Lots of experts are doing lots of things to try to make health care better. But how does a specific doctor or clinic or hospital or insurer know what innovations to adopt in a specific setting and when and how to adopt (or adapt) them?

The Agency for Healthcare Research and Quality held a webinar on that question based on a new paper titled "Will It Work Here? A Decisionmaker's Guide to Adopting Innovations."  Readers of this blog know that diffusion of innovation is one of our passions.  Delivery system reform is a vital element of improving health care for all Americans, but improvement is a slow and painful process.  It can be very hard for champions of innovation to penetrate the culture of certain organizations.

Will It Work Here? isn't a treatise on how or why innovations spread, but rather a preliminary tool to be used when reviewing quality improvement methods that have worked in other settings.  The HTML version is especially useful with tons of hyperlinks to supporting documents.

As much as we like to highlight innovations that have improved care and reduced cost on this blog, it's also important to be aware of innovations that have been tried unsuccessfully elsewhere.  Consider the case of faxing reminders to physicians to improve their patients' antidepressant adherence. 

Antidepressants are very effective if taken continuously for six months, however, adherence to these regimens are low and physicians have no way of knowing if a patient has refilled a prescription.  Harvard Pilgrim Health Care in Massachusetts came up with an idea: use automated fax alerts and tie them to real-time pharmacy claims data.  Pretty cool, right?  Unfortunately, it had no effect on decreasing the percentage of non-adherents.  Possible causes of failure include a lack of training for physicians, nurses, and office staff to ensure they knew what to do with the information.  No follow up was conducted to see whether physicians used the faxes at all. The innovation was terminated. (Amazing how quaint faxes now seem, isn't it? New models of tracking medication adherance use computerized medical records...)

The paper runs through four modules: Does the innovation fit? Should we do it here? Can we do it here? And how will we do it here?  All four are interesting, but I'm going to touch on Module III, which one webinar call participant  paraphrased as "ingredients for success."  This module emphasizes the need for innovation champions, something we've highlighted before ourselves on this blog discussing the Baylor Physician Champions. 

The paper cites the initiative to implement rapid response teams at North Carolina Children's Hospital.  According to one decision maker, the innovation wouldn't have been successful without a champion.  The hospital was later spotlighted for an IHI story for their significant reduction in cardiac arrests.  Another paper linked from Canada (remember that they have a private delivery system!) says that you should identify opinion leaders and then work with them to get their buy-in to new activities. Different order, same idea.

On the call, it was said that change agents need to protect themselves from organizational antibodies, i.e. those who oppose changes to the current ways of doing things.  This often manifests itself in the statement we learned from our Baylor study: "That's not the way we do it here."   

Will It Work Here? is a useful tool for those seeking to improve the care given by their organizations.  Check it out for yourself here.