Table 5 Learning/belonging tensions associated with healthcare innovation
Authors | Type of innovation | Stage of innovation process | Type of tension (dilemma or paradox) | Conflicting elements |
|---|---|---|---|---|
Lehn et al. (2018) | Readmission prevention program | Implementing projects | Standardization vs. Resistance to control (Dilemma) | A: Standardization: Standardizing a process independent of professional competence to improve the outcome of the program (p. 7) B: Resistance to control: Self-conception of a professional to be clinically competent and making decisions based on his/her expert judgement (p. 7) |
Bagot et al. (2020) | Acute stroke telemedicine program | Developing proposals, Implementing projects | Lack of trust vs. Collaboration (Dilemma) | A: Lack of trust: Lack of trust and confidence in skill between the neurologists and remote hospital clinicians (p. 86) B: Collaboration: Increased access to stroke specialists and treatments to eligible patients (p. 80) |
Mathers et al. (2014) | One-to-one peer-support from health trainers (HTs) | Implementing projects | Professionalism vs. Peer relationship (Paradox) | A: Professionalism: HTS’s capability and validity was challenged by professional NHS staff’s biomedical understanding of therapeutic efficacy (p. 742) B: Peer relationship: “HTS’s ‘intervention’ is as therapeutic through its contextual peer relationship as through the delivery of psychological behavior change interventions” (p. 742) |
Bonello et al. (2018) | Interprofessional education (IPE) | Implementing projects | Routine preservation vs. Adoptability (Dilemma) | A: Routine preservation: Demanding a shift from established norms, behaviors, and paradigms (p. 7) B: Adoptability: Creating a collaborative practice-ready workforce (…) to address challenges and improve outcomes across realms and practices (p. 3) |
Gagnon et al. (2006) | Telehealth in rural/remote regions | Implementing projects | Regional referral vs. Direct care access (Dilemma) | A: Regional referral: Accessing specialized services via the usual referral process to the regional hospital (p. 6) B: Direct care access: Accessing specialized services directly via telehealth (p. 6) |
Gardner et al. (2010) | Audit and best practice for chronic disease (ABCD) as part of a continuous quality improvement (CQI) | Implementing projects | Drive for improvement vs. Focus on core tasks (Dilemma) | A: Drive for improvement: Stimulating improved outcomes and care delivery through staff motivation (p. 7) B: Focus on core tasks: Sense of burden due to high demands and uncertainty leads to meeting obligations for core tasks only (p. 7) |
Merkel et al. (2015) | Transcatheter aortic valve implantation (TAVI) | Implementing projects | Routine preservation vs. Interprofessional relations (Dilemma) | A: Routine preservation: Creating an issue of competence by shifting treatments which originally belonged to cardiac surgeons to the responsibility of cardiologists (p. 6) B: Interprofessional relations: Cooperation creates multiple advantages (medical outcomes and the improved quality of life of patients) compared to the standard surgical procedure, thereby supporting the implementation process (p. 5) |