Facilitating Dissemination of Innovations in Public University Hospitals

Sammanfattning: The health sector is today facing many challenges, requiring a need for capabilities in managing innovations. At Karolinska University Hospital in Sweden, the management of some of the innovations has been centralized to the Innovation Center. The Innovation Center can be involved in all phases of an innovation process, but have identified difficulties to deal with innovations that have already been successfully implemented. Further implementation of these innovations to other hospital units, creates benefits for more patients and care givers, and is therefore of high importance. Therefore, managing innovations also includes making sure that successfully implemented innovations are spread to other clinics in the hospital, a phenomenon hereby called dissemination of innovations. Studies show that many innovations, even though they are successfully implemented at one location, disseminate slowly, or not at all. In fact, two out of three implementation efforts in the health care sector fail due to various barriers. The purpose of this master thesis is therefore to explore how dissemination of innovations can be facilitated at university hospitals in public health care systems. By dissemination we refer to the intentional spreading of innovations to other hospital units, or repeated implementations following the initial implementation target. Therefore, dissemination is targeted by studying the dynamics of implementation processes through the following research question: How do organizational factors affect the implementation of innovations at public university hospitals? By organizational factors we mean general areas that can be influenced by central management functions, such as: funding, leadership and culture.   The research question has been studied qualitatively through a literature study, a contextual study and three case studies. The cases consist of three innovation projects managed by the Innovation Center that have undergone some sort of dissemination. The empirical data has been collected through semi-structured interviews with both administrative and clinical staff. The data has been structured and analyzed using a theoretical framework developed from findings in previous research. In accordance to previous research, our results indicate that various organizational factors affect the dissemination of innovations. For instance, the complex and unstandardized way of getting funding to dissemination projects are impeding the process. Also, it needs to be clearly established who is to assume responsibility of an innovation, both during its initial implementation process as well as its dissemination. Resistance from clinicians may also function as a barrier and is caused by, for instance, a lack of information about the innovation or bad experiences from earlier failed projects. Additionally, if innovations do not meet identified and prioritized needs at the clinic, or if it is not properly adapted to local conditions and requirements, this may also impede the implementation. To properly involve clinicians is therefore of high significance in order to enable a successful implementation. Finally, rigid structures affect implementation negatively. These are built up by, for instance: extensive use of, and sometimes contradicting, policies and regulations; high administrative requirements as well as an organizational structure that separates medical disciplines. This inertia, together with sparse time allocated for innovation activities among the clinics, leads to difficulties when implementing and disseminating innovations in the hospital.