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Impeding and stimulation factors after re-training
Knowledge transfer » Impeding and stimulation factors after re-training
Last modified on Thu 10 Jul 2014

 

 

OVERVIEW

Diffusion of minimally invasive therapy in the Netherlands, Vondeling Hendrik, Haerkens Enria, de Wit Ardine, Bos Michael and Banta David, Health Policy 1993;23:67-81
Diffusion of laparoscopic technologies in Denmark. Peter Bo Poulsen, Sven Adamsen, Hindrik Vondeling, Torben Jorgensen. Health Policy 1998;45:149-167
Organizational differences in rates of learning: evidence from the adoption of minimally invasive cardiac surgery.Pisano Gary P, Bohmer Richard MJ, Edmondson Amy C. Management Science 2001;47:752-768

Adopters Ratings of reasons for Adoption

1. Keep up with state of the art
2. Improve patient outcomes
3. patient preference
4. Maintain or increase referrals
5. professional prestige
6. Prepare for other MIT techniques
7. Pressure from referring physiciancs
8. pressure from hospitals

Nonadopters' Ratings of Reasons for Nonadoption

1. Concern about safety
2. Planning to retire
3. Equipment not available
4. Too few patients to make it worthwhile
5. Time and effort it takes to learn
6. Lack of support from hospitals
7. Technical difficulty
8. Lack of support from referring physicians

 

Diffusion of laparoscopic cholecystectomy among general surgeons in United States. Escarce JJ, Bloom BS, Hillman AL, Shea JA, Schwartz JS. Med Care 1995;33:256-71
Method of physician payment, degree of market competition, and type of medical practice all may influence physician adoption of new physician-based technologies. The rate of diffusion of a particular procedure probably depends on physician's perception of the relative advantages of the procedure and on patient demand.
Diffusion of laparoscopic cholecystectomy among general surgeons in United States. Escarce JJ, Bloom BS, Hillman AL, Shea JA, Schwartz JS. Med Care 1995;33:256-71

Types of Knowledge transfer within or between companys

1. Diffusion of innovations in a population of organizations
The diffusions of innovations. Rogers, E 1995, 4th ed. the Free Press, New York intraorganizational diffusion of technology
2. Diffusion of innovations with organizations: Electronic switching in the Bell System, 1971-1982. Cool, K.O., Dierickx I, Szulanski G 1997. Organ. Sci. 8;543-559
3. transfer of best practices within a firm
If only we knew what we know: transfer of internal knowledge and best practice. O'Dell CS, Grayson CJ, Essaides N 1998. Free Press, New York
4. Replication
Replication as Strategy. Sidney G. Winter, Gabriel Szulanski. organization Science 2001;12:730-743

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1. FINANCIAL ASPECTS

For patient

For the physician

For the health service provider

Diffusion of laparoscopic technologies in Denmark. Peter Bo Poulsen, Sven Adamsen, Hindrik Vondeling, Torben Jorgensen. Health Policy 1998;45:149-16
Perhaps the most important factor in the diffusion of innovations such as MIT in European health care systems is the payment system.
Without some sort of pressure people continue to do what they were already doing. In many cases this is justified by the lack of evaluative studies.
Diffusion of minimally invasive therapy in Europe. Banta HD, Vondeling H Health Policy 1993;23(1-2):125-133

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2. TECHNOLOGICAL PULL

Medical innovation is driven by technological push and also by the pull or the demand for a technology
The dynamics of innovation in minimally invasive therapy, Gelijns Annetine and Fendrick Mark, Health Policy, 1993;23:153-166

 

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2.1 PATIENT

The most important force facilitating the diffusion of MIT is patient demand, as has been seen in the cases of PTCA, ESWL, arthroscopic surgery and laparoscopic cholecystectomie.
Diffusion of minimally invasive therapy in Europe. Banta HD, Vondeling H Health Policy 1993;23(1-2):125-133
Real world events have a major impact on the application of a medical technology.
Communication between the physician and the patient is about bodily images, divorced from the person. The definition of those images are firmly within medical control; patients cannot determine the concepts used in this language. The patient-choice becomes problematic.
The development of minimal invasive therapy in the United Kingdom Ong Bie Nio, Health Policy 1993;23:83-95

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2.2 CARDIOLOGIST

Competition between specialities stimulated diffusion. Diffusion of laparoscopic technologies in Denmark. Peter Bo Poulsen, Sven Adamsen, Hindrik Vondeling, Torben Jorgensen. Health Policy 1998;45:149-167

