Hospitals as innovators in the health-care system: A literature review and research agenda

Impact of C-level positions on hospital performance: a scoping review protocol

INTRODUCTION

The objective of this scoping review is to identify evidence of the impact of hospital managers in top management (c-suite) on hospital performance. Managers generally have various effects on organisational objectives of their organisations. In recent years, the healthcare sector has experienced alterations in hospital governance structures, together with the emergence of new c-suite positions, aligning more closely with those found in private organisations. Their impact on hospital performance (ie, quality of care) is not well known. This scoping review seeks to identify all the available evidence of their impact on the organisational objectives. This scoping review will include primary studies, reviews and commentaries that describe the impact of top management team members on organisational outcomes in a hospital setting.

METHODS AND ANALYSIS

The search strategy aims to locate both published and unpublished documents (ie, grey literature) using a three-step search strategy. An exploratory search of Medline and Google Scholar identified keywords and Medical Subject Headings terms. A second search of Medline (PubMed), Web of Science Core Collection, ScienceDirect, Business Source Premier (EBScoHost), JSTOR, BASE, Lens.org and the Google Search Engine will be performed. The scope of the search will cover 1990-present time using English search terms. Manual searching by two reviewers will be added to the search strategy. The identified documents will be independently screened, selected by two researchers and extracted by one researcher. The data are then presented in tables and graphics coupled with a descriptive summary.

ETHICS AND DISSEMINATION

As this study neither involves human participants nor unpublished secondary data, an ethics approval is not required. Findings will be disseminated through professional networks, conference presentations and publication in a scientific journal.

TRIAL REGISTRATION NUMBER

The protocol was registered on the Open Science Framework (https://doi.org/10.17605/OSF.IO/EBKUP).

Standing together at the helm - how employees experience employee-driven innovation in primary care

Primary care needs to find strategies to deal with today's societal challenges and continue to deliver efficient and high-quality care. Employee-driven innovation is increasingly gaining ground as an accessible pathway to developing successful and sustainable organisations. This type of innovation is characterised by employees being engaged in the innovation process, based on a bottom-up approach. This qualitative study explores employees' experiences of employee-driven innovation at a primary care centre in Sweden. Data are collected by focus group interviews and analysed by inductive qualitative content analysis. The result is presented with the overarching theme "Standing together at the helm" followed by three categories: "Motivating factors for practising employee-driven innovation", "Challenges in practising employee-driven innovation" and "Benefits of employee-driven innovation", including nine subcategories. The study found that employee-driven innovation fosters organisational innovation, empowers employees, and enhances adaptability at personal and organisational levels. This enables individual and collective learning, and facilitates the shaping, development, and adaptation of working methods to meet internal and external requirements. However, new employees encountered difficulty grasping the concept of employee-driven innovation and recognising its long-term advantages. Additionally, the demanding and task-focused environment within primary care posed challenges in sustaining efforts in innovation work. The employees also experienced a lack of external support to drive and implement some innovative ideas.

Model for managing scientific research in a public hospital: case study: Chilean National Cancer Institute, from 2015-2022

Research is an essential element in the practice of healthcare, and hospitals play a fundamental role in its promotion. Research in hospitals can improve the quality of care, knowledge of diseases and the discovery of new therapies. Hospitals can conduct research in various fields, including basic research, clinical research, population-based research and even hospital management research. The findings of hospital research can be directly applied to clinical practice and management, thereby enhancing the quality of patient care, a central paradigm in translational health. This article details the experience of the National Cancer Institute of Chile over the past 8 years in its role as a high-complexity public hospital, specialised institute, healthcare centre, teaching institution, and research facility. It reviews the work of generating and strengthening its institutional research model since its redesign in 2018, the key elements that underpin it, and discusses the challenges the institute faces in its growth amidst the increasing cancer epidemiology in Chile, the recent enactment of a National Cancer Law, the post-pandemic scenario that has left a significant waiting list of oncology patients, and the initiation of the design and construction process for the new institute building.

