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Understanding innovation in end-of-l...

Bikson, Karra Linda.

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Understanding innovation in end-of-life care: A comparative case study of hospital-based palliative care programs.

Record Type:	Language materials, printed : Monograph/item
Title/Author:	Understanding innovation in end-of-life care: A comparative case study of hospital-based palliative care programs./
Author:	Bikson, Karra Linda.
Description:	219 p.
Notes:	Adviser: A.E. Benjamin.
Contained By:	Dissertation Abstracts International69-01A.
Subject:	Agriculture, Agronomy. -
Online resource:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=3299557
ISBN:	9780549440826

Understanding innovation in end-of-life care: A comparative case study of hospital-based palliative care programs.
Bikson, Karra Linda.

Understanding innovation in end-of-life care: A comparative case study of hospital-based palliative care programs. - 219 p.

Adviser: A.E. Benjamin.

Thesis (Ph.D.)--University of California, Los Angeles, 2007.

This study explores facilitators and barriers to the adoption of an innovative service technology, palliative care, in the complex organization of the hospital. It uses a conceptual model that integrates Hasenfeld's human service organizations framework with innovation diffusion theory to understand interactions between organizational factors, characteristics of the innovation, and the implementation process. I carried out a comparative case study of hospital-based palliative care programs in three healthcare systems that varied by organizational type, specifically financing mechanisms and VA-mandated program versus non-VA voluntary program.

ISBN: 9780549440826Subjects--Topical Terms:

1018679
Agriculture, Agronomy.

Understanding innovation in end-of-life care: A comparative case study of hospital-based palliative care programs.
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100 1 $a Bikson, Karra Linda. $3 1275820
245 1 0 $a Understanding innovation in end-of-life care: A comparative case study of hospital-based palliative care programs.
300 $a 219 p.
500 $a Adviser: A.E. Benjamin.
500 $a Source: Dissertation Abstracts International, Volume: 69-01, Section: A, page: 0376.
502 $a Thesis (Ph.D.)--University of California, Los Angeles, 2007.
520 $a This study explores facilitators and barriers to the adoption of an innovative service technology, palliative care, in the complex organization of the hospital. It uses a conceptual model that integrates Hasenfeld's human service organizations framework with innovation diffusion theory to understand interactions between organizational factors, characteristics of the innovation, and the implementation process. I carried out a comparative case study of hospital-based palliative care programs in three healthcare systems that varied by organizational type, specifically financing mechanisms and VA-mandated program versus non-VA voluntary program.
520 $a I conducted in-person interviews with key players (physicians, nurses, social workers, administrators, and executives, total n = 22), which I analyzed qualitatively coding for themes within and across cases; I supplemented these data with archival material from each program. Variations in palliative care programs were compared and generalized back to theorized relationships with the service technology (interdisciplinary palliative care), organizational environment (healthcare system), and implementation process factors.
520 $a Integrating palliative care challenges the dominant ideologies and practices of the hospital---because of the emphasis on curative care and saving life, and cultural norms about death and dying. The interdisciplinary nature of palliative care itself challenges established hierarchies, power relations and disciplinary domains in the organizational structure of the hospital. The interdisciplinary team includes role incumbents who communicate, collaborate, and deliver care in ways that transgress traditional hospital boundaries and protocols. Organizations with capitated financing mechanisms have financial incentives to implement palliative care. In addition to innovation champions and executive support, including users in the implementation process and increasing opportunities for observability of outcomes are among the best ways to overcome resistance to palliative care. Implementing hospital-based palliative care requires some reciprocal adaptation to meet these challenges; the technology is redefined and the organization is restructured, to accommodate each other in that process. The conceptual model integrating innovation diffusion theory with Hasenfeld's service organization framework was especially useful in illuminating processes by which particular innovations in health service delivery are implemented and sustained within multiple levels of context.
590 $a School code: 0031.
650 4 $a Agriculture, Agronomy. $3 1018679
650 4 $a Gerontology. $3 533633
650 4 $a Health Sciences, Health Care Management. $3 1017922
650 4 $a Social Work. $3 617587
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710 2 $a University of California, Los Angeles. $3 626622
773 0 $t Dissertation Abstracts International $g 69-01A.
790 $a 0031
790 1 0 $a Benjamin, A.E., $e advisor
791 $a Ph.D.
792 $a 2007
856 4 0 $u http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=3299557