Sklar, David P. MD
Acknowledgments: Dr. Sklar would like to thank Mary Beth DeVilbiss, Anne Farmakidis, Debra Weinstein, Steve Durning, and Jan Carline for their help in developing this new concept and putting together the publication criteria noted above.
Editor’s Note: The opinions expressed in this editorial do not necessarily reflect the opinions of the AAMC or of its members.
When I was a medical resident 37 years ago, most of the difficult decisions about treating our patients were based upon the opinions of faculty, who could quell a debate about treatment with a preemptive “In my experience….” Accurate, relevant information was difficult to find, and we were content to depend upon the experience of our attending faculty and upon textbooks for treating less difficult conditions. Now all of that has changed. Residents and medical students can conduct searches of various published materials on their smartphones during rounds as soon as a question arises, and they can have the answer before the patient presentation has finished.
The easy and widespread availability of medical information has been one of the most profound changes in health care during my career. This information is not only available to health care providers. Patients and their families also can access current medical information. And there is so much of it! One of the greatest challenges in health care is to sort through the continuous flood of new information to find what is really important and applicable. How are we to identify what is valuable and new? How are we to evaluate the quality of the information, and how are we to remember it? For a journal such as Academic Medicine, which receives thousands of submissions each year, it is a constant struggle to select and present the information that will be most valuable to readers in their teaching, practice, research, or management of academic medicine’s institutions.
One area of emphasis for the journal has been the presentations of innovations in education, clinical care research, or related areas such as communications or professionalism. Although innovation has occurred throughout the history of medicine, recently we have learned several important characteristics of innovation. Innovation can occur incrementally, which happens when a product undergoes continued improvement. Hwang and Christensen1 call this a sustaining innovation because it sustains the current product through gradual improvements. However, another type of innovation is a disruptive innovation. A disruptive innovation is typically of lower quality than the existing product but is less expensive and meets the needs of a less demanding part of a market, which either could not afford the existing product or did not need all of its capabilities. Over time, the newer product improves and develops more capabilities that draw the market from the original product, eventually replacing it. An example of a disruptive innovation is the personal computer, which replaced mainframe computers. In this issue of Academic Medicine, Prober and Khan2 and Mehta et al3 describe examples of disruptive innovations in education that could be as transformative as the personal computer was.
A second important characteristic of innovations involves how they are adopted and spread through a population. For an innovation to spread, not only must it have advantages over what existed previously, but something about it must convince people to switch. Everett Rogers,4 one of the pioneers of innovation diffusion theory, described five steps in the process of diffusing an innovation: knowledge, persuasion, decision, implementation, and confirmation. Understanding how to encourage the spread and adoption of innovations may be as important as the idea of the innovation itself, because an innovation that remains isolated and unknown will be of little value. Berwick5 has described an application of Rogers’ theory to health care, emphasizing three factors important in the adoption of an innovation: the perceived benefit of the innovation, the compatibility of the innovation with values and current needs, and the simplicity of the innovation. People vary in how rapidly and how willingly they participate in an innovation, and identification and encouragement by the early adopters can help speed up the pace of diffusion.5
In spite of our understanding of the dissemination of innovations, Balas and Boren6 have described the many ways in which new information is lost or delayed in reaching the clinical practice environment, estimating that only 14% of original research becomes incorporated into patient care and that, on average, this takes 17 years from the completion of the research.
A few years ago, Steve Kanter,7 the editor of our journal at that time, discussed the presentation of innovations in these pages and identified nine features of an innovation that he would assess in deciding whether the innovation warranted publication in Academic Medicine. These included a clear and thorough description of the problem; generalizability; identification of the key stakeholders; description of the possible solutions, including the one chosen; how it was implemented; its potential impact; and what we can learn from it. This approach has served the journal well, and we will continue to use it, but as the number and variety of innovations accelerate, the journal staff and I have felt the need to provide some additional options for the presentation of innovations in Academic Medicine. The option we have chosen is a new category of article, which we have named an innovation report.
We are hopeful that providing this venue for the presentation of promising new ideas at an early stage of their development may help speed the adoption of those that fulfill their promise. There is a pressing need to improve the quality of health care and to integrate our educational, research, and clinical care systems, and we at the journal wish to assist this transformation. The ideas offered in innovation reports may be new ways of teaching, thinking, organizing care, communicating, analyzing information, or managing medical schools and teaching hospitals. They may describe disruptive products, ways of disseminating innovations, or incremental quality improvements that integrate education, research, and clinical care. They may also describe new configurations of clinical care teams and new methodologies and analytic approaches to problems. Innovation reports will present ideas that challenge how we think about and define problems and will help us incubate ideas that can be tried out in our communities.
These reports will differ from previous innovation articles in that the evaluation or analysis may be at an earlier, pilot stage. They may be from single institutions but should include enough information to allow for replication of the work, and they should feature innovations that have the promise for larger scaling to multiple institutions or other settings. Two examples of innovation reports appear in this issue of Academic Medicine. One, by Pingleton et al,8 integrates quality improvement and continuing education. The other, by Jacobs et al,9 provides information on how faculty in a department of medicine participate in public policy activities.
An innovation report should be no more than 2,000 words long (not including the abstract or references). The abstract and text should be organized under the main-level headings of Problem, Approach, Outcomes, and Next Steps. The reports should have no more than five references and no more than a total of three tables, figures, charts, lists, or appendices.
The publication criteria that we will use to review submissions in this category may be found at http://journals.lww.com/academicmedicine/Pages/publicationcriteriaforinnovationreports.aspx. We look forward to providing an accessible forum for your best new ideas and assisting in their dissemination.
David P. Sklar, MD
1. Hwang J, Christensen CM. Disruptive innovation in health care delivery: A framework for business-model innovation. Health Aff (Millwood). 2008;27:1329–1335
2. Prober CG, Khan S. Medical education reimagined: A call to action. Acad Med. 2013;88:1407–1410
3. Mehta NB, Hull AL, Young JB, Stoller JK. Just imagine: New paradigms for medical education. Acad Med. 2013;88:1418–1423
4. Rogers EM Diffusion of Innovation. 19954th ed New York, NY Free Press
5. Berwick DM. Disseminating innovations in health care. JAMA. 2003;289:1969–1975
6. Balas EA, Boren SABemmel J, McCray AT. Managing clinical knowledge for health care improvement. Yearbook of Medical Informatics 2000. Patient-Centered Systems. 2000 Stuttgart, Germany Schattauer Verlagsgesselschaff mbH:65–70
7. Kanter SL. Toward better descriptions of innovations. Acad Med. 2008;83:703–704
8. Pingleton SK, Carlton E, Wilkinson S, et al. Reduction of venous thromboembolism (VTE) in hospitalized patients: aligning continuing education with interprofessional team-based quality improvement in an academic medical center. Acad Med. 2013;88:1454–1459
9. Jacobs DB, Greene M, Bindman AB. It’s academic: Public policy activities among faculty members in a department of medicine. Acad Med. 2013;88:1460–1463