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.

Quantum computing led innovation for achieving a more sustainable Covid-19 healthcare industry

Involvement of multiple stakeholders in healthcare industry, even the simple healthcare problems become complex due to classical approach to treatment. In the Covid-19 era where quick and accurate solutions in healthcare are needed along with quick collaboration of stakeholders such as patients, insurance agents, healthcare providers and medicine supplier etc., a classical computing approach is not enough. Therefore, this study aims to identify the role of quantum computing in disrupting the healthcare sector with the lens of organizational information processing theory (OIPT), creating a more sustainable (less strained) healthcare system. A semi-structured interview approach is adopted to gauge the expectations of professionals from healthcare industry regarding quantum computing. A structured approach of coding, using open, axial and selective approach is adopted to map the themes under quantum computing for healthcare industry. The findings indicate the potential applications of quantum computing for pharmaceutical, hospital, health insurance organizations along with patients to have precise and quick solutions to the problems, where greater accuracy and speed can be achieved. Existing research focuses on the technological background of quantum computing, whereas this study makes an effort to mark the beginning of quantum computing research with respect to organizational management theory.

Nurturing innovative culture in a healthcare organisation - Lessons from a Swedish case study

PURPOSE

Healthcare organisations are often described as less innovative than other organisations, since organisational culture works against innovations. In this paper, the authors ask whether it has to be that way or whether is possible to nurture an innovative culture in a healthcare organisation. The aim of this paper is to describe and analyse nurturing an innovative culture within a healthcare organisation and how culture can support innovations in such a healthcare organisation.

DESIGN/METHODOLOGY/APPROACH

Based on a qualitative case study of a healthcare unit that changed, within a few years, from having no innovations to repeatedly generating innovations, the authors describe important aspects of how innovative culture can be nurtured in healthcare. Data were analysed using inductive and deductive analysis steps.

FINDINGS

The study shows that it is possible to nurture an innovative culture in a healthcare organisation. Relationships and competences beyond healthcare, empowering structures and signalling the importance of innovation work with resources all proved to be important. All are aspects that a manager can influence. In this case, the manager's role in nurturing innovative culture was very important.

PRACTICAL IMPLICATIONS

This study highlights that an innovative culture can be nurtured in healthcare organisations and that managers can play a key role in such a process.

ORIGINALITY/VALUE

The paper describes and analyses an innovative culture in a healthcare unit and identifies important conditions and strategies for nurturing innovative culture in healthcare organisations.

Organisational support for healthcare innovation in hospitals: Towards a commitment framework

The article investigates organisational drivers and restrainers of innovation in hospitals on the background of different institutional logics. It presents evidence from a multiple case study in Polish hospitals, which reveals different dynamics on the micro-, meso- and macro-level of organisations in enabling and implementing new procedures and technologies. In particular, the study documents an ambiguous influence of medical professionalism as a specific logic in the healthcare sector, which can affect innovation positively as well as negatively. The article therefore proposes a managerial framework based in innovation action commitment to control the effects of professionalism in healthcare.

Analysing Researchers' Engagement in Research Hospitals: A Pilot Study in IRCCS-Italian Research Hospitals

Despite universities in the UK, USA and Australia having developed tools and strategies to enhance academic engagement, there is a paucity of information from universities and research hospitals where conceptual and theoretical research still appears more heterogeneous. In Italy, there is a growing recognition that more needs to be done to define strategies to improve research engagement. Italian research hospitals are represented by the Scientific Institute for Research, Hospitalization and Healthcare (named IRCCS from the Italian acronym of these organisations), representing the best of Italian research and the National Health Service System. This article provided a pilot description of research engagement in a representative Italian IRCCS hospital for the first time. A pilot study was developed, and a brief questionnaire was validated to explore research engagement. The identified clusters of researchers' engagement were provided to describe an initial theory-grounded framework. Based on the perspective of research administrators and the Ministry of Health during round tables, the developed questionnaire identified two clusters of researchers' engagement and measured "Project-oriented" and "Organisation-oriented" engagement. Among the responders, IRCCS senior researchers tended to have higher project-oriented engagement, while young researchers had slightly higher organisation-oriented engagement. The contribution of this article is a hypothesised two-level theory-grounded framework to study and improve research engagement activities and strategies in a research hospital, with the potential for an overlap with other European research institutions.

