Presence of Innovation Adoption-Facilitating Elements in Hospitals, and Relationship to Implementation of Clinical Guidelines

Abstract

Background: Despite evidence of benefit from implementation of clinical guidelines, numerous studies have found suboptimal guideline compliance among health professionals. Objective: To determine the presence in US hospitals of innovation adoptionfacilitating elements (IAE), assess associations between organizational characteristics and presence of IAE, and assess associations between presence of IAE and implementation of specific clinical guidelines. Methods: A mail survey of pharmacy directors in a national random sample of 236 general medical and surgical hospitals with more than 25 beds stratified by state was conducted. Key variables were presence of IAE, the leader's openness to change, centralization, formalization, complexity, size, and guideline implementation. Survey items from preexisting scales were revised for this study. Content validity of survey scales was assessed using expert panel ratings. Cognitive interviews were conducted during survey development to confirm that items were interpreted consistently across respondents. A modified Dillman approach was used to survey 236 hospitals. Results: The survey response rate was 69.5%. On average, sample hospitals had implemented 66.9% of IAE inquired about in the survey. Openness to change (p < 0.001), participation in decision-making (p < 0.001), and formalization (p < 0.001) were significantly associated with presence of IAE. However, complexity (p = 0.135) and hospital active bed size (p = 0.195) were not associated with presence of IAE. There was a positive association between presence of IAE and guideline implementation based on an overall score (p = 0.045); however, when guidelines were examined individually, only 1 of the 4 had a positive association (p = 0.029). Conclusions: There was a modest presence of IAE in the US hospitals reported here and significant positive association of leaders' openness to change, centralization, and formalization with presence of IAE in hospitals. Findings also indicate that presence of IAE within a hospital is associated with higher levels of clinical guideline implementation.