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Pathways and complexity of innovaƟon in health care

 
Zoheir Ezziane 1

ABSTRACT: The focus of this research is to explore various possibili es to inject innova ve solu ons in 

day‐to‐day healthcare opera ons. The concept of healthcare innova on itself is o en vague, leading to 
confusion  about  how  to  sustain  and  enforce  innova ve  prac ce.  It  inves gates  the  culture  and  com‐
plexity including organiza onal culture and climate, care delivery, costs, quality pa ent outcomes, and 
staff efficiencies. Innova on in health care leads to improve care and cut the skyrocke ng costs. Many 
successful experiences, case studies, and frameworks in health care are discussed and culminated with 
valuable  lessons.  This  paper  also  tackles  the  issues  of  medical  malprac ce  and  negligence,  and  how 
healthcare ins tu ons are implemen ng prac cal steps to minimize such undesirable outcomes. 
 

KEYWORDS: health  care  innova on;  healthcare  management;  healthcare  efficiency;  medical 
malprac ce; medical negligence; medical misconduct; medical incompetence; healthcare ins ‐
tu ons.  

Introduction
Creativity is the generating force that rejuvenates the
change process and promotes new ways of thinking. In-
novation is defined as “new ideas plus action or imple-
mentation which results in an improvement, a gain, or a
profit” (Kelly, 2005). In another definition by Carlson
and Wilmot (2006), innovation is “the process of creat-
ing and delivering new customer value in the market-
place.” The concept of innovation carrying new elements
that add value to the customer and resulting in an action
for change was validated in the Medici Effect (Johansson,
2004) in which it was reported that it is impossible to
determine if an idea or vision is truly innovative until
society decides whether the idea is both new and valua-
ble.
The innovation journey as illustrated in figure 1
(Schroeder et al., 1986; Schroeder et al., 1989; Van de
1
 Wharton Fellow. The Wharton Entrepreneurship and Family 
Business Research Centre CERT Technology Park, PO Box 5464, 
Abu Dhabi, United Arab Emirates  care. The third phase of this journey culminates with
This work is supported by the Wharton Entrepreneurship and 
Family Business Research Centre, Abu Dhabi, United Arab Emir‐
ates.   the current environment. Many barriers such as poor
Correspondence: zezziane@hct.ac.ae 
Ven and Angle, 1989; Van de Ven et al., 1999; Gabbay et
al., 2011) includes three phases: (1) conception; (2) devel-
opment; and (3) assimilation/termination. The first phase
allows the initiation of ideas triggered by multiple events
calling for the need for change. These include for exam-
ple deteriorating organizational performance, or
“Technology-push” and “demand-pull” events. It is then
followed by various discussions and business plans. The
second phase is triggered by a “shock” which helps to
concentrate attention and focus the efforts of various
stakeholders in the organization. A shock might include
service failure, new leadership, or a budget crisis. Subse-
quently, a plan gets more attention and starts to develop
further into a proliferation of varying ideas and activities;
however, errors and obstacles may lead to a potential
failure. During this stage many changes could happen,
for example, in key management positions, infrastructure
or organizational restructuring. The changing success
criteria and policy involve, for example, interpreting
policies well and using new measures to improve health
either stopping the entire plan or adopting it and making
it as new health policy that integrates harmoniously with