Academic intrapreneurship for health care innovation: the importance of influence, perception, and time management in knowledge commercialization at a University’s Medical Centre

Academic intrapreneurship refers to the individual behaviours of scientists who depart from their customary research and education initiatives and become involved in knowledge commercialization without leaving academia. This paper aims to examine how academic intrapreneurs perceive and respond to organizational factors set by departments, faculties, schools, and university boards that influence knowledge transfer, the initiation of an internal project, and the collaboration with societal stakeholders. We employ an embedded case study approach to examine the role of perceived control and influence within the internal work environment of a knowledge commercialization process within the DiabetesStation, a healthcare innovation at the Erasmus Medical Center (MC), a university hospital in Rotterdam, the Netherlands. We used a semi-structured interview strategy and analyzed 12 individual respondent interviews. The results show that the relationship between academics and the Knowledge Commercialization Process within the DS at Erasmus MC was influenced by six factors (i.e., external collaboration, product quality, time availability, external financing, internal financing, and rewards and reinforcement). Our study highlights that the perception of- the academic intrapreneur’s control and influence seems to impact effectively transferring academic knowledge from academic institutions to the private sector for economic and societal benefit. The research results highlight three controllable areas of an academic institution’s internal work environment that can enhance the relationship between knowledge valorization and academic intrapreneurship—time availability, rewards and reinforcement, and internal financing.

Innovation intermediaries revised: a systematic literature review on innovation intermediaries’ role for knowledge sharing

The decision to collaborate for companies in knowledge exchange processes has become more complex due to a greater diversity of innovation intermediaries from companies, universities, government and societal actors. The aim of this study is to uncover and conceptualize the role of innovation intermediaries in knowledge sharing. Specifically in tacit knowledge sharing, intermediaries function as boundary spanners between various stakeholders in the innovation process. Despite this potential, which has been discussed in a large strand of case studies, there is no comprehensive concept to determine factors that influence innovation intermediaries in knowledge sharing. This paper develops an analytical framework of innovation intermediaries for prospective empirical work building on factors influencing innovation intermediaries in knowledge sharing by systematically reviewing related literature. It specifically presents what are the determinants, factors and indicators discussed empirically innovation intermediaries in knowledge sharing. The first results is that the measurement of innovative outcome intermediaries enables a broader perspective in comparison to traditional innovation indicators. The second results that literature discusses indirect innovation that enhances clients’ innovative capabilities and their entrepreneurial activities. The third results demonstrates, that while the internal perspective varies with the heterogeneous actors, the development of contextual knowledge of intermediaries in networks and its transfer is central for empirical analysis. The conceptualization of this framework paves the path for further research needed to uncover the role of intermediaries.

Innovation in Rural Health Services Requires Local Actors and Local Action

Objectives: We examine the role of “local actors” and “local action” (LALA) in health service innovation in high-resource small rural settings and aim to inform debates about the extent to which communities can be empowered to drive change in service design and delivery.

Methods: Using an adapted roles and activities framework we analyzed 32 studies of innovation projects in public health, clinical interventions, and service models.

Results: Rural communities can investigate, lead, own and sustain innovation projects. However, there is a paucity of research reflecting limited reporting capacity and/or understanding of LALA. Highlighting this lack of evidence strengthens the need for study designs that enable an analysis of LALA.

Conclusion: Innovation and community participation in health services are pressing issues in small rural settings where population size and distance from health infrastructure make service delivery challenging. Current reviews of community participation in rural health give little insight into the process of innovation nor understanding of how local actors produce improvements in innovation. This review outlines how communities and institutions can harness the essential role of LALA in supporting health innovations.

