Dissemination Science. OK, that's a useful way of thinking about it.
A framework for training competency in implementation and dissemination science - now that sounds very useful.

Acad Med. 2012 Mar;87(3):271-8.A framework for training health professionals in implementation and dissemination science.Gonzales R, Handley MA, Ackerman S, Oʼsullivan PS.


This is their abstract

"The authors describe a conceptual framework for implementation and dissemination science (IDS) and propose competencies for IDS training. Their framework is designed to facilitate the application of theories and methods from the distinct domains of clinical disciplines (e.g., medicine, public health), population sciences (e.g., biostatistics, epidemiology), and translational disciplines (e.g., social and behavioral sciences, business administration education). They explore three principles that guided the development of their conceptual framework: Behavior change among organizations and/or individuals (providers, patients) is inherent in the translation process; engagement of stakeholder organizations, health care delivery systems, and individuals is imperative to achieve effective translation and sustained improvements; and IDS research is iterative, benefiting from cycles and collaborative, bidirectional relationships. The authors propose seven domains for IDS training-team science, context identification, literature identification and assessment, community engagement, intervention design and research implementation, evaluation of effect of translational activity, behavioral change communication strategies-and define 12 IDS training competencies within these domains. As a model, they describe specific courses introduced at the University of California, San Francisco, which they designed to develop these competencies. The authors encourage other training programs and institutions to use or adapt the design principles, conceptual framework, and proposed competencies to evaluate their current IDS training needs and to support new program development."

What is disruptive innovation?

A disruptive innovation is not a breakthrough innovation that has taken something and made better.It is an event or product which transforms the entire notion of the experience or product.
We would like disruptive innovation in healthcare, but mostly we do breakthrough innovation - at best.

Listen (<5mins) to the definition of disruptive innovation from the man himself, courtesy of Harvard Business Review (HBR)

Is Activity Theory useful for large scale change?

There's no shortage of theories and models for how good practice can be "spread". I'm part fo the problem by generating some of them.... I've recently become curious about the use of Activity Theory as a means of large scale change in healthcare settings.   It's a bit of an eclectic theory from the social sciences - but then, PDSA cycles were once an eclectic Japanese theory.

Wikipedia has a good intro.  Basically, the benefits of Activity Theory is it combines all system levels into one model of change - from individual through to policy. And I like that.

Greg, Entwistle and Beech have a new paper which considers how AT can be applied usefully in healthcare.

Soc Sci Med. 2012 Feb;74(3):305-12. Epub 2011 Mar 1.
Addressing complex healthcare problems in diverse settings: Insights from activity theory. 
This is their abstract: "In the UK, approaches to policy implementation, service improvement and quality assurance treat policy, management and clinical care as separate, hierarchical domains. They are often based on the central knowledge transfer (KT) theory idea that best practice solutions to complex problems can be identified and 'rolled out' across organisations. When the designated 'best practice' is not implemented, this is interpreted as local - particularly management - failure. Remedial actions include reiterating policy aims and tightening performance management of solution implementation, frequently to no avail. We propose activity theory (AT) as an alternative approach to identifying and understanding the challenges of addressing complex healthcare problems across diverse settings. AT challenges the KT conceptual separations between levels of policy, management and clinical care. It does not regard knowledge and practice as separable, and does not understand them in the commodified way that has typified some versions of KT theory. Instead, AT focuses on "objects of activity" which can be contested. It sees new practice as emerging from contradiction and understands knowledge and practice as fundamentally entwined, not separate. From an AT perspective, there can be no single best practice. The contributions of AT are that it enables us to understand the dynamics of knowledge-practice in activities rather than between levels. It shows how efforts to reduce variation from best practice may paradoxically remove a key source of practice improvement. After explaining the principles of AT we illustrate its explanatory potential through an ethnographic study of primary healthcare teams responding to a policy aim of reducing inappropriate hospital admissions of older people by the 'best practice' of rapid response teams."

Why don't we search for evidence?

So I'm perplexed.

I've spent years listening to leaders at all levels - from unit, to department, to organisation, to region, to National  - all say they want "other people" (usually those "beneath" them) to adopt existing good practices.

That's all good and well.

But when I press these leaders on what efforts they've made to check the literature, search for existing guidelines or consider the experience of people similar to themselves - they all look at me blankly.  One recently told me that "that sort of thing is for the people who need to improve, not me. They need to adopt guidelines."  When I pressed him about the opportunity he has to learn from others in the design of his large scale intervention, he replied "We're different."

I shall invest a new piece of equipment - a mirror.

Self Management Support Tools and Resources

Hoorah! We're finally moving from what often feels the patronising approach of "empowering patients" to finding ways to truly be partners in their care process.  There are multiple projects and programs round the world which demonstrate what can be done.  I've put together a list of resources which you may find useful.

1. My favourite are from The Health Foundation. Their package is comprehensive and includes materials for training staff so is excellent for getting the message out there in a practical way. They've also got resources for improving patient skills.

2. The Institute for Improvement has a short guide which is useful if you want to check what you may need to do to get some benefits.

3. There's an excellent write up about the long term conditions collaborative in Scotland where they identify the top high impact changes you can make.

4. Selfmanagement,.co.uk also has resources and it's one of the few places I've seen where there's information on relevant published literature.  In fact, the more I look at this website, the more I feel it is perhaps the most comprehensive and useful...

Do you have any favourite self management support resource links you'd like to share? Please comment below and I'll add to this blog.

Do you share your experiences?

I recently watched a three year old coming to terms with her one year old brother's need to hold a toy that until recently she thought belonged to her.  Sharing - it doesn't necessarily get any easier. But for some people, it is automatic. Dr Michael Bergstrom from SKL, Sweden, sent me a one page summary and a pictures of the top 10 slides (in his opinion) from the Paris Euroforum.

Just a perfect example - of sharing.