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Innovative physical therapy practice: a qualitative verification of factors that support diffusion of innovation in outpatient physical therapy practice.

ABSTRACT: Background and purpose:New ideas, methods, and technologies spread through cultures through typical patterns described by diffusion of innovation (DOI) theory. Professional cultures, including the physical therapy profession, have distinctive features and traditions that determine the adoption of practice innovation. The Consolidated Framework for Implementation Research (CFIR) proposes a framework of innovation implementation specific to health care services. While the CFIR has been applied to medical and nursing practice, it has not been extended to rehabilitation professions. The purpose of this qualitative study was to verify the CFIR factors in outpatient physical therapy practice. Design:Through a nomination process of area rehabilitation managers and area directors of clinical education, 2 exemplar, outpatient, privately owned physical therapy clinics were identified as innovation practices. A total of 18 physical therapists (PTs), including 3 owners and a manager, participated in the study. Methods:The 2 clinics served as case studies within a qualitative approach of directed content analysis. Data were collected through observation, spontaneous, unstructured questioning, workflow analysis, structured focus group sessions, and artifact analysis including clinical documents. Focus group data were transcribed. All the data were analyzed and coded among 4 investigators. Results:Through data analysis and alignment with literature in DOI theory in health care practice, the factors that determine innovation adoption were verified. The phenomena of implementation in PT practice are largely consistent with models of implementation in health care service. Within the outpatient practices studied, patient-centered care and collaborative learning were foundational elements to diffusion of an innovation. Conclusion:Innovation in outpatient physical therapy practice can be understood as a social process situated within the culture of the physical therapy professional that follows predictable patterns that strongly align with DOI theory and the CFIR.

SUBMITTER: Sabus C

PROVIDER: S-EPMC5741001 | biostudies-literature | 2016

REPOSITORIES: biostudies-literature

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Innovative physical therapy practice: a qualitative verification of factors that support diffusion of innovation in outpatient physical therapy practice.

Sabus Carla C Spake Ellen E

Journal of healthcare leadership 20161201

<h4>Background and purpose</h4>New ideas, methods, and technologies spread through cultures through typical patterns described by diffusion of innovation (DOI) theory. Professional cultures, including the physical therapy profession, have distinctive features and traditions that determine the adoption of practice innovation. The Consolidated Framework for Implementation Research (CFIR) proposes a framework of innovation implementation specific to health care services. While the CFIR has been app ...[more]

PMID: 29355199

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Project description:BackgroundStructured workplace training supports pharmacists in achieving individual career goals as well as health services to meet workforce development goals. Hospital pharmacy residency programs offer structured training pathways for early career pharmacists. A residency program was introduced in Australia, modelled on formal programs already established in other countries.ObjectiveThis qualitative study explored key stakeholders' expectations and early experiences with the implementation of a pharmacy residency program using an analytical framework derived from implementation science.MethodsThree focus groups and seven semi-structured interviews were conducted over a 24-months period with pharmacy managers, senior pharmacists and resident and non-resident pharmacists from different Australian State and hospital settings. They were audio recorded and transcribed verbatim. Transcripts were analysed via thematic analysis using Diffusion of Innovation Theory as a categorising framework.ResultsThirty stakeholders participated in focus groups and interviews. Three of the five main factors that influenced the adoption of an innovation according to Diffusion of Innovation Theory were identified as prominent, two as weaker themes. The relative or perceived advantage of adopting or participating in a residency program was identified as a major theme. Pharmacy managers and resident pharmacists regarded individual and workforce advancement as creating a potential advantage for them. The complexity of the program's implementation, with concerns about its resourcing requirements and sustainability, influenced uptake. The compatibility of the program with already existing training pathways was explored, with the residency sharing similar objectives with current pharmacy education and workforce development goals. Observability and trialability played lesser roles in facilitating program uptake.ConclusionThe implementation and diffusion of the pharmacy residency program can be interpreted by referring to key principles of Diffusion of Innovation Theory. Findings from this study and consideration of theory can inform the diffusion and ongoing maintenance of pharmacy workplace training and education programs.

Project description:IntroductionPatient complexity is an increasingly used concept in clinical practice, policy debates and medical research. Yet the literature lacks a clear definition of its meaning and drivers from the health provider's perspective. This shortcoming is problematic for clinical practice and medical education in the light of a rising number of multimorbid patients and the need for future healthcare providers that are adequately trained in treating complex patients.ObjectivesTo develop an empirically grounded framework of healthcare providers' perceptions of patient complexity and to characterise the relationship between case complexity, care complexity and provider experience as complexity-contributing factors.DesignQualitative study based on semistructured in-depth interviews with healthcare practitioners.SettingA Swiss hospital-based HIV outpatient clinic.ParticipantsA total of 31 healthcare providers participated. Participants volunteered to take part and comprised 17 nurses, 8 junior physicians (interns) and 6 senior physicians (residents, fellows and attendings).ResultsPerceived patient complexity arises from the combination of case complexity drivers, the provider's perceived controllability, and a set of complexity moderators at the levels of the patient, the care provider and the broader care context. We develop a conceptual framework that outlines key relationships among these complexity-contributing factors and present 10 key questions to help guide medical professionals in making complexity more explicit and more manageable in daily practice.ConclusionsThe framework presented in this study helps to advance a shared understanding of patient complexity. Our findings inform curriculum design and the teaching of essential skills to medical students in areas characterised by high patient complexity such as general internal medicine and geriatrics. From a policy perspective, our findings have important implications for the design of more effective healthcare interventions for complex patients.

Dataset Information

Innovative physical therapy practice: a qualitative verification of factors that support diffusion of innovation in outpatient physical therapy practice.

Publications

Innovative physical therapy practice: a qualitative verification of factors that support diffusion of innovation in outpatient physical therapy practice.

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