Implementation of Magnetic Resonance Imaging-Guided Radiation Therapy in Routine Care: Opportunities and Challenges in the United States

Purpose

Magnetic resonance image (MRI)-guided radiation therapy with the 1.5 Tesla magnetic resonance linear accelerator (MR-Linac) is a rapidly evolving and emerging treatment. The MR-Linac literature mainly focused on clinical and technological factors in technology implementation, but it is relatively silent on health care system-related factors. Consequently, there is a lack of understanding of opportunities and barriers in implementing the MR-Linac from a health care system perspective. This study addresses this gap with a case study of the US health care system.

Methods and Materials

An exploratory, qualitative research design was used. Data collection consisted of 23 semistructured interviews ranging from clinical experts at the radiation therapy and radiology department to insurance commissioners in 7 US hospitals. Analysis of opportunities and barriers was guided by the Nonadoption, Abandonment, Scale-up, Spread and Sustainability framework for new medical technologies in health care organizations.

Results

Opportunities included high-precision MR-guidance during radiation therapy with potential continued technical advances and better patient outcomes. MR-Linac also offers opportunities for research, professional, and economic development. Barriers included the lack of empirical evidence of clinical effectiveness, technological complexity, and large staffing and structural investments. Furthermore, the presence of patients with disadvantaged socioeconomic background, and the lack of appropriate reimbursement as well as regulatory conditions can hinder technology implementation.

Conclusions

Our study confirms the current literature on implementing the MR-Linac, but also reveals additional challenges for the US health care system. Alongside the well-known clinical and technical factors, also professional, socioeconomic, market, and governing influences affect technology implementation. These findings highlight new connections to facilitate technology uptake and provide a richer start to understanding its long-term effect.

Organizational arrangements as a key to enhancing innovativeness and efficiency - analysis of a restructuring hospital in Finland

Background

Challenged to innovate and improve efficiency both at the policy level and in everyday work, many health care organizations are undergoing radical change. However, in many earlier studies, the significance of individuals’ perceptions of their organization and its innovativeness and efficiency during restructuring is not well acknowledged. Our study examines how various organizational arrangements; performance-, hierarchy-, tradition-, and leader-focused types, as well as collaborative and fragmented ones, connect to reaching innovativeness and efficiency in health care during restructuring.

Method

We built on previous organization and management research, innovation studies, and on research focusing in health care restructuring, and conducted an exploratory quantitative case study in a public sector hospital in Finland. Data comprising 447 responses from 19 professional groups across the hospital was analyzed using hierarchical regression analysis.

Results

Our results demonstrate that multiple, co-existing organizational arrangements can promote innovation and efficiency. The perceptions of the organizational members of the nature of their organization need to be generally positive and reflect future-orientation to show positive connections with efficiency and innovativeness; fragmentation in the members’ perceptions of the character of their organization and their inability to go beyond established organizational traditions pose risks of inefficiency and stagnation rather than fruitful exploration. Our study further shows, somewhat surprisingly, that while collaborative organizational arrangements are positively related to increases in perceived efficiency, the same does not apply to innovativeness.

Conclusions

Our study addresses understudied, yet inherently important aspects in providing high-quality health care: the relationships between different organizational arrangements and exploitation and exploration-related outcomes. In particular, examination of individuals’ perceptions (that may have even more weight for the subsequent developments than the actual situation) adds insight to the existing knowledge that has addressed more objective factors. Implications on how to support high levels of performance are drawn for management of professional and pluralistic organizations undergoing restructuring. Our findings also generate information that is useful for policy making concerned with public sector health care.

The Effect of Slack Resources on Innovation Performance and the Environmental Adaptability of Public Hospitals: The Empirical Evidence From Beijing of China

Background:

The development level of public hospitals has a direct impact on people's health. The reform of the medical industry in China has been gradually underway in recent years, while hospitals face a complex and uncertain environment. This study aims to explore the mechanism of resources slack in buffering environmental uncertainty and promoting innovation in public hospitals.