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Figure 1. Machinery of the innovation journey
communication can hinder the success of innovation
(Rogers, 2003). (See Figure 1)
To differentiate between directional innovation and in-
tersectional innovation, Johansson (2004) reports that
directional innovation creates change in fairly expected
and planned steps, resulting in enhancements. This type
of innovation occurs in health care when operational
changes are implemented to enhance quality care. In
contrast, intersectional innovation involves radical
change and dives toward new routes which can pave the
way for new fields of study.
One of the most appropriate perceptions of innovation
in the healthcare context is suggested by Greenhalgh et
al. (2004):
“An innovation in health service delivery and organi-
zation is a set of behaviours, routines and ways of
working, along with any associated administrative
technologies and systems, which are:
 Perceived as new by a proportion of key stake-
holders
 Linked to the provision or support of healthcare
 Discontinuous with previous practice
 Directed at improving health outcomes, adminis-
trative efficiency, cost-effectiveness, or the user
experience, and
 Implemented by means of planned and co-
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ordinated action by individuals, teams or organi-
zations.”
Innovation in any healthcare setting needs to be under-
stood in a different context. The transformation of how
healthcare services are delivered and the implied organi-
zational change constitute the innovation. Within a pub-
lic sector context, the profit motive should not be con-
sidered as the sole driver for innovation; however vari-
ous private healthcare providers might argue otherwise.
Clinicians and physicians are loosely autonomous pro-
fessionals who are not generally keen to learn from other
colleagues to improve care. Hence, contemporary organ-
izational change efforts present a sort of existentially
crisis for some clinicians and physicians. This poses a
major problem in conducting a transformational change
to improve care.
This work focuses more on innovative approaches which
focus more on organizational transformation and
change within healthcare organizations. It discusses cul-
ture and innovation, complexity, illustrative case sum-
maries, and how to reduce malpractice and negligence in
health care. Lam (2004) reviewed different aspects of
organizational innovation and discussed three different
but interdependent perspectives: a) the relationship be-
tween organizational structural forms and innovative-
ness; b) innovation as a process of organizational learn-
ing and knowledge creation; and c) organizational ca-

