Lost in translation? : negotiating technological innovation in healthcare

Technological innovation in healthcare is growing at a rapid pace. Developments in genetics, stem cell research, bioinformatics, imaging and screening techniques have broadened out the arena of health technology. These developments in sophisticated technology, it is suggested, have the potential to revolutionize the practices of medicine and healthcare by providing more proactive and powerful tools for the diagnosis, treatment, and prevention of illness and disease (Liddell et al, 2008; Webster, 2002). In support of such claims, available research findings suggest that the adoption of new innovative health technologies (IHTs) can result in reducing healthcare costs, increasing productivity, healthcare effectiveness, and improving the patient’s experience of care by better management of chronic diseases (Liddell et al, 2008; Healthcare Industries Task Force, 2004). At the same time, new innovative health technologies present many challenges. Evidence indicates that patient safety and proven clinical effectiveness are insufficient to ensure the adoption and implementation of new clinical technologies. The prevailing organizational and policy context is crucially important as this may present barriers which slow or even prevent uptake (Lehoux 2006). In recent years there has been a continuing debate around issues of clinical resistance, organizational/clinical restructuring, procurement and commissioning, public trust, and, more widely, around the ethical and social implications of techno-scientific innovations in medicine and health (Williams and Dickinson, 2008; Webster, 2006; Ferlie et al., 2005). Moreover, cost-effectiveness evidence is now required to inform decisions about the funding and procurement of new healthcare services and technologies (Fitzgerald et al., 2002). Overall, the value of the innovation has to be clearly evident to a number of different stakeholders if technologies are to be embedded into actual work practices. These potential barriers have given rise to questions related to the diffusion and adoption of emerging medical and healthcare innovations. This paper examines the dynamics and complexity of innovation adoption processes in the context of a rapidly changing healthcare policy landscape. Drawing upon the inherently socially negotiated character of meaning, this paper illustrates the ambivalent nature of technological innovation by examining the complex ongoing interplay of heterogeneous discourses in shaping the adoption of innovative health technologies (Law, 1987, 1994). Drawing upon Rye and Kimberly (2007) adoption is here understood as a distinct organizational process related to an organization’s potential interest in implementing a technological innovation. In so doing, this paper draws on the findings of a three year research project which examines the adoption of innovative clinical technologies in the UK NHS. In particular, we explore the nature, role and dynamics of heterogeneous discourses (technological, managerial/professional, clinical), in shaping the adoption of a retinal imaging technology in a UK hospital Trust. In this regard, we contribute to the development of alternative ways of describing, analysing, and theorizing the process of technological innovation in healthcare

Law Enforcement Cardiovascular Health: A Qualitative Study on Law Enforcement Officers\u27 Risk Awareness and The Targeted Mitigation of Cardiovascular Disease

Cardiovascular disease-related deaths and injuries are prevalent among law enforcement officers (Han et al., 2017; Keeler et al., 2021), with attribution pointing to the strong associations between the inherent stressors of police work directly impacting the psychological and physical health of police officers (Santa Maria et al., 2018; Violanti et al., 2017). As such, several researchers have studied the associations between police officers\u27 perceptions of stress and the presence of cardiovascular disease risk factors. However, there is a current gap in the literature on information examining the relationship between law enforcement officers\u27 cardiovascular disease risk perceptions and their utilized health behaviors for mitigating such risk. The aim of this case study was to understand the perceptions of cardiovascular disease risk among law enforcement officers in Ohio, United States. Rosenstock\u27s (1966/1974) health belief model theory, which suggests a positive relationship between one\u27s perceptions of risk and health behaviors, provided this study\u27s guiding principles. The researcher explored police officers\u27 perceptions of their cardiovascular disease risk and their reported health behaviors. This researcher conducted in-depth interviews with a purposive sample of 11 Ohio law enforcement officers with varied demographic backgrounds. Following data collection and qualitative analysis, the researcher reported findings and provided recommendations for improving the lives of police officers, their families, and the communities they serve

Gambling in a remote Aboriginal setting - the good, the bad and the ugly

In 2009 the Ceduna Koonibba Aboriginal Health Service, an Indigenous-specific service, and Statewide Gambling Therapy Service joined together to investigate the impact that gambling was having on the Aboriginal people living in this region. Both organisations were funded through the state-based Office for Problem Gambling to provide gambling intervention. A number of signs indicate that the community development approach has proven effective. Towards the end of the first year of the project six people signed up for one-on-one therapy to address gambling; a small group of women met regularly to learn more about how to overcome gambling and provide support to each other. In general, there has been a notable improvement in the level of engagement with the program amongst health and welfare workers in the town, with the Project Officers regularly meeting with staff across agencies

Facilitating the implementation of clinical technology in healthcare : what role does a national agency play?