Methods

Based on previous literature related to environmental adaptability, resources slack, and innovation performance, this study has conducted a literature review and has established a study framework. A questionnaire survey has been conducted among clinicians in representative tertiary public hospitals in Beijing. A total of 318 valid data have been eventually obtained, while regression models have been used to analyze the data.

Results

Innovation performance has played a mediating role in the impact of both resources slack and its three dimensions on environmental adaptability of public hospitals. Among them, there has been a complete mediating effect for time slack, while there has been a partial mediating effect for staff and space dimensions.

Conclusion

This study found that resources slack in public hospitals can improve environmental adaptability by affecting innovation performance. It is necessary for public hospitals to reserve resources slack to ensure that there is sufficient condition for innovation in the face of uncertain changes.

Using systems thinking to increase understanding of the innovation system of healthcare organisations

PURPOSE

This paper applies systems thinking modelling to enhance the dynamic understanding of how to nurture an innovative culture in healthcare organisations to develop the innovation system in practice and speed up the innovative work. The model aims to provide a holistic view of a studied healthcare organisation's innovation processes, ranging from managerial values to its manifestation in improved results.

DESIGN/METHODOLOGY/APPROACH

The study is based on empirical material from a healthcare unit that, within a few years, changed from having no innovations to repeatedly generating innovations. The study uses the modelling language of causal loop diagrams (CLDs) in the system dynamics methodology to identify the key important aspects found in the empirical material.

FINDINGS

The proposed model, based on the stories of the interviewees, explores the dynamics of inertia when nurturing an innovative culture, identifying delays attributed to the internal change processes and system relationships. These findings underscored the need for perseverance when developing an innovative culture in the entrepreneurial phases.

PRACTICAL IMPLICATIONS

The approach of using systems thinking to make empirical healthcare research results more tangible through the visual notations of CLDs and mental simulations is believed to support exploring complex phenomena to induce and nurture both individual and organisational learning.

ORIGINALITY/VALUE

The results from this approach provide deepened analysis and provoke the systems view to explain how the nurturing of the culture can accelerate the innovation processes, which helps practitioners and researchers to further expand their understanding of their healthcare contexts.

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.

Critical literature reviews: A critique and actionable advice

This article treats critical literature reviews as a distinct review type, and presents a critique of author-labeled critical literature reviews in Organization and Management Studies. We identify and problematize 275 review articles that claim to critically review a body of literature and find that most to not deliver on this claim. Many critical literature reviews do not adequately explain what is meant by “critical” and are highly uncritical in their execution. We reveal the following two significant problems: lack of construct clarity and a prevailing “group, re-present, and summarize” approach. We also identify 19 exemplary critical literature reviews—those that exhibit judgment about the literature they cover. These are drawn from across the onto-epistemological spectrum, so include works from within both the positivist and interpretivist traditions. We propose a “Call for Action” aimed at authors, reviewers, and editors to increase critical literature reviews’ quality and impact. We enhance the long tradition within Management Learning for improving scholarship and focus on a skill all academics are required to learn, exercise, and demonstrate—to conduct high-quality literature reviews.

Supporting the vital role of boundary-spanning physician researchers in the advancement of medical innovation

A wide range of stakeholders recognise that physicians play a vital role in medical innovation and, in particular, the importance of boundary-spanning engagement between physicians and industry in clinical research. While UK physicians are keen to take part in research, this article draws on a range of literature to identify apparent and anticipated challenges that discourage or prevent cross-sector engagement by physician researchers. To encourage greater interaction and exploration of associated support mechanisms, we present a full spectrum of engagement modes, funding opportunities and illustrative initiatives, showing how different stakeholders (from government institutions, charities, professional bodies and industry) can contribute to improving the engagement of physicians in boundary spanning research. We emphasise the importance of mutual understanding, trust and commonly shared practices, as well as adequate resources, to encourage these vital interactions.

