National Institute of Health Research

HS&DR - 08/1201/038: How to spread good ideas - A systematic review of the literature on diffusion, dissemination and sustainability of innovations in health service delivery and organisation

Project title How to spread good ideas - A systematic review of the literature on diffusion, dissemination and sustainability of innovations in health service delivery and organisation
Research type Evidence Synthesis
Status Project complete
Start date October 2002
Publication date

March 2004

Cost £ 79,643.00
Chief Investigator Professor Trisha Greenhalgh
Co-investigators Professor Paul Bate (UCL Medical School), Dr Anna Donald, Dr Sarah Fraser, Dr Fraser Macfarlane (University of Surrey), Mr Paul Plsek, Professor Glenn Robert (King's College London)
Contractor University College London
Plain English summary There are good ways and bad ways of organising and delivering health services. Sometimes, what is a good service in one place will not work so well in another. Most of us have experienced inefficient or poorly run health services, either in general practice services or in hospitals, or perhaps more commonly, at the boundary between the two. Patients, carers and health professionals often think: surely there is a more efficient or less expensive] way of delivering this service? . Or since the service in Hospital X works so much better than that in Hospital Y, why doesn t Hospital Y change its service and do what Hospital X does? . These seemingly simple questions are in reality very difficult to answer, and many different approaches have been taken to research them. For example, psychologists have looked at how best to change individual behaviour; educationists have looked at how adults learn; anthropologists have looked at the culture of organisations and how this changes over time; and sociologists have looked at how the relationships between individuals prompt communication and transfer of ideas between organisations. There is also a vast literature from management theory on such things as leadership, marketing, and innovation. A number of writers, most notably Everett Rogers, have tried to pull together the findings from these different approaches, in order to produce a general theory of how innovations are taken up and sustained. Recent research has suggested that Rogers Diffusion of Innovations Theory is useful up to a point, but that not all examples of the take-up of innovations can be explained by it. So if we base the modernisation of the NHS and the spread of best practice on this theory alone, potentially useful innovations may fail to catch on. At the same time, we may waste resources trying to encourage others to take up practices that may not work in different settings. The review, now being undertaken, aims to look thoroughly at a wide range of scientific literature. It will examine Rogers approach to diffusion critically, and the report which results will identify a number of ways in which the spread of best practice in the delivery and organisation of health services can be promoted to others in the service.
Scientific summary Aims of the project: 1. To prepare a comprehensive review of the literature that identifies the barriers to adoption of evidence based innovations in service delivery and organisation (SDO) at individual, team, organisational and supra-organisational level; describes, evaluates and summarises studies that have attempted to overcome such barriers; makes clear recommendations for practice; places all the above in the particular policy context of the Modernisation Agency and NHS Plan; 2. To develop a robust theoretical framework that gives coherence to the existing literature, and into which new research can be added as it becomes available; 3. To highlight factors likely to act as promoters of, or barriers to, the success of initiatives to implement improvements in SDO in particular contexts, with a focus on pragmatic recommendations that reflect the real world; 4. To identify areas of research and practice that may continue to inform leaning. In particular, to highlight areas for cross-disciplinary research between knowledge management, psychology, communication, marketing and evidence based practice; 5. To describe the extent of uncertainty in this topic and identify areas for further research. Type and location: Systematic literature review, based in Central London. Methods of working: The study will employ standard methodology for systematic review of the biomedical literature where appropriate. Note, however, that the research topic is a highly complex area that spans a vast literature and includes a range of disciplines and methodologies. The emerging academic field of complex research synthesis offers a range of potential secondary methodologies that may be more appropriate than conventional systematic review, and these will be fully explored and incorporated. Outcome measure: No simple set of outcome measures is available or appropriate for this study. Indeed, the focus of the review will be more on the process of adoption, spread, and sustainability, for which we will use a range of measures designed to reflect the complexity and contextual features of each different method or approach.
  1. Decision technologies as normative instruments: Exposing the values within

    Authors: Boivin, A; Legare, F; Lehoux, P

    Reference: Patient Education and Counseling 2008;73(3):426-430

  2. Diffusion of innovations in service organisations: systematic review and recommendations

    Authors: Greenhalgh, T; Robert, G; Macfarlane, F; Bate, P; Kyriakidou, O

    Reference: Milbank Quarterly 2004;82(4):581-629

  3. Effectiveness and efficiency of search methods in systematic reviews of complex evidence: audit of primary sources

    Authors: Greenhalgh, T; Peacock, R

    Reference: BMJ 2005;331:1064-1065

  4. Soft networks for bridging the gap between research and practice: illuminative evaluation of CHAIN

    Authors: Russell, J; Greenhalgh, T; Boynton, P; Rigby, M

    Reference: BMJ 2004;328:1174

  5. Storylines of research in diffusion of innovation: a meta-narrative approach to systematic review

    Authors: Greenhalgh, T; Robert, G; Macfarlane, F; Bate, P; Kyriakidou, O; Peacock, R

    Reference: Social Science & Medicine 2005;61(2):417-430


Final Report (PDF File - 1.8 MB)

Briefing Paper (PDF File - 385.7 KB)

Commissioning Brief (PDF File - 37.4 KB)

Appendix 1 (PDF File - 503.7 KB)

Executive Summary (PDF File - 127.3 KB)

Addendum This project was commissioned by the NIHR Service Delivery and Organisation (NIHR SDO) programme under the management of the National Coordinating Centre for the Service Delivery and Organisation (NCCSDO) which was based at the London School of Hygiene and Tropical Medicine. The project was managed by NCCSDO and the final report resulting from this project was reviewed and published by NCCSDO.


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