Exploring the Adoption and Implementation of Healthcare Innovation: Case Studies of Two Antimicrobial Stewardship Programs in Saskatchewan

Abstract

Health innovations can play an important role in improving quality of care and in reducing healthcare costs. However, even promising innovations are not always successfully implemented because the process can be challenging. Thus, there is a significant gap between healthcare innovations and their application in routine practice. In this study, I explored determinants that influence adoption and implementation of a healthcare innovation, using the Regina Qu’Appelle Health Region (RQHR) and the Saskatoon Health Region (SHR) Antimicrobial Stewardship Programs (ASPs) as case studies. Considering the increasing risks of antimicrobial resistance, international bodies such as the World Health Organization, United Nations, the World Economic Forum and the Government of Canada have called for antimicrobial stewardship. Accreditation Canada has also required acute care facilities, inpatient cancer, inpatient rehabilitation and complex continuing care facilities to implement an ASP. Antimicrobial stewardship activities are focused on appropriate selection, dosing, route, and duration of antimicrobial therapy. I initiated this study prior to the amalgamation of the province’s health regional authorities into the Saskatchewan Health Authority (SHA). Understanding potential challenges and strategies adopted for the two health regions may help inform the development of a provincial antimicrobial stewardship approach as well as other healthcare institutions that are in the process of adopting or implementing their own ASP. I utilized a qualitative case study approach and conducted semi-structured interviews of eight stakeholders involved in the adoption and/or implementation of the RQHR and SHR ASPs. I included a prescribing physician, ASP implementing team members and organizational champions as study participants. I obtained additional information from the health regions’ websites, publicly available documents and the ASP teams. The RQHR and the SHR ASPs demonstrated a complex innovation process. The decision to adopt an ASP required multiple years, and various factors and stakeholders. Accreditation Canada’s requirement appeared to be the key determinant for the decision to adopt a formal ASP for both health regions. There were additional enabling factors for the RQHR: “policy push” from key healthcare institutions (e.g., the World Health Organization, United Nations and the Public Health Agency of Canada) and innovation champions. In terms of implementation, the majority of determinants that I identified for the health regions are shared: (1) dedicated resources and time for the ASP team; (2) data infrastructure; (3) availability of tools and information for prescribing physicians; (4) competencies of the ASP implementing team; (5) fit of the innovation to health professional’s values and goals; and (6) collegial conversations of the ASP team with prescribers. Most of these factors are consistent with published studies suggesting that these commonalities transcend different contexts. Thus, it may be helpful for healthcare organizations, including the newly established SHA, to pay attention to these factors when planning and/or implementing their ASPs. This study adds to the limited information on the adoption and implementation of ASPs in Canada and internationally. Despite Accreditation Canada’s ASP requirement, there appears to be limited ASP implementation in Canadian healthcare facilities. My study offers lessons and strategies that could facilitate planning and implementation of ASPs. Also, this research contributes to the growing area of implementation research and demonstrates the utility of using a theoretical framework to guide analysis of results.