Characteristic of Innovation ~Degree to which innovation provides or is: | Promoting Factor for SMA Implementation | Hindering Factor for SMA Implementation | Addressing the Issues to Facilitate Implementation and Sustainability |
---|---|---|---|
Relative advantage or utility over existing or other methods | Advantage of seeing several experts at same time, especially for behavioral barriers | No clear evidence; questioned value and whether patients would accept group format | Proved not to be a major issue |
Compatibility with existing norms and values | Consistent with norm and values of achieving process measures | Inconsistent with norm and value of sacred primary care provider-patient relationship; Different roles of healthcare professionals filling in-difficult switching from traditional to multidisciplinary team approach | Had a few team building and motivational interviewing learning sessions-lecture versus facilitation of patient info |
Complexity of explaining, understanding and using | Â | Too vague and many unknowns; not easy to explain | Explain and sell it and take advantage of a trial period with small numbers of patients to highlight success and have observers (it was easier for providers to see it first hand) |
Costs relative to benefits and level of investment | Â | Efficacy questioned regarding clinical physiological outcomes and uncertain level of investment for various stakeholders | 1. Reorganizing flow allowed up to 18 patients to be seen in one SMA |
 |  |  | 2. Change in way patient data distributed in order to reduce prep time of Clinical Pharmacist and overall cost |
 |  |  | 3. Introduced use of templated notes that included documentation of SMA activities at a general group level and also permitted individualized patient level documentation |
Risks related to uncertainty regarding results and consequences |  | High-risk – no conceptual model for designing or plan for diffusion | The organizational culture supported risk taking |
Flexibility, adaptability to situation/needs of local context/target group | Vagueness provided options for adapting to local context and needs | Key non-flexible components not consistent with micro-system and mesosystem silo design | Recognition of additional patient needs prompted addition of a nutritionist to the team |
Involvement of target group in development | High involvement of the core team only | Existing structure impeding additional staff involvement | Unanticipated impact on staff not involved feeling left out addressed by creating opportunities for these staff to observe and get feedback/up dates |
Divisibility so able to try out parts separately | Â | Low divisibility of shared appointments (i.e., can't try out various parts) | Unable to address; we have kept the basic model of SMAs |
Trialability, reversibility without risk if doesn't work | High and approached as a trial period | Â | Because of early successes, this proved not to be a major issue |
Visibility, observability of results by other people | High – part of local culture is feedback | High – part of local culture is feedback | Patient successes led to increased referral of patients close to performance measure goals overloading the clinic and prompting the redirection of resources |
Centrality of impact on daily working routine | Â | High | Impact of patients' stories has contributed to team finding meaning in their work, negating the effects of the changes in work routine |
Pervasiveness, scope, impact on total work, people involved, time it takes and relationships | Â | High: fear more work and would jeopardize primary care provider-patient relationships | Proved not to be a major issue |
Magnitude, disruptiveness, radicalness | Â | High | The core team was made up of individuals willing to take risk and were unafraid of the potential disruption |
Duration for when innovation/change must take place | Not a pressing factor | Â | Â |
Form, physical properties of innovation: material or social; technical or administrative, etc.) | Â | High: material change, space requirements, schedule changes, administrative and technical adjustments | Continues to provide challenges |
Collective action related to decisions | Low collective action | Strong core team (3–5 members) | Unanticipated impact on staff not involved feeling left out. Some of these staff were recruited to participate in other types of SMAs where they were involved in the decision-making. |
Nature of Presentation: length, clarity, attractiveness | High attractiveness | Low clarity | Began projects to share knowledge and experience with others |