Factors associated with degree of adoption by hospitals in the central states of the agency for health care policy and research clinical practice guideline for management of cancer pain

Abstract

<p>Using contingency theory (Damanpour, 1991) and Rogers' (1995) diffusion of innovations theory, this study: (1) determined the degree of adoption of AHCPR management of cancer pain clinical practice guideline (CPG) by hospitals; and (2) examined organizational-level and individual-level factors associated with adoption of the CPG. Organizational-level (macro) factors included: (1) structural variables&mdash;functional differentiation, vertical differentiation, centralization, external/cosmopolitan communication in a social system, and internal/local communication in a social system; (2) contextual variables&mdash;competition, size, age. Individual-level (micro) factors included moderator variables&mdash;type/characteristics of the innovation (radical/incremental, relative advantage, complexity, compatibility, trialability, observability) and time/stage of adoption. Data were collected in two phases: (1) Phase I&mdash;mailed survey of chief nurse executives in six central states, and (2) Phase II&mdash;8 intensive case studies. The mailed survey was sent to 227 chief nurse executives and 102 usable responses were returned (45% response rate). The content of the CPG was adopted by only 32% of the hospitals when judged by a dichotomous measure. All 8 regression models testing ability of structural variables alone and structural variables in presence of contextual variables were statistically significant with issues of greater extent of communication and idea champion (internal communication) and centralized decision making having a positive effect on adoption. Less than half of the models using moderator variables were significant, with radical nature of the CPG having negative effect and compatibility having positive effect. In Phase II, data from 8 case studies indicated that quality of care concerns motivated adoption. External channels of communication provided the initiating event, while extensive internal communication and shared governance slowed the decision stage but improved implementation. A multidisciplinary group with physician champion was effective. These findings support the important role that nurses have in adoption of innovations by hospitals. Through personal commitment and perseverance, nurses can skillfully use structural, contextual, and moderator factors to ensure effective adoption of an innovation.</p>