Organisational factors influencing the diffusion of process innovations from manufacturing to health services settings

Background: This paper presents an Organisational Behaviour perspective of organisational factors influencing diffusion of innovation in a medium-sized tertiary public hospital. The innovation consists of applying Lean principles coupled with computer simulation of process changes. The diffusion of product innovations is well documented in the innovation management literature. However, the diffusion of process innovations across industries is relatively unexplored. In the last twenty years Lean manufacturing techniques increasingly appear in health settings accompanied by reports of quality and financial gains, and warnings of workforce resistance. Aim: This research addresses an important gap in theoretical and practical knowledge through examining the organisational factors that predispose a public hospital to adopt process innovations originating outside the health sector. Methodology: Case research was used to examine an early adopter of Lean thinking coupled with computer simulation to analyse and optimise patient flow between Emergency and Imaging Departments. Semi-structured interviews with key informants were combined with analysis of government and hospital policy documents and internal surveys in a retrospective evaluation of recent changes to scheduling processes. Thematic analysis was used to identify organisational factors that influence diffusion of innovation in health settings, including culture, leadership and links with other organisations. Findings: The influence of intra-organisation factors, including but not limited to a recent organisational crisis, culture, attitude to risk taking, tensions prompting change and informal inter-organisational networks were evaluated. Hospital leadership emerged as an important factor in reducing insularity within the organisation. Clinician cohort age and crisis conditions (real or perceived) appeared as factors influencing diffusion of innovation. Conclusions and Implications: Hospital characteristics supporting the adoption of performance-enhancing innovations from dissimilar settings are reviewed in the context of a recent improvement project. The cultural acceptability of highly empirical quality improvement techniques (evidence based management) to professionals accustomed to evidence based medicine is also considered.