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2.3 SURGEON

rewards under any format by any party
competition within (same or other unit) and between disciplines
Diffusion of laparoscopic technologies in Denmark. Peter Bo Poulsen, Sven Adamsen, Hindrik Vondeling, Torben Jorgensen. Health Policy 1998;45:149-167


2.4 ANESTHETIST

2.5 HEALTH SERVICE PROVIDER AND PURCHASER

 

2.6 MEDIA

Unhappiness is caused within the medical community by media publicity about pioneer operations, often only a day or so after first been done: patient expectations are raised before the availability of good efficacy in the long term.
New interventional procedures: efficacy, safety and training, Johnson A.G., Aust.N.Z. J. Surg. 1998;68:3-5
Media stimulated diffusion.
Diffusion of laparoscopic technologies in Denmark. Peter Bo Poulsen, Sven Adamsen, Hindrik Vondeling, Torben Jorgensen. Health Policy 1998;45:149-167
Press reporting has fostered patient demand and physician interest, often to good effect, but not always.
Diffusion of minimally invasive therapy in Europe. Banta HD, Vondeling H Health Policy 1993;23(1-2):125-133

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3. TECHNOLOGICAL PUSH

Immature procedures

Technological imperatives

A 'technological imperative' that drives physicians to offer patients the latest technology has been identified as a major influence on medical practice in the United States.
For better and worse: the technological imperative in health care. Barger-Lux, Heany RP. Soc Sci Med 1986;22:1313
It is consistent with modern organisation theory, as espoused by the Drucker Foundation, that it is new technology, rather than politics or social circumstances, that drives change.
The Organisation of the Future, Henelbein F, Goldsmith M, Beckhard R., San Francisco, California: Jossey-Bass, 1997

Extra benefit

The surgeon's perception of the additional benefits of an endoscopic technique over the conventional operation is that which is the most important whether it will be adopted or not. This factor should serve as a prerequesite and must be proven before other factors are allowed to stimulate the diffusion of a mediacl technology.
Diffusion of six surgical endoscopic procedures in the Netherlands. Stimulating and restraining factors. carmen D Dirksen, Andre JH Ament, peter MN Go. Health Poilicy 1996;37:

 

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4. DEPARTMENT

 

4.1 CHAIRMAN

Opinion of the chairman

The veto of the chairman was the impeding factor in 55 % of the non-starters after a laparoscopic course
Survey on Torino courses, Morino M. Festa V., Garone C., Surg Endosc 1995;9:46-48

The role model

Implementing a new technology starts with the chairman.

The chairman should provide psychological safety

Psychological safety, which describes a shared belief that well-intentioned interpersonal risks will not be punished, has been shown to foster learning behavior in work teams.  Implementing new technology should not involve career risks.
Psychological safety and learning behavior in work teams, Edmondson AC, Administrative Sciences quarterly 1999;44:350-383
 

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4.2 CULTURE

4.2.1 ADOPTION BY OTHER PHYSICIAN

The impact of prior adoption by another surgeon in the same department was larger than the effects of most of the other explanatory variables in hazard analysis.
Externalities in hospitals and physician adoption of a new surgical technology: an exploratory analysis, Escarce Joé, Journal of Health Economics 1996;15:715-734
When perforrmance relies on codified knwoledge, later adopters should improve performance more quickly than earlier adopters.
Learning how and learning what: effect of tacit and codified knowledge on performance improvement following technology adoption, Edmondson Amy C, Winslow Ann B, Bohmer Richard M J, Pisano Gary P, Decision Sciences, 2003;vol 34 nr 2:197-222
Concerning the complex interaction between performance improvemnts and future adoption there may be virtuous and vicious circles at work. early adopters with initial success (failure) may then have an interest in doing more (fewer) cases. this lead to growing (declining) volume, which, in turn, may stimulate further performance improvement (deteriotation).
Analyses of learning curves for rayon producers found differences in the abilities to benefit from their own cumulative production experience.
Learning by doing and competition in the early rayon indusytry. Jarmin RS Rand J Econom 1994; 25:441-454

 

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4.2.2 EARLY VERSUS LATE ADOPTERS

 

4.2.3 DEBRIEF ACTIVITIES, OUTCOME ANALYSIS

Debriefing activities can allow a team to reflect on its past actions and design any changes needed to streamline its task, which would likely foster greater efficiency.
Organizational differences in rates of learning: evidence from the adoption of minimally invasive cardiac surgery.Pisano Gary P, Bohmer Richard MJ, Edmondson Amy C. Management Science 2001;47:752-768
Databases make it possible to study practice. Tracking and reacting to patient outcome data.
Practice-based learning and improvement: a dream that become a reality. Phil R. Manning J Continuing Education in Health Professions;23:S6-S9

