DDHA 8601 Week 4 Adoption Analysis Example

Will the Device Nurses Keep Using the Single Worklist? An Adoption Analysis on Rogers' Five Attributes, Written From the Chair of the Nurse Who Has to Change

Student Name

Walden University

DDHA 8601: Technology and Innovation in Healthcare

Instructor Name

Month Day, Year

Will the Device Nurses Keep Using the Single Worklist? An Adoption Analysis on Rogers' Five Attributes, Written From the Chair of the Nurse Who Has to Change

The Innovation and the People Deciding

Linden Ford Community Hospital's cardiac device clinic has piloted a platform that gathers remote transmissions from four device manufacturers into one worklist. Whether the hospital buys it will depend less on the contract than on whether the clinic's three device nurses and two electrophysiologists keep using it when the pilot's attention fades. This analysis scores the platform on the five attributes Rogers (2003) linked to how quickly an innovation spreads: how much better it seems, how well it fits, how hard it is, whether it can be tried and whether its results can be seen. It spends unequal time on them, because they do not matter equally here, and it takes the position of the person who would change their daily routine, not the position of the hospital.

Relative Advantage

Rogers (2003) treats relative advantage as a matter of perception: how much better the new idea seems to the people who would use it than the one it would replace. For a device nurse, the question is whether a morning with the worklist is better than a morning without it.

In some ways it plainly is. The nurse no longer logs into four manufacturers' websites, each with its own password rules and its own layout, which the nurses estimate saves 20 to 30 minutes each morning. Transmissions from all manufacturers appear in one list sorted by urgency, so the nurse does not have to remember which website she checked last. Overdue transmissions from all four manufacturers appear together, which makes the calls to patients with missed transmissions easier to organize. During the pilot, routine transmissions showing normal function, about seven in ten, could be reviewed and documented without leaving the worklist.

In one important way it is worse. For transmissions that show an arrhythmia or a device alert, the nurses want to see the full electrogram tracing, and the platform displays a summary and a report file rather than the interactive tracing on the manufacturer's site. For about three transmissions in ten, then, the nurse now opens the worklist, sees the alert, and still logs into the manufacturer's website, adding a step. The nurses' view is that the platform makes easy transmissions easier and hard ones harder. Because the hard transmissions are the ones that matter clinically, and the ones a nurse remembers at the end of the day, the perceived advantage is smaller than the time saved would suggest.

The electrophysiologists see a different advantage. They receive escalated transmissions in one format rather than four, which they value. Their relative advantage is clearer than the nurses', but they are not the ones who use the worklist every morning.

Compatibility

Compatibility is the fit between the innovation and existing routines, values and beliefs. The routine at the clinic is organized by manufacturer: each nurse owns one or two manufacturers' patients and reviews their transmissions. The worklist organizes by urgency across all manufacturers, which breaks that ownership. Several nurses said during the pilot that they no longer knew which patients were theirs.

The more important incompatibility is with a belief about the work. The nurses believe, with reason, that judging an alert requires seeing the tracing, and the expert consensus on remote monitoring places responsibility for reviewing and acting on alerts squarely with the following clinic (Slotwiner et al., 2015). The platform's design assumes that a summary is enough for triage. Its filtering feature, which hides transmissions it judges not to need action, conflicts directly with that belief. Greenhalgh et al. (2004), reviewing the diffusion of innovations in health service organizations, found that innovations are adopted more readily when they fit the values and norms of the people using them, and that a mismatch at that level is hard to overcome with training.

Complexity

Complexity is best described here as the number of decisions a nurse makes per transmission. Under the old routine, a nurse decides whether the transmission is normal, whether it needs escalation and what to document: three decisions. Under the platform, she also decides whether to trust the summary or open the manufacturer's site, and, if filtering is on, whether to check a filtered transmission. For routine transmissions the count stays at three; for alerts it rises to five. The screens are simpler, but the decisions are not.

Trialability

Trialability concerns whether people can try an innovation on a limited basis. A concrete arrangement is available, and it costs little. Run the platform for only the manufacturer with the largest share of the clinic's patients, about 40%, for two months, while the other three stay on their own websites. That lets each nurse experience the worklist on part of the panel without giving up the routine for the rest.

Observability

Observability is the degree to which results are visible to others. A concrete arrangement would make them visible: a short weekly huddle at which each nurse reports morning review time from a simple log and any transmission where the summary was misleading. Seeing colleagues' times, and seeing that misleading summaries are counted rather than ignored, would make the platform's results visible in the nurses' own terms.

Where Adoption Is Most Likely to Stall

Compatibility is where adoption is most likely to stall, specifically the clash between the platform's summary-first design and the nurses' belief that alerts must be judged from tracings. Relative advantage would follow it down, because the extra step for alerts falls exactly where the belief applies. The hospital should not try to change the belief, which is clinically sound. It should ask the vendor whether full tracings can be displayed for alert transmissions and should turn filtering off until it has been tested in parallel. If neither is possible, the nurses are likely to keep the worklist for routine transmissions and return to the manufacturers' sites for everything else, which is a partial adoption the business case should anticipate.

References

Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. The Milbank Quarterly, 82(4), 581-629. https://doi.org/10.1111/j.0887-378X.2004.00325.x

Rogers, E. M. (2003). Diffusion of innovations (5th ed.). Free Press.

Slotwiner, D., Varma, N., Akar, J. G., Annas, G., Beardsall, M., Fogel, R. I., Galizio, N. O., Glotzer, T. V., Leahy, R. A., Love, C. J., McLean, R. C., Mittal, S., Morichelli, L., Patton, K. K., Raitt, M. H., Ricci, R. P., Rickard, J., Schoenfeld, M. H., Serwer, G. A., . . . Yu, C.-M. (2015). HRS expert consensus statement on remote interrogation and monitoring for cardiovascular implantable electronic devices. Heart Rhythm, 12(7), e69-e100. https://doi.org/10.1016/j.hrthm.2015.05.008