pacity for change and adaptation. Shieh and Wang
(2010) revealed the relationship between the effective
integration of resources and information innovation
can be enhanced by an innovative culture. Recently,
Taggart (2011), reported that organizations have to be
more flexible to respond to multiple market changes
calls and need to emphasize the development of lead-
ers at all levels of the organization.
Approaches to innovation in health care
There are many approaches to health care innovation;
however, before illustrating different aspects of such
successful experiences, it is important to understand
the culture and environments that have the potential
to turn into a breeding ground for innovation, and
the characteristics of such innovation.
Culture and innovation
Kotter and Schlesinger (2008) argued that the ability
of organizations to respond to environmental change
is of critical concern for the future. This response is in
a form of a new culture which includes a vision infra-
structure adaptable for future change. Stability in
healthcare environments is not a goal that leaders
should seek; instead, constant processes of evaluating
new suggestions while making sure that high quality
and safe patient care are provided should be the de-
sired goal.
Ongoing innovation, usually defined as the introduc-
tion of something new or radical that leads to positive
change (Mckeown, 2008), is vital for renovating the
healthcare system and gradually enhancing the quali-
ty of care being delivered. Innovation must have evi-
dence and be empirically supported, resulting in in-
creasing the confidence level of policy makers,
healthcare executives, as well as clinicians and nurses.
Sustainable innovation is possible in health care in a
milieu with a culture that promotes creative thinking
that challenges existing systems and leads towards a
positive change (Jaramillo et al., 2008).
To initiate a culture that promotes and sustains inno-
vations to transform health care, innovation must be
encapsulated in the vision and mission of the organi-
zation. Orientation sessions should be designed for
new medical staff to emphasize the goals of the or-
ganization and how they can contribute towards
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achieving them. As the culture for innovation ma-
tures, the development of a strategic plan that out-
lines action strategies with timelines and potential
barriers with means to overcome them is vital
(Melnyk and Fineout-Overhold, 2005). Clinicians
must be invited to be part of the strategic planning
process which results in a major investment from
their part in it and in the organization (Melnyk et al.,
2010).
High-quality care services would only be met if the
ability to adopt and share innovation is developed.
Innovation would be the way forward to face the
myriad challenges and particularly within a strained
global economy. One way of promoting this is to
push for an incentive aiming at setting up a health
policy that promotes and rewards innovation. This
entails some form of collaboration between various
institutions including NGOs and academia to design
and develop prototypes and evaluate constantly new
technologies. The following areas in healthcare inno-
vation include the major areas where improvement is
required within any healthcare organization:
 Service innovation
 Healthcare delivery
 Health improvement
 Patient safety and empowerment
The objectives of such an initiative would help to
achieve the following targets:
 Creating a culture that will provide patients
faster access to cutting-edge medicines;
 Developing measures to ensure the national
body (or entity) is able to lead the way in the
uptake of groundbreaking and cost-effective
medicines and technologies;
 Encouraging academic institutions to offer bio/
health sciences degrees to ensure graduates
leave with the skills required by industry.
Complexity of innovation in health care
Plsek (2003) proposes a circular model for the adop-
tion and diffusion of innovation in health care as
shown in figure 2. Consequently; the importance of
context and the role that various individuals need to
exert in the entire innovation process and especially
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the necessity of capturing and enacting constructive
feedback.
The innovation process in health care as illustrated in
figure 2 cannot and should not be seen as a linear
process which occurs in silos. In addition, it can also
be affected by a host of contextual factors – both in-
ternal and external. Hence, each innovative approach
discussed in this paper does have a local/
environmental factor that leads to its successful im-
plementation.
Figure 2. Complexity associated with innovation in health care.
Plsek (2003)
Most of the organizational changes that occur in
healthcare come with various challenges as pressure
mounts in relation with numerous changes needed to
be implemented. In addition, healthy relationship
infrastructure is largely linked to both effective com-
munication and trust (Nutting et al., 2010).
Any innovation is associated with a transformational
change which requires a paradigm shift within the
organization. For example, a healthcare organization
should not just deliver care to its patients taking into
consideration only the convenience of the physician;
instead, it should necessarily satisfy patients’ require-
ments. Such a change entails major shift in duties of
medical staff as well as re-engineer practice processes.
The complexity of a healthcare environment leads to
observe that each practice requires an individual de-
velopmental pathway to achieve successful transfor-
mation which depends on baseline conditions, the
adaptive reserve of the practice, and the nature and
timing of personal and organizational transformation
(Nutting et al., 2010).
Illustrative case summaries
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A health care innovation is viewed as a change in the
delivery of care, intentionally selected by existing
organisations’ leaders and executives for the purpose
of improving the performance of care delivery. The
following case studies demonstrate how innovation
was achieved in particular environments. Evidently,
the outcomes of such approaches are contextualized;
however, it is worthwhile analyzing these results and
then investigating the possibility of applying a partic-
ular solution but in different setting.
Healthcare restructuring to disseminate innovation
in the Netherlands
A study in the Netherlands reported that most inno-
vations simultaneously improved quality of care from
the patient’s point of view, professional pride, speed,
clinical outcomes, costs, and safety (Schrijvers,
Oudendijk, and De Vries, 2003). Brainstorm sessions
took place with the innovators and in the presence of
experts on the quickest way to disseminate the inno-
vations in healthcare organizations. These sessions
were conducted to identify the following nine key
factors that enable the dissemination of the projects:
1. A clear distribution of responsibilities between
professionals within the innovation
2. Enough educational programs about the inno-
vations for the professionals
3. Adequate information and communication
technology support for the running of the inno-
vations
4. Suitable publicity for the innovations
5. An adequate payment system for innovative
care providers
6. The right size of catchment area for the innova-
tions
7. Enough professional freedom to adopt the in-
novation
8. Fast managerial and public decision-making
about the adoption of the innovation
9. The embedding of the innovations in quality
management assurance policy.
The above study points out different types of innova-
tion including new methods of delivery and multidis-
ciplinary structures within hospitals. This study sug-
gested that a better quality of care from the patient’s
point of view represents the most important result of

such new methods of care delivery such as neonatal
hearing screening, care of women with incontinence,
care for high-risk pregnant women at home and the
implementation of laparoscopic surgery. The intro-
duction of medical technology helped, for example,
hearing screening and the new surgery. These innova-
tions improved health care for the patients, such as
earlier detection of deafness (hearing screening), bet-
ter quality of life (incontinence treatment and treat-
ment of high risk pregnant women at home) and
fewer complications afterwards (laparoscopic sur-
gery).
The Netherland’s study also reported that the multi-
disciplinary structures within hospitals include multi-
disciplinary outpatient coronary heart disease (CHD)
care, integrated oncological care, and comprehensive
trauma care and regionally integrated emergency
services all part of the central focus of hospitals. These
care centers demonstrated better performance with
two common features. Firstly, there is integration
between different medical specialists, e.g. surgeons
and internists admitting patients on the same onco-
logical ward. Cardiologists and cardiac surgeons co-
operate in the CHD clinic. Secondly, more integra-
tion was also noticed between medical specialists and