 

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4.3 STRUCTURE

 

4.3.1 HIERARCHICAL VS WEB-TYPE

 

4.3.2 SPECIALITY

Surgeons in single-speciality groups adopted earlier than surgeons in multispeciality groups.
Multispeciality groups tend to be larger than single-speciality groups, and are more likely to function as formal organizations in which decisions such as setting fees, hiring personel, purchasing medical equipment are made collectively with input from administrators rather than individually by practicing physicians. In addition, surgeons in multispecialty groups may be relatively protected from competitive pressures owning to the presence of primary care physicians and nonsurgical specialists-a potentially captive referral base-within the group.
Diffusion of laparoscopic cholecystectomy among general surgeons in United States. Escarce JJ, Bloom BS, Hillman AL, Shea JA, Schwartz JS. Med Care 1995;33:256-71

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4.3.3 LEADERSHIP STYLE

Traditional medical leadership styles, which encourage controlling, magnify the resistance common to all change efforts. Skills such as self-awareness, shared authority, conflict resolution, and nonpunitive critique can emerge in practice only when they are taught.
Physician leadership: influence on practice-based learning and improvement Stephen E. Prather, David N Jones. J of Continuing Education in the Health Professions;23:S63-S72

See Educational Background of CMEST, Dynamic theory of organizational knowledge creation,

 

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4.3.4 HOSPITAL SIZE

Large hospitals were the earliest adopters of laparoscopic technologies in Denmark.
Diffusion of laparoscopic technologies in Denmark. Peter Bo Poulsen, Sven Adamsen, Hindrik Vondeling, Torben Jorgensen. Health Policy 1998;45:149-167
Increased hospital size was associated in proportional hazard regression with earlier adoption of laparoscopic cholecystectomy in Denmark in comparison to The Netherlands.
Timing of adoption of laparoscopic cholesystectomy in Denmark and in The netherlands: a comparative study. Peter Bo Poulsen, Hindrik Vondeling, Carmen D. Dirksen, Sven Adamsen, Peter MNYH Go, Andre JH Ament Health Policy 55 (2001): 85-95

 

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4.4 ROUTINES

Functional consequences

Habitual routines in task-performing teams, Gersick CJG, Hackman JR, Organisational behavior and human decision processes, 1999;47:65-97

Dysfunctional consequences

    • inappropriate reactions to stimuli or to the context wherein these stimuli are presented, leading to suboptimal performance
    • reduced innovation
    • contingencies: inappropriate reaction when change is needed, reduced flexibity

influence is related

    1. to the frequency of these performance-relevant changes
    2. to the severity of these changes
 

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5. FOLLOW-UP QUESTIONAIRE

The follow-up packet is a value (for change)-free data-collection instrument but could also bean additional exposure to learning and a stimulus for change.
Effects of a signature on rates of change: a randomized controlled trial involving continuing education and the commitment-to-change model, Mazmanian Paul E, Johnson Robert E, Zhang Aixiu, Boothby John, Yeatts Elaine,Academic Medicine 2001;76:642-646
Self reports of behavior change by physicians as a result of a CME course are accurate when compared with observation of changes.
Validity of self-reports of behavior changes by participants after a CME course, Curry Lynn, Purkis Ian, Journal of Medical Education 1986;61:579-584

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6. EVIDENCE
Initiation stickness is the difficulty in recognizing oppportunities to transfer and acting upon them. An opportunity to transfer exists as soon as the seed for that transfer is formed. The eventfulnesss of the initiation stage depends on how difficult it is to find an opportunity to transfer and to decide wheather to pursue it. This becomes more demanding when existing operations are inadequatley understood or when relevant and timely measures of performance as well as internal or external yardsticks are missing.
The process of knowledge transfer: a diachronic analysis of stickiness. Szulanski Gabriel. organizational behaviour and human decision processes 2000;82:9-27

 

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7. PHYSICIAN

 

7.1 THE SURGEON

 

7.1.1 UNSKILLED AND UNAWARE

It is one of the essential features os incompetence that the person so afflicted, is incapable of knowing that he is incompetent.  To have such knowledge would already be to remedy a good portion of the offense.
Miller WL 1993, Humiliation, Ithaca New York: Cornell University Press, page 4

