Susan E. Hernandez, MPA, is PhD Student, Department of Health Services, School of Public Health, University of Washington, Seattle. E-mail: . Douglas A. Conrad, PhD, MBA, MHA, is Professor, Department of Health Services, School of Public Health, University of Washington, Seattle. E-mail: . Miriam S. Marcus-Smith, RN, MHA, is Research Manager, Patient-Centered Care Project, Department of Health Services, University of Washington, Seattle. E-mail: . Peter Reed, MPH, is MD Student, School of Medicine, Duke University, Durham, North Carolina. E-mail: . Carolyn Watts, PhD, is Professor and Chair, Department of Health Administration, School of Allied Health Professions, Virginia Commonwealth University, Richmond. E-mail: . Health care management review
(Impact Factor: 1.3).
06/2012; 38(2). DOI: 10.1097/HMR.0b013e31825e718a
BACKGROUND:: Patient-centered innovation is spreading at the federal and state levels. A conceptual framework can help frame real-world examples and extract systematic learning from an array of innovative applications currently underway. The statutory, economic, and political environment in Washington State offers a special contextual laboratory for observing the interplay of these factors. PURPOSE:: We propose a framework for understanding the process of initiating patient-centered innovations-particularly innovations addressing patient-centered goals of improved access, continuity, communication and coordination, cultural competency, and family- and person-focused care over time. The framework to a case study of a provider organization in Washington State actively engaged in such innovations was applied in this article. METHODS:: We conducted a selective review of peer-reviewed evidence and theory regarding determinants of organizational change. On the basis of the literature review and the particular examples of patient-centric innovation, we developed a conceptual framework. Semistructured key informant interviews were conducted to illustrate the framework with concrete examples of patient-centered innovation. FINDINGS:: The primary determinants of initiating patient-centered innovation are (a) effective leadership, with the necessary technical and professional expertise and creative skills; (b) strong internal and external motivation to change; (c) clear and internally consistent organizational mission; (d) aligned organizational strategy; (e) robust organizational capability; and (f) continuous feedback and organizational learning. The internal hierarchy of actors is important in shaping patient-centered innovation. External financial incentives and government regulations also significantly shape innovation. PRACTICE IMPLICATIONS:: Patient-centered care innovation is a complex process. A general framework that could help managers and executives organize their thoughts around innovation within their organization is presented.