A practice-based model to guide nursing science and improve the health and well-being of patients and caregivers

AIMS AND OBJECTIVES

The purpose of this paper is to describe a model to guide nursing science in a clinical practice-based setting. Exemplars are provided to highlight the application of this nursing research model, which can be applied to other clinical settings that aim to fill evidence gaps in the literature.

BACKGROUND

Nurse scientists are well positioned to develop new knowledge aimed at identifying global health solutions to multiple disparities. The generation and application of this knowledge are essential to inform and guide professional nursing practice. While a number of evidence-based practice models exist to guide the integration of literature findings and other sources of evidence into practice, there is a need for additional models that serve as a guide and focus for the conduct of research in distinct scientific areas in practice-based settings.

DESIGN

Model development and description.

METHODS

Mayo Clinic is a large, comprehensive healthcare system with a mission to address unmet patient needs through practice, research and education. PhD-prepared nurse scientists engage in practice-based research as an integral component of Mayo Clinic's mission. A practice-based nursing research model was developed with the intent to advance nursing research in a clinical setting.

RESULTS

The components of the Mayo Clinic Nursing Research model include symptom science, self-management science and caregiving science. The generation of nursing science is focused on addressing needs of patients with complex health conditions, inclusive of caregivers.

CONCLUSIONS

While clinical settings provide rich opportunities for the conduct of research, priorities need to be established in which to focus scientific endeavours. The Mayo Clinic Nursing Research model may be applicable to nurses around the globe who are engaged in the generation of knowledge to guide practice.

RELEVANCE TO CLINICAL PRACTICE

The Mayo Clinic Nursing Research model can be used by nurse scientists embedded in healthcare settings to address clinically relevant questions, advance the generation of new nursing knowledge and ultimately improve the health and well-being of patients and caregivers.

Developing innovation governance readiness in regenerative medicine: lessons learned from the Macchiarini crisis

The generation and clinical adoption of workable therapies in regenerative medicine has been slow, despite its alleged potential to relieve suffering and improve health outcomes. This has been explained by a fundamental difference between advanced cell and gene therapies and conventional drug- and device-based therapies, raising questions about how the readiness of existing healthcare systems to adopt such therapies can be evaluated and improved. In this paper, we use the lessons learned from the Macchiarini crisis at the Karolinska Institute in Sweden to take the first step in formulating the concept of innovation governance readiness. We propose it as a tool to help evaluate and improve the ability of private, public and civil society actors to work together to build and put into practice therapies based on emerging medical technologies such as regenerative medicine.

Leveraging Organizational Health Literacy to Enhance Health Promotion and Risk Prevention: A Narrative and Interpretive Literature Review

Organizational health literacy involves the health care organizations' ability to establish an empowering and co-creating relationship with patients, engaging them in the design and delivery of health services in collaboration with health professionals. Although scholars agree that organizational health literacy contributes to health promotion and risk prevention via patient empowerment, literature is not consistent in depicting the interplay between organizational health literacy and preventive medicine. The article intends to shed light into this issue, summarizing current knowledge about this topic and advancing avenues for further development. A narrative literature review was performed through a systematic search on PubMed^®, Scopus^®, and Web of Science^™. The review focused on 50 relevant contributions. Organizational health literacy triggers the transition towards a patient-centered approach to care. It complements individual health literacy, enabling patients to actively participate in health promotion and risk prevention as co-producers of health services and co-creators of value. However, many obstacles - including lack of time and limited resources available - prevent the transition towards health literate health care organizations. Two initiatives are required to overcome extant barriers. On the one hand, a health literate workforce should be prepared to increase the institutional ability of health care organizations to empower and engage patients in health co-creation. On the other hand, increased efforts should be made to assess organizational health literacy and to make its contribution to preventive medicine explicit.