People miscalibrate their own competence due to a lack in metacognitive skill (the capacity to distinguish accuracy from error).  Paradoxically improving the skills of participants, and thus improving their metacogintive competence, helped them recognize the limitations of their abilities.
Unskilled and Unaware of it: how difficulties in recognizing one'own incompetence lead to inflated self-assessments Journal of Personality and Social Psychology 1999;77:no6:1121-1131
Kruger Justin and Dunning David

 

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7.1.2 AGE

positive effect

Older age favors the adoption of new technologies due to experience in enhancing information processing
Externalities in hospitals and physician adoption of a new surgical technology: an exploratory analysis, Escarce Joé, Journal of Health Economics 1996;15:715-734
More experienced surgeons may have a greater capacity to acquire and process the emerging information about laparoscopic cholecystecomy, and hence to reduce more rapidly their initial uncertainty about the profitability and clinical benefits of adoption.
Diffusion of laparoscopic cholecystectomy among general surgeons in United States. Escarce JJ, Bloom BS, Hillman AL, Shea JA, Schwartz JS. Med Care 1995;33:256-71

negative effect

Time since residency increases the psychic costs of adopting new technology
Externalities in hospitals and physician adoption of a new surgical technology: an exploratory analysis, Escarce Joé, Journal of Health Economics 1996;15:715-734
The return to investment decreases with the number of years left in practice. Human Capital, University of Chicago Press, Chicago Ill, Becker G.S.
Psychic costs of adopting laparoscopic cholecystectomy are expected to be lower for younger surgeons, who are closer to their residencies and are likely to be more confident of theit ability to learn new techniques. Younger surgeons also have a longer remaining time in practice in which to make adoption wothwhile. On the other
Diffusion of laparoscopic cholecystectomy among general surgeons in United States. Escarce JJ, Bloom BS, Hillman AL, Shea JA, Schwartz JS. Med Care 1995;33:256-71
Younger surgeons adopted laparoscopic cholecystectomy earlier than older surgeons.
Diffusion of laparoscopic cholecystectomy among general surgeons in United States. Escarce JJ, Bloom BS, Hillman AL, Shea JA, Schwartz JS. Med Care 1995;33:256-71

no effect

Senior surgeons learn in simulated environments their technical skills in a fashion similar to residents
Objective evaluation of a laparascopic surgical skill program for residents and senior surgeons. Rosser JC Jr, Rosser LE, Savalgi RS, Arch Surg 1998;133:657-661

 

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7.1.3 SKILLS

A⁄ cognitive skills

B⁄ technical skills

basic training

The moment has come to abandon 2-3 day courses and replace them by formal inclusion in the basic training.
Survey on Torino courses, Morino M. Festa V., Garone C., Surg Endosc 1995;9:46-48

re-training

Education and information enhance the capacity to overcome the resistance created by adoption costs and uncertainty, and thereby raise the probability of adopting profitable innovations.The profitability of beeing an early adopter provides a source of return tohuman capital and information acquisition investments.
Human Capital, Information, and the Early Adoption of New technology. Gregory D Wozniak The Journal of human resources XXII 1:101-112
The diffusion of most minimal invasive techniques has been slow due to a lack of education, training and the constraints of acquiring equipment.
Diffusion of minimally invasive therapy in the Netherlands, Vondeling Hendrik, Haerkens Enria, de Wit Ardine, Bos Michael and Banta David, Health Policy 1993;23:67-81
Appropriated training courses have stimulated the diffusion of laparoscopic technologies in Denmark.
Diffusion of laparoscopic technologies in Denmark. Peter Bo Poulsen, Sven Adamsen, Hindrik Vondeling, Torben Jorgensen. Health Policy 1998;45:149-167
Despite an international consensus that arthroscopic knee surgery should replace open knee surgery, it has not. the main reason is probably that those doing knee surgery were not trained in arthroscopic techniques.
Diffusion of minimally invasive therapy in Europe. Banta HD, Vondeling H Health Policy 1993;23(1-2):125-133
Some physicians do not take up new procedures because of the difficulty in learning how to do them. Others take them up without appropriate preparation, and undoubtly harm patients.
Diffusion of minimally invasive therapy in Europe. Banta HD, Vondeling H Health Policy 1993;23(1-2):125-133

re-inforcement of relevant skills

A critical deterrent to securing the transfer of skill is incomplete initial training of the original task. This raises questions about the value of attendance at an isolated workshop without allowance for the subsequent reinforcement of the relevant skills (working on an low fidelity model after the training)
Acquiring surgical skills, Hamsdorf JM and Hall JC
British Journal of Surgery 2000;87:28-37

