The literature on the sustainability of service innovations was, incidentally, very sparse, and so we did not include it in this article.ĭistill and discuss recommendations for practice, policy, and further research.įor each empirical study, we developed a data extraction form (available on request) to summarize the research question, study design, validity and robustness of methods, sample size and power, nature and strength of findings, and validity of conclusions. In particular, we added both overview articles and “landmark” empirical studies from outside the health sector if they had important methodological or theoretical lessons for our research question. We therefore extended our criteria to a wider range of literature. But as the review unfolded, two things became clear: first, in many areas, the evidence meeting all these criteria was sparse, and second, we could gain critical insights from beyond the parameters we had set. Our original inclusion criteria were (1) studies from the health care sector (2) those that had addressed innovation in service delivery and organization (3) those that had looked specifically at the diffusion, dissemination, implementation, and/or routinization of these innovations and (4) those that met our stringent criteria for methodological quality. Our search strategy was designed to concentrate on the service sector, particularly health care. Because formal search techniques (e.g., entering index terms or key words in electronic databases) drew a poor yield, we relied mainly on “snowball” methods (pursuing references of references and using citation-tracking software) and sought advice on sources from experts in various fields. The breakdown of sources that contributed to the final report is shown in Figure 1. But we did note an ambiguity in the notion of sustainability (i.e., the longer an innovation is sustained, the less likely the organization will be open to additional innovations). We distinguished among diffusion (passive spread), dissemination (active and planned efforts to persuade target groups to adopt an innovation), implementation (active and planned efforts to mainstream an innovation within an organization), and sustainability (making an innovation routine until it reaches obsolescence).

We defined innovation in service delivery and organization as a novel set of behaviors, routines, and ways of working that are directed at improving health outcomes, administrative efficiency, cost effectiveness, or users’ experience and that are implemented by planned and coordinated actions. We defined a systematic review as a review of the literature according to an explicit, rigorous, and transparent methodology. Instead, we encourage interested readers to read the complete project report ( Greenhalgh et al. Because of the size and scope of our review, we cannot describe all our findings or discuss all our sources in this article. 1997 Meyers, Sivakumar, and Nakata 1999 Rogers 1995 Tornatsky and Klein 1982 Wejnert 2002 Wolfe 1994), focuses primarily, but not exclusively, on research studies of health care. Our review, which supplements and extends previous overviews and meta-analyses ( Damanpour 1991, 1992, 1996 Granados et al. The United Kingdom Department of Health explicitly commissioned this work, which was carried out between October 2002 and December 2003, for its National Health Service's extensive modernization agenda ( UK Department of Health 2001). This article summarizes the findings of a systematic literature review of the diffusion of service innovations.

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