Moving from service to sustainable services: a healthcare case study

Purpose

Worldwide, healthcare systems struggle to sustain the delivery of services at a time of increasing demand, limited resources and growing expectations from users, coupled with dealing with the aftermath of the Covid-19 pandemic and the threat of other outbreaks. There has never been a more important time to sustain innovation and improvements. Using an illustrative case, the authors assess the application of two existing frameworks to identify the key propositions and dimensions required to deliver sustainable services.

Design/methodology/approach

This illustrative case study focuses on a service provided by a chronic disease, multidisciplinary community healthcare team in the UK. Experienced-based interviews were conducted with health professionals, patients and relatives to provide a rich account of a care pathway design. A high-level process map is used to visualise the key touch points.

Findings

The authors identify all seven propositions of the SERVICE framework being present along with additional dimensions relating to sustaining innovation and improvement.

Research limitations/implications

This research is limited to a chronic disease care pathway. However, the authors believe the results could be applicable to other medical conditions, which are supported by a similar multi-disciplinary service delivery model.

Practical implications

The authors provide a sustainable public service operations SERVICES framework for health professionals and managers to consider when (re)designing care pathways.

Originality/value

This research contributes to the emerging discipline of public service operations research by empirically testing for the first time the SERVICE framework within healthcare. The authors have included additional factors associated with innovation and improvement and recommended further development of the framework to include factors, such as economic sustainability, highly relevant to the context of universal healthcare systems.

Employee involvement in innovation activities in hospitals: How perception matters

Employees are a very important source of innovation and essential for the generation, dissemination and implementation of these ideas throughout the organization. This is especially relevant when considering innovation in services during service (co-) creation such as within the healthcare sector. However, perceived employee involvement in innovation (EII) and between stakeholder group interactions in hospitals has not yet been studied in detail. This paper addresses the following research questions: "How do different employee groups perceive their involvement in the innovation process in hospitals and how do their actual involvement levels differ?" and (2) "How do different employee groups perceive their interaction with other employee groups in the innovation process and how do their actual interactions differ?" We analyzed a single typical German research hospital and conducted episodic interviews with employees representing different staff groups. We revealed that while all groups of employees are involved in innovation activities, perception of their involvement in innovation activities differs widely. There is a gap between perception and actual involvement particularly for lower level employees such as nurses. Further, their interaction differs among employee groups and innovation takes place in-group, rather than through group interaction. With our paper, we add to the understanding of perceived EII in hospitals and discuss measures for hospital management to increase EII.

Problems and Promises of Introducing the Magnetic Resonance Imaging Linear Accelerator Into Routine Care: The Case of Prostate Cancer

The new radiotherapy high field, 1.5 Tesla MRI-guided linear accelerator (MR-Linac) is being clinically introduced. Sensing and evaluating opportunities and barriers at an early stage will facilitate its eventual scale-up. This study investigates the opportunities and barriers to the implementation of MR-Linac into prostate cancer care based on 43 semi-structured interviews with Dutch oncology care professionals, hospital and division directors, patients, payers and industry. The analysis was guided by the Non-adoption, Abandonment, Scale-up, Spread, and Sustainability framework of new medical technologies and services. Opportunities included: the acquirement of (1) advanced MRI-guided radiotherapy technology with (2) the potential for improved patient outcomes and (3) economic benefits, as well as (4) professional development and (5) a higher hospital quality profile. Barriers included: (1) technical complexities, (2) substantial staffing and structural investments, (3) the current lack of empirical evidence of clinical benefits, (4) professional silos, and (5) the presence of patient referral patterns. While our study confirms the expected technical and clinical prospects from the literature, it also reveals economic, organizational, and socio-political challenges.

ITEMAS ontology for healthcare technology innovation

BACKGROUND

The Platform for Innovation in Medical and Health Technologies (ITEMAS) is a network of 66 healthcare centres focused on fostering innovation in medical and health technologies as an essential tool for increasing the sustainability of the Spanish healthcare system. The present research is focused on defining a formal representation that details the most relevant concepts associated with the creation and adoption of innovative medical technology in the Spanish healthcare system.