 

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7.1.4 RESISTANCE

The UK case study demonstrates that the primary barriers to diffusion of minimally invasive techniques lie within the profession itself. Physicians cite structural and procedural factors (human or material resources) but have no insight in their own resistances.
The development of minimal invasive therapy in the United Kingdom Ong Bie Nio, Health Policy 1993;23:83-95

 

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7.1.5 SELF-ASSESSMENT

The surgeon needs to be willing to allow himself to become a partner with the rest of the team so he accept input. He should explicitly encourage input and feedback from other team members in the operating room.
Organizational differences in rates of learning: evidence from the adoption of minimally invasive cardiac surgery.Pisano Gary P, Bohmer Richard MJ, Edmondson Amy C. Management Science 2001;47:752-768

 

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7.1.6 CONFERENCES AND RELATED ACTIVITIES

 

7.2 ANESTHESIA SUPPORT

the cardiac anesthetist and his training process

 

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7.3 GROUP MEMBERSHIP STABILITY

If know how is collective, the rate of performance is likely to be influenced by group membership stability, because knowing what other group members know helps individuals coordinate their actions (transactive memory of the group).
Learning who knows what in work groups and organisations, Moreland RL, Shared cognition in organisations: the management of knowledge Malwah NJ Erlbaum 3-2, by Thompson LL, Levine J M, Messick D M (Eds)
It promotes speed of learning when the adopting surgeon handpick the team based on their prior experience working together and their demonstrated ability to work well together.
It allows a consistent group of people to work on a consistent task and therby improve cordination.
In contrary when a team that was sent to training was picked largely on the basis of availability and willingness to go, learning gets difficult.
Organizational differences in rates of learning: evidence from the adoption of minimally invasive cardiac surgery.Pisano Gary P, Bohmer Richard MJ, Edmondson Amy C. Management Science 2001;47:752-768
The early cases should be managed by the adopting surgeon. the surgeon mandate the stability of both the surgical team and the surgical procedure in the early cases. E.g. a successful team that went to a training programm performed the first 15 cases before any new members were added or substituted.
Organizational differences in rates of learning: evidence from the adoption of minimally invasive cardiac surgery.Pisano Gary P, Bohmer Richard MJ, Edmondson Amy C. Management Science 2001;47:752-768
Katz identified a curvilenar relationship between memship stability and performance in product development teams, in which performance initially improved with membership stability, but over time, began to worse.
The effect fo group longevity on project communication and performance, Katz R, Administrative Science Quarterly, 1982;27:81-104

 

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7.4 PRE-VISIT OPCAB EXPERIENCE BY TEAM

The number of prior OPCAB cases becomes more important for late performance when knowledge is based on tacit knowledge, but most knowledge given in Leuven is codified.
Learning how and learning what: effect of tacit and codified knowledge on performance improvement following technology adoption, Edmondson Amy C, Winslow Ann B, Bohmer Richard M J, Pisano Gary P, Decision Sciences, 2003;vol 34 nr 2:197-222
Learning new routines needed for a new technology necessarily means unblearning old routines, typically taken for granted and tacit, albeit potentially subject to codification by an outsider. The taken for granted nature of existing practices makes unlearning them difficult.
How organisations learn and unlearn, Hedberg B 1981. In P C Nystrom and W H Starbuck (Eds), Handbook of organisational design, Vol 1 Oxford : Oxford University Press 3-27
Analyses of learning curves for rayon producers found differences in the abilities to benefit from their own cumulative production experience.
Learning by doing and competition in the early rayon indusytry. Jarmin RS Rand J Econom 1994; 25:441-454
Some level of cummulative experience may be necessary to master a technology, it is unlikely to be sufficient. Unless an organization puts into place mechanisms for capturing knowledge and implementing learning, experience may not translate into competence.
Organizational differences in rates of learning: evidence from the adoption of minimally invasive cardiac surgery.Pisano Gary P, Bohmer Richard MJ, Edmondson Amy C. Management Science 2001;47:752-768

 

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7.5 CROSS-DEPARTMENT COMMUNICATION AND COOPERATION

In an successful training programm the surgeon organizes a series of meetings with other departments that might be affected by the new technology. Important subjects are: referral of appropriate patients by the cardiologists, agreement on standard terminology that they would use during the operations, ...
Organizational differences in rates of learning: evidence from the adoption of minimally invasive cardiac surgery.Pisano Gary P, Bohmer Richard MJ, Edmondson Amy C. Management Science 2001;47:752-768