Background: Accelerating the implementation of new technology in healthcare is typically complex and multi-faceted. One strategy is to charge a national agency with the responsibility for facilitating implementation. This study examines the role of such an agency in the English National Health Service. In particular, it compares two different facilitation strategies employed by the agency to support the implementation of insulin pump therapy. Methods: The research involved an empirical case study of four healthcare organisations receiving different levels of facilitation from the national agency: two received active hands-on facilitation; one was the intended recipient of a more passive, web-based facilitation strategy; the other implemented the technology without any external facilitation. The primary method of data collection was semi structured qualitative interviews with key individuals involved in implementation. The integrated-PARIHS framework was applied as a conceptual lens to analyse the data. Results: The two sites that received active facilitation from an Implementation Manager in the national agency made positive progress in implementing the technology. In both sites there was a high level of initial receptiveness to implementation. This was similar to a site that had successfully introduced insulin pump therapy without facilitation support from the national agency. By contrast, a site that did not have direct contact with the national agency made little progress with implementation, despite the availability of a web-based implementation resource. Clinicians expressed differences of opinion around the value and effectiveness of the technology and contextual barriers related to funding for implementation persisted. The national agency’s intended roll out strategy using passive web-based facilitation appeared to have little impact. Conclusions: When favourable conditions exist, in terms of agreement around the value of the technology, clinician receptiveness and motivation to change, active facilitation via an external agency can help to structure the implementation process and address contextual barriers. Passive facilitation using web-based implementation resources appears less effective. Moving from initial implementation to wider scale-up presents challenges and is an issue that warrants further attention

Larrakia language project: a living culture in a changing world – a tribute to Yirra

Larrakia country covers the areas of Darwin and surrounds. It is bounded by the mouth of the Finniss River, Manton Dam, and around to the mouth of the Adelaide River. The Larrakia Language Project is introduced by a summary discussion of the changes that occurred in the lives of Larrakia people during the first half of the twentieth century. Particular examples of such change are examined from the personal perspective of an individual whose life spanned the first fifty years of the past century. The effect of the changes experienced on the Larrakia language is demonstrated in the life of this person and that of her children. Today's talk begins with the introduction of the person central to my presentation

Strategic Planning for Research Use in Nursing Practice

Background/Objective: To prepare for a culture change to integrate research utilization into daily nursing practice, the authors conducted a descriptive survey of all registered nurses (RNs) in an integrated healthcare delivery system. The purposes of this study were to assess RNs\u27 knowledge, attitudes, and practices (KAP) of nursing research activities, assess factors that support a research environment, and determine facilitating and challenging factors related to conducting regional nursing research. Methods: A 33-item survey based on the Iowa Model for Evidence-Based Practice was developed, validated, and determined to be reliable by the authors. Site coordinators organized and managed the orientation, administration, and collection of data from the 2,736 registered nurses who worked in 6 hospitals, 65 affiliated clinics, and 3 business units. Narrative notes taken by study investigators were analyzed for themes to determine challenging and facilitating factors for conducting regional research. Results: Education and job title significantly predicted knowledge and ability to perform research activities but was not related to willingness to engage in research activities. Several environmental factors were associated with knowledge of, willingness to engage in, and ability to perform research utilization activities. Challenging and facilitating factors to conducting regional research were identified. Conclusions/Implications: Our research environment is changing to value research as shown in the philosophy, conceptual framework, and bylaws for the professional nursing staff. Novice-to-expert research utilization expectations are included in the promotional model for nursing. All RN job descriptions and the annual performance tool were revised to include responsibilities related to research activities. The Iowa Model for Evidence-Based Practice was adopted as the method for creating practice validation and change. Train-the-trainer educational and experiential sessions are being designed for nurse leaders; all new RN employees complete a self-assessment tool of research utilization knowledge and the nursing division strategic goals incorporate research utilization expectations. The elements of this plan may be useful for nurse executives. Healthcare systems are restructuring throughout the world and within the United States. These changes are occurring to better meet the evolving healthcare needs of the population through cost-effective approaches. Within the United States, emerging organized healthcare systems require research related to patient care outcomes and the health systems that can best address them