METHODS

The methodology applied is based on the methontology process, including peer-review identification and selection of concepts from the ITEMAS innovation indicators and innovation management system standards. This stage was followed by an iterative validation process. Concepts were then conceptualised, formalised and implemented in an ontology.

RESULTS

The ontology defined describes how relationships between employees, organisations, projects and ideas can be applied to generate results that are transferrable to the market, general public and scientific forums. Overall, we identified 136 concepts, 138 object properties and 30 properties in a five-level hierarchy. The ontology was tested and validated as an appropriate framework for calculating the ITEMAS innovation indicators.

CONCLUSIONS

The consensus concepts were expressed in the form of an ontology to be used as a single communication format between the members of the ITEMAS network. Healthcare centres can compare their innovation results and obtain a better understanding of their innovation context based on the reasoning techniques of artificial intelligence. As a result, they can benefit from advanced analytical capabilities to define the most appropriate innovation policies for each centre based on the common experience of the large number of healthcare centres involved. The results can be used to create a map of agents and knowledge to show capabilities, projects and services provided by each of the participating centres. The ontology could also be applied as an instrument to match needs with existing projects and capabilities from the community of organisations working in healthcare technology innovation.

Forecasting the Maturation of Electronic Health Record Functions Among US Hospitals: Retrospective Analysis and Predictive Model

BACKGROUND

The Meaningful Use (MU) program has promoted electronic health record adoption among US hospitals. Studies have shown that electronic health record adoption has been slower than desired in certain types of hospitals; but generally, the overall adoption rate has increased among hospitals. However, these studies have neither evaluated the adoption of advanced functionalities of electronic health records (beyond MU) nor forecasted electronic health record maturation over an extended period in a holistic fashion. Additional research is needed to prospectively assess US hospitals' electronic health record technology adoption and advancement patterns.

OBJECTIVE

This study forecasts the maturation of electronic health record functionality adoption among US hospitals through 2035.

METHODS

The Healthcare Information and Management Systems Society (HIMSS) Analytics' Electronic Medical Record Adoption Model (EMRAM) dataset was used to track historic uptakes of various electronic health record functionalities considered critical to improving health care quality and efficiency in hospitals. The Bass model was used to predict the technological diffusion rates for repeated electronic health record adoptions where upgrades undergo rapid technological improvements. The forecast used EMRAM data from 2006 to 2014 to estimate adoption levels to the year 2035.

RESULTS

In 2014, over 5400 hospitals completed HIMSS' annual EMRAM survey (86%+ of total US hospitals). In 2006, the majority of the US hospitals were in EMRAM Stages 0, 1, and 2. By 2014, most hospitals had achieved Stages 3, 4, and 5. The overall technology diffusion model (ie, the Bass model) reached an adjusted R-squared of .91. The final forecast depicted differing trends for each of the EMRAM stages. In 2006, the first year of observation, peaks of Stages 0 and 1 were shown as electronic health record adoption predates HIMSS' EMRAM. By 2007, Stage 2 reached its peak. Stage 3 reached its full height by 2011, while Stage 4 peaked by 2014. The first three stages created a graph that exhibits the expected "S-curve" for technology diffusion, with inflection point being the peak diffusion rate. This forecast indicates that Stage 5 should peak by 2019 and Stage 6 by 2026. Although this forecast extends to the year 2035, no peak was readily observed for Stage 7. Overall, most hospitals will achieve Stages 5, 6, or 7 of EMRAM by 2020; however, a considerable number of hospitals will not achieve Stage 7 by 2035.

CONCLUSIONS

We forecasted the adoption of electronic health record capabilities from a paper-based environment (Stage 0) to an environment where only electronic information is used to document and direct care delivery (Stage 7). According to our forecasts, the majority of hospitals will not reach Stage 7 until 2035, absent major policy changes or leaps in technological capabilities. These results indicate that US hospitals are decades away from fully implementing sophisticated decision support applications and interoperability functionalities in electronic health records as defined by EMRAM's Stage 7.