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Cited by 732Health Policy Implementation ScienceHealth Sciences Research and EducationDelphi Technique in Research

Determinants of innovation within health care organizations: Literature review and Delphi study

Fleuren, M.·2004·International Journal for Quality in Health Care
DOI 10.1093/intqhc/mzh030
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Abstract

PURPOSE: When introducing innovations to health care, it is important to gain insight into determinants that may facilitate or impede the introduction, in order to design an appropriate strategy for introducing the innovation. To obtain an overview of determinants of innovations in health care organizations, we carried out a literature review and a Delphi study. The Delphi study was intended to achieve consensus among a group of implementation experts on determinants identified from the literature review. DATA SOURCES: We searched 11 databases for articles published between 1990 and 2000. The keywords varied according to the specific database. We also searched for free text. Forty-four implementation experts (implementation researchers, programme managers, and implementation consultants/advisors) participated in the Delphi study. STUDY SELECTION: The following studies were selected: (i) studies describing innovation processes, and determinants thereof, in health care organizations; (ii) studies where the aim of the innovations was to change the behaviour of health professionals; (iii) studies where the health care organizations provided direct patient care; and (iv) studies where only empirical studies were included. DATA EXTRACTION: Two researchers independently selected the abstracts and analysed the articles. The determinants were divided into four categories: characteristics of the environment, characteristics of the organization, characteristics of the user (health professional), and characteristics of the innovation. When analysing the determinants, a distinction was made between systematically designed and non-systematically designed studies. In a systematic study, a determinant analysis was performed and the innovation strategy was adapted to these determinants. Furthermore, the determinants were associated with the degree of implementation, and both users and non-users of the innovation were asked about possible determinants. In the Delphi study, consensus was defined as agreement among 75% of the experts on both the influence of a determinant and the direction towards which that influence tended (i.e. facilitating, impeding, or neutral). RESULTS: From the initial 2239 abstracts, 57 studies were retrieved and 49 determinants were identified that affected (impeded or facilitated) the innovation process. The experts identified one other determinant. Seventeen studies had a more-or-less systematic design; the others did not. After three rounds, consensus was reached on the influence of 49 out of 50 determinants. CONCLUSION: The results of the literature review matched those found in the Delphi study, and 50 potentially relevant determinants of innovation processes were identified. Many of the innovation studies had several methodological flaws, such as not adjusting innovation strategies to relevant determinants of the innovation process, or that data on determinants were gathered only from non-users. Furthermore, the degree of implementation was evaluated in several ways, which made comparison difficult.

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Crossref · 10.1093/intqhc/mzh030

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  • Implementation outcomes in schools are influenced not only by characteristics of the health promotion program itself, but also by characteristics related to actors, the inner school setting, and the broader school setting.

    “This means that any implementation outcomes as indicators of the implementation process in schools are influenced not only by the characteristics of the HP program itself, but also by characteristics related to its actors (e.g., teachers and students), the inner school setting (e.g., school size), and the broader school setting (e.g., education sector) [9, 10].”

    From Balancing Fidelity and Adaptation: Action‐Oriented Research Towards Implementing a Nutrition Education Program Among Adolescents (2025) · cites this paper as [10]

  • The success rate of an innovation is dependent on the level of the innovation itself, end users, organization, and the social-political context.

    “Fleuren et al (2004) state that the success rate of an innovation is dependent on the level of the innovation itself, end users, organization, and the social-political context [19].”

    From Lessons Learned From a Living Lab on the Broad Adoption of eHealth in Primary Health Care (2018) · cites this paper as [19]

  • Improving the adoption and implementation of evidence-based interventions into routine practice involves changes in healthcare professionals' behaviors that may be influenced by a range of individual, organizational, and social factors.

    “Improving the adoption and implementation of evidence-based interventions into routine practice involves changes in healthcare professionals’ behaviors that may be influenced by a range of individual, organizational, and social factors [16-20].”

    From Discriminant content validity of a theoretical domains framework questionnaire for use in implementation research (2014) · cites this paper as [16]

  • The initial version of the questionnaire included items related to characteristics of the innovation, organization, socio-political context, and innovation strategies.

    “The initial version of the questionnaire included items related to characteristics of the innovation, organization, socio-political context, and innovation strategies [16-20]”

    From Discriminant content validity of a theoretical domains framework questionnaire for use in implementation research (2014) · cites this paper as [16]

  • The TDF mainly focuses on factors related to the adopting person, instead of taking into account a variety of factors related to characteristics of the innovation, patient, social setting, organizational context, and innovation methods and strategies.

    “the TDF [37], however, mainly focuses on factors related to the adopting person, instead of taking into account a variety of factors related to characteristics of the innovation, patient, social setting, organizational context, and innovation methods and strategies [16-20]”

    From Discriminant content validity of a theoretical domains framework questionnaire for use in implementation research (2014) · cites this paper as [16]

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Authors
Fleuren, M.
Affiliations
Netherlands Organisation for Applied Scientific Research (NL)
Corresponding author
Fleuren, M.
ORCID
Fleuren, M.
Venue
International Journal for Quality in Health Care
Publisher
Oxford University Press (OUP)
Published
2004-04-01
Volume
16
Issue
2
Pages
107-123
ISSN
  • 1353-4505 (ISSN-L)
  • 1464-3677
DOI
10.1093/intqhc/mzh030
OpenAlex
W2241196545
Cited by
732
References
69
Citations by year
2026: 11 · 2025: 24 · 2024: 43 · 2023: 36 · 2022: 43 · 2021: 41 · 2020: 42 · 2019: 45 · 2018: 32 · 2017: 44 · 2016: 44 · 2015: 50 · 2014: 49 · 2013: 56 · 2012: 42
FWCI
18.53
Type
journal article
Language
en
Open access
closed
Locations
  • International Journal for Quality in Health Care (publishedVersion)
  • PubMed (publishedVersion)
  • VU Research Portal (publishedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Topics
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
  • Social Sciences › Sociology and Political Science › Delphi Technique in Research
Keywords
innovation determinants, healthcare innovation, innovation implementation, health care organization, organizational characteristics, environmental characteristics, innovation characteristics, barriers and facilitators, innovation strategy, expert consensus, patient care organization, health care financing
MeSH terms
Cross-Sectional Studies, Delphi Technique, Diffusion of Innovation, Health Services Research, Humans, Netherlands, Health Facility Administration

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