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7.6 COACHING BEHAVIOR

Coaching behavior may allow other team members to feel more confortable to speak up quickly about their observations thus enabling quicker response and ultimately faster operations.
Organizational differences in rates of learning: evidence from the adoption of minimally invasive cardiac surgery.Pisano Gary P, Bohmer Richard MJ, Edmondson Amy C. Management Science 2001;47:752-768

 

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7.7 MOTIVATION AND COMMITMENT

A motivated recipient of a new technology can intensify, rather than mitigate, the difficulty during the ramp-up stage. Highly motivated adopters have been found to exacerberate problems of implementation by prematurely dismissing outside help, expanding seeemingly straightforwared modifications to preserve pride of ownership and status or to let out hiddden resentment, or switching to new practices at a suboptimal moment because of unchekced enthusiasm.
The process of knowledge transfer: a diachronic analysis of stickiness. Szulanski Gabriel. organizational behaviour and human decision processes 2000;82:9-27
The results from the study by Campbell et al. support Schoen's hypothesis that learning stimulated by ' reflection-on-action' is more likely to lead to a change in practice than learning stimulated by 'reflection-in-action. Reviewing the managment of more than one patient and clinical audits operate at the stage of 'reflection-on-action' in Schoen's model of learning practice.
Study of the factors influencing the stimulus to learning recorded by physicians keeping a learning portfolio Craig Campbell, John Parboosingh, Tunde Gondocz, Galina Babitskaya, Ba Pham. J Continuing education in the Health Professions;19:16-24

 

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8. ABSENCE OF AUDITING MECHANISM

The undisciplined introduction of laparoscopic techniques during the early 1990's led Cuschieri to comment about the uncontrolled expansion of surgical endoscopic practice which amounted to the biggest un-audited free-for-all in the history of surgery.
Whither minimal access surgery: tribulations and expectations, Cuschieri A., Am J Surg 1995;169:466-472

Johnson suggests a sequence for the introduction of a new procedure:

  1. register hypothesis or idea
  2. animal or cadaver work
  3. apply to ethics committee (national or local)
  4. apply to a trial certification organisation
  5. result publication mandatory
  6. compulsary ongoing audit
  7. after acceptance, limited licence and formulation of training requirements

New interventional procedures: efficacy, safety and training, Johnson A.G., Aust.N.Z. J. Surg. 1998;68:3-5

 

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9. LATE SUPERVISION

A specially trained individual was allocated for this task, but was not enough understood by the scholars and by the Industry (personal comment P Sergeant about opcab-retraining).

 

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10. ENABLING MATERIAL GIVEN AT CMEST

The more codified knowledge has been moved from tacit into codified, and the more this is included in the given enabling material, the greater the late impact of the CMEST should be.
Learning how and learning what: effect of tacit and codified knowledge on performance improvement following technology adoption, Edmondson Amy C, Winslow Ann B, Bohmer Richard M J, Pisano Gary P, Decision Sciences, 2003;vol 34 nr 2:197-222

 

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11. PROCESS OF IMPLEMENTATION OR ENACTMENT

Shifting back and forth between the conventional to OPCAB techniques increases the challenge for participants to fall prey to habitual routines. So the optimal chance of success is total implementation.
Habitual routines in task-performing teams, Gersick CJG, Hackman JR, Organisational behavior and human decision processes, 1999;47:65-97
Technological artifact vs. Technologies-in-practice
The term technology-in-practice refers to the specific structure routinely enacted as we use the specific machine, technique, appliance, device, or gadget in recurrent ways in our everyday situated activities.
The assumptions of technological stability, completeness, and predictiability break down in the face of empirical research that shows people modifying technologies and their conceptions of technology long after design and development.
Technology may, deliberatly or inadvertently, used in a way not anticipated by the developers.
While a technology can be seen to embody particular symbol and material properties, it does not embody structures because those are only instantiated in practice.
use of technology is strongly influenced by users' understandings of the properties and functionality of a technology, and these are strongly influenced by the images, descriptions, rhetorics, ideologies, and demonstrations presented by intermediaries such as vendors, journalists, consultants, champions, trainers, managers, and 'power' users.
Using Technology and Constituing structures: a practice lens for studying technology in organisations, Orlikowski Wanda, Organisation SCience, 2000;11, nr 4 July-August, 404-428

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