development, including responsibility and quality consciousness (with a significant increase of 55%, 52/95), adaptation skills (with an increase of 44%, 42/95) and cooperation and communication skills (with an increase of 55%, 52/95). Investments in the development of skills for innovation are mainly focused on aligning professional training with an organizational strategy (69%, 66/95) as well as collaboration in taskforces (61%, 58/95) and cross-department teams (60%, 57/95). However, the dynamics between the supply and demand of skills for innovation are better explained through a broader perspective of organizational changes towards enhancing learning opportunities and engagement of health professionals to boost innovation.

Conclusions

The results of this study illustrate that hospitals are unlikely to enhance their innovation capacity if they pursue strategies failing to match the skills needed. Within this context, hospitals with high investments in innovation tend to invest more in skills development. The demand of skills and investments in training are influenced by many other factors, including the hospital’s strategies, as well as changes in the work organization. Relevant implications for managers and policy makers can be drawn from the empirical findings of this paper, building on the current efforts from leading innovating hospitals that are already defining the future of health care.

How do social networks and faculty development courses affect clinical supervisors' adoption of a medical education innovation? An exploratory study

PURPOSE

To examine the impact of social networks and a two-day faculty development course on clinical supervisors' adoption of an educational innovation.

METHOD

During 2007-2010, 571 residents and 613 clinical supervisors in four specialties in the Netherlands were invited to complete a Web-based questionnaire. Residents rated their clinical supervisors' adoption of an educational innovation, the use of structured and constructive (S&C) feedback. Clinical supervisors self-assessed their adoption of this innovation and rated their communication intensity with other clinical supervisors in their department. For each supervisor, a centrality score was calculated, representing the extent to which the supervisor was connected to departmental colleagues. The authors analyzed the effects of supervisor centrality and participation in a two-day Teach-the-Teacher course on the degree of innovation adoption using hierarchical linear modeling, adjusting for age, gender, and attitude toward the S&C feedback innovation.

RESULTS

Respondents included 370 (60%) supervisors and 357 (63%) residents. Although Teach-the-Teacher course participation (n=172; 46.5%) was significantly related to supervisors' self-assessments of adoption (P=.001), it had no effect on residents' assessments of supervisors' adoption (P=.371). Supervisor centrality was significantly related to innovation adoption in both residents' assessments (P=.023) and supervisors' self-assessments (P=.024).

CONCLUSIONS

A clinical supervisor's social network may be as important as faculty development course participation in determining whether the supervisor adopts an educational innovation. Faculty development initiatives should use faculty members' social networks to improve the adoption of educational innovations and help build and maintain communities of practice.

Quality assurance of endoscopy units

This chapter reflects on how England has led the world in service development and quality assurance of endoscopy. It draws out themes of leadership, strategic vision and organisational culture. It emphasises the pivotal importance of focussing service improvement on enhancing the quality of a patient's experience of endoscopy. It describes the processes used here for quality assurance of endoscopy units and how these have dovetailed with other strands of work in transforming the English endoscopy service. The chapter presents discussion of the responses to accreditation processes and how the design of the JAG Accreditation process maximises its effectiveness.

What motivates professionals to engage in the accreditation of healthcare organizations?

OBJECTIVE

Motivated staff are needed to improve quality and safety in healthcare organizations. Stimulating and engaging staff to participate in accreditation processes is a considerable challenge. The purpose of this study was to explore the experiences of health executives, managers and frontline clinicians who participated in organizational accreditation processes: what motivated them to engage, and what benefits accrued?

DESIGN/PARTICIPANTS

The setting was a large public teaching hospital undergoing a planned review of its accreditation status. A research protocol was employed to conduct semi-structured interviews with a purposive sample of 30 staff with varied organizational roles, from different professions, to discuss their involvement in accreditation. Thematic analysis of the data was undertaken.

RESULTS

The analysis identified three categories, each with sub-themes: accreditation response (reactions to accreditation and the value of surveys); survey issues (participation in the survey, learning through interactions and constraints) and documentation issues (self-assessment report, survey report and recommendations). Participants' occupational role focuses their attention to prioritize aspects of the accreditation process. Their motivations to participate and the benefits that accrue to them can be positively self-reinforcing. Participants have a desire to engage collaboratively with colleagues to learn and validate their efforts to improve.

CONCLUSION

Participation in the accreditation process promoted a quality and safety culture that crossed organizational boundaries. The insights into worker motivation can be applied to engage staff to promote learning, overcome organizational boundaries and improve services. The findings can be applied to enhance involvement with accreditation and, more broadly, to other quality and safety activities.

Assessing and understanding quality of care in a labour ward: a pilot study combining clinical and social science perspectives in Gondar, Ethiopia

Ensuring high quality intrapartum care in developing countries is a crucial component of efforts to reduce maternal and neonatal mortality and morbidity. Conceptual frameworks for understanding quality of care have broadened to reflect the complexity of factors affecting quality of health care provision. Yet, the role of social sciences within the assessment and understanding of quality of care in this field has focused primarily on seeking to understand the views and experiences of service users and providers. In this pilot study we aimed to combine clinical and social science perspectives and methods to best assess and understand issues affecting quality of clinical care and to identify priorities for change. Based in one referral hospital in Ethiopia, data collection took place in three phases using a combination of structured and unstructured observations, interviews and a modified nominal group process. This resulted in a thorough and pragmatic methodology. Our results showed high levels of knowledge and compliance with most aspects of good clinical practice, and non-compliance was affected by different, inter-linked, resource constraints. Considering possible changes in terms of resource implications, local stakeholders prioritised five areas for change. Some of these changes would have considerable resources implications whilst others could be made within existing resources. The discussion focuses on implications for informing quality improvement interventions. Improvements will need to address health systems issues, such as supply of key drugs, as well as changes in professional practice to promote the rational use of drugs. Furthermore, the study considers the need to understand broader organizational factors and inter-professional relationships. The potential for greater integration of social science perspectives as part of currently increasing monitoring and evaluation activity around intrapartum care is highlighted.

Disseminating educational innovations in health care practice: training versus social networks

Improvements and innovation in health service organization and delivery have become more and more important due to the gap between knowledge and practice, rising costs, medical errors, and the organization of health care systems. Since training and education is widely used to convey and distribute innovative initiatives, we examined the effect that following an intensive Teach-the-Teacher training had on the dissemination of a new structured competency-based feedback technique of assessing clinical competencies among medical specialists in the Netherlands. We compared this with the effect of the structure of the social network of medical specialists, specifically the network tie strength (strong ties versus weak ties). We measured dissemination of the feedback technique by using a questionnaire filled in by Obstetrics & Gynecology and Pediatrics residents (n=63). Data on network tie strength was gathered with a structured questionnaire given to medical specialists (n=81). Social network analysis was used to compose the required network coefficients. We found a strong effect for network tie strength and no effect for the Teach-the-Teacher training course on the dissemination of the new structured feedback technique. This paper shows the potential that social networks have for disseminating innovations in health service delivery and organization. Further research is needed into the role and structure of social networks on the diffusion of innovations between departments and the various types of innovations involved.