Factors Related to the Implementation and Use of an Innovation in Cancer Surgery

Objective: Nationally, efforts to implement an innovation in cancer surgery—a Web-based synoptic reporting tool—are ongoing in five provinces. The objective of the present study was to identify the key multilevel factors influencing implementation and early use of this innovation for breast and colorectal cancer surgery at two academic hospitals in Halifax, Nova Scotia. Methods: We used case-study methodology to examine the implementation of surgical synoptic reporting. Methods included semi-structured interviews with key informants (surgeons, implementation team members, and report end users; n = 9), nonparticipant observation, and document analysis. A thematic analysis was conducted separately for each method, followed by explanation-building to integrate the evidence and to identify the key multilevel factors influencing implementation. An audit was performed to determine use. Results: Key factors influencing implementation were these: 1. Innovation–values fit; 2. Flexibility with the innovation and implementation; 3. The innovation is not flawless; 4. Strengthening the climate for implementation; 5. Resource needs and availability; 6. Partner engagement; 7. Surgeon champions and involvement. In a 6-month period after implementation, 91.2% and 58.0% respectively of eligible breast and colorectal cancer surgeries were reported using the new tool. Conclusions: An improved understanding of the multilevel factors influencing the implementation of innovations is critical to planning effective change interventions in health care. Further study is needed to explore differences in the use of the innovation between breast and colorectal cancer surgeons. Findings will inform the study of additional cases of synoptic reporting implementation, enabling cross-case analyses and identification of higher-level themes that may be applied in similar settings or contexts.