Table 11 Organizing tensions associated with healthcare innovation
Authors | Type of innovation | Stage of innovation process | Type of tension (dilemma or paradox) | Conflicting elements |
|---|---|---|---|---|
Hamilton et al. (2008) | Respiratory service | Developing proposals, Implementing projects | Central development vs. Local adoption (Dilemma) | A: Central development: Centrally driven innovation (p. 9) B: Local adoption: Local adoption of good ideas (p. 9) |
Kreindler (2017) | Improvement of patient flow | Developing proposals, Implementing projects | Standardization vs. Customization (Dilemma) | A: Standardization: Spreading of best practice is impeded by an overemphasis of site uniqueness (p. 7) B: Customization: Spreading of best practice demands an allowance for site uniqueness (p. 7) |
Mansfield et al. (2018) | Pilot project implementation in general | Implementing projects | Clinical duties vs. Project demands (Dilemma) | A: Clinical duties: Clinicians are required to provide patient care and not necessarily engage in research-related work (see quote p. 12). B: Project demands: Project trajectories require time and skills, i.e. for administrative responsibilities and research (p. 10) |
Rowe and Hogarth (2005) | Four primary care trust (PCT) pilot sites | Implementing projects | Openness vs. Stability (Paradox) | A: Openness: Large productivity through an open process and need for openness and time for debate and reflection (p. 400) B: Stability: Levels of uncertainty during the process causing anxiety, sometimes expressed as hostility or distress (p. 400) |
Shaller (2004) | Quality measures for children’s health care | Developing proposals, Implementing projects | Fidelity vs. Adaptability (Dilemma) | A: Fidelity: Need for standardization to assure comparability and consistency (p. 225) B: Adaptability: Preference to customize approaches to fit circumstances or at least retain the option to do so (p. 225) |
Hoekstra et al. (2017) | Health promotion program in multi-disciplinary settings | Implementing projects | A: Fidelity: Implementation of a program according to protocol (p. 2) B: Adaptability: Adapting a program to the local context (p. 2) | |
Mignogna et al. (2018) | Cognitive behavioral therapy in primary care | Implementing projects | A: Fidelity: Delivering of a treatment as it was intended to be delivered (p. 2) B: Adaptability: Changing the intervention to improve its “fit” (p. 2) | |
Sharp et al. (2020) | Smart phone application for use by rheumatoid arthritis patients | Implementing projects, Diffusing lessons | A: Fidelity: Widening the use through standardization and efficiency (p. 12) B: Adaptability: Meeting specific patient groups and diagnostic needs (p. 12) | |
Lehn et al. (2018) | Readmission prevention program | Implementing projects | Interdisciplinary work vs. Mono-professional working structures (Dilemma) | A: Interdisciplinary work: Requirement for interdisciplinary cooperation in the initial screening stage (p. 8) B: Mono-professional working structures: Information and demand for interdisciplinary responsibilities and judgment is unclear and in opposition to the accepted organization of clinical work (p. 8) |
Porter et al. (2018) | Computerised clinical decision support (CCDS) in emergeny pre-hospital care | Implementing projects | Standardization vs. Autonomy (Dilemma) | A: Standardization: Professionalizing paramedic practice by using formalizing and standardizing tools (p. 8) B: Autonomy: Autonomy of clinical decision-making as part of professionalism in paramedic practice (p. 8) |