OBJECTIVE: Nationally, efforts to implement an innovation in cancer surgery-a Web-based synoptic reporting tool-are ongoing in five provinces. The objective of the present study was to identify the key multilevel factors influencing implementation and early use of this innovation for breast and colorectal cancer surgery at two academic hospitals in Halifax, Nova Scotia. METHODS: We used case-study methodology to examine the implementation of surgical synoptic reporting. Methods included semi-structured interviews with key informants (surgeons, implementation team members, and report end users; n = 9), nonparticipant observation, and document analysis. A thematic analysis was conducted separately for each method, followed by explanation-building to integrate the evidence and to identify the key multilevel factors influencing implementation. An audit was performed to determine use. RESULTS: Key factors influencing implementation were these: Innovation-values fitFlexibility with the innovation and implementationThe innovation is not flawlessStrengthening the climate for implementationResource needs and availabilityPartner engagementSurgeon champions and involvementIn a 6-month period after implementation, 91.2% and 58.0% respectively of eligible breast and colorectal cancer surgeries were reported using the new tool. CONCLUSIONS: An improved understanding of the multilevel factors influencing the implementation of innovations is critical to planning effective change interventions in health care. Further study is needed to explore differences in the use of the innovation between breast and colorectal cancer surgeons. Findings will inform the study of additional cases of synoptic reporting implementation, enabling cross-case analyses and identification of higher-level themes that may be applied in similar settings or contexts.
OBJECTIVE: Nationally, efforts to implement an innovation in cancer surgery-a Web-based synoptic reporting tool-are ongoing in five provinces. The objective of the present study was to identify the key multilevel factors influencing implementation and early use of this innovation for breast and colorectal cancer surgery at two academic hospitals in Halifax, Nova Scotia. METHODS: We used case-study methodology to examine the implementation of surgical synoptic reporting. Methods included semi-structured interviews with key informants (surgeons, implementation team members, and report end users; n = 9), nonparticipant observation, and document analysis. A thematic analysis was conducted separately for each method, followed by explanation-building to integrate the evidence and to identify the key multilevel factors influencing implementation. An audit was performed to determine use. RESULTS: Key factors influencing implementation were these: Innovation-values fitFlexibility with the innovation and implementationThe innovation is not flawlessStrengthening the climate for implementationResource needs and availabilityPartner engagementSurgeon champions and involvementIn a 6-month period after implementation, 91.2% and 58.0% respectively of eligible breast and colorectal cancer surgeries were reported using the new tool. CONCLUSIONS: An improved understanding of the multilevel factors influencing the implementation of innovations is critical to planning effective change interventions in health care. Further study is needed to explore differences in the use of the innovation between breast and colorectal cancer surgeons. Findings will inform the study of additional cases of synoptic reporting implementation, enabling cross-case analyses and identification of higher-level themes that may be applied in similar settings or contexts.
Authors: Jason Park; Venu G Pillarisetty; Murray F Brennan; William R Jarnagin; Michael I D'Angelica; Ronald P Dematteo; Daniel G Coit; Maria Janakos; Peter J Allen Journal: J Am Coll Surg Date: 2010-07-14 Impact factor: 6.113
Authors: Karl Y Bilimoria; Joseph D Phillips; Colin E Rock; Amanda Hayman; Jay B Prystowsky; David J Bentrem Journal: Ann Surg Oncol Date: 2009-05-15 Impact factor: 5.344
Authors: Neal W Wilkinson; Azin Shahryarinejad; Janet S Winston; Nancy Watroba; Stephen B Edge Journal: J Am Coll Surg Date: 2003-01 Impact factor: 6.113
Authors: John R Srigley; Tom McGowan; Andrea Maclean; Marilyn Raby; Jillian Ross; Sarah Kramer; Carol Sawka Journal: J Surg Oncol Date: 2009-06-15 Impact factor: 3.454