Show simple item record

dc.contributor.authorBrewster, Amanda Lauren
dc.date.accessioned2015-12-22T15:00:41Z
dc.date.issued2015
dc.identifier.urihttps://hdl.handle.net/2144/13652
dc.description.abstractWith medical evidence constantly advancing, the health care system faces pressure to generate, apply and integrate innovations to improve the quality of patient care. This dissertation examines how organizational characteristics influence these processes. The first study, a systematic review, investigates how organizational features influence the translation of basic research findings to clinical applications. Results showed a dearth of peer-reviewed literature on this topic, despite a proliferation of efforts to accelerate translational research by manipulating organizational structures and processes. Few studies effectively linked structures, processes and outcomes and no organizational feature was associated conclusively with translation of research into clinical practice. The second study draws on in-depth qualitative interviews (82 participants at 10 hospitals) to understand how hospitals that reduced readmission rates had applied innovations in clinical practice and organizational context. High performing and low performing hospitals had both implemented similar clinical practice changes in their efforts to reduce readmissions; however, high performing hospitals reported greater investment in creating an organizational context to facilitate readmissions. This included more extensive efforts to improve collaboration within the hospital, greater coordination between the hospital and outside providers, deeper engagement in learning and problem solving related to readmissions, and greater senior leadership support. The third study draws on an expanded set of interviews from the same data collection (90 participants at 10 hospitals) to investigate mechanisms through which innovations become integrated into hospital routines. Despite a well-developed literature on the initial implementation of new practices, we have limited knowledge about the mechanisms by which integration occurs. Results showed that when an innovation was integrated successfully, a small number of key staff held the innovation in place for as long as a year while more permanent integrating mechanisms began to work. Innovations that proved intrinsically rewarding to staff integrated through shifts in attitudes and norms over time. Innovations that did not provide direct benefits to staff were integrated through changed incentives or automation. Together, these studies illuminate opportunities for hospitals to improve patient care by managing the organizational context in which innovations are deployed. Understanding how organizational context affects translation requires further research.en_US
dc.language.isoen_USen_US
dc.subjectHealth care managementen_US
dc.subjectHospital managementen_US
dc.subjectIntegrationen_US
dc.subjectReadmissionsen_US
dc.subjectTranslational researchen_US
dc.titleOrganizational influences on innovation to improve quality in health careen_US
dc.typeThesis/Dissertation
dc.date.updated2015-10-03T01:28:36Z
dc.description.embargo2017-10-02T00:00:00Z
etd.degree.nameDoctor of Philosophyen_US
etd.degree.leveldoctoralen_US
etd.degree.disciplineHealth Services Researchen_US
etd.degree.grantorBoston Universityen_US


This item appears in the following Collection(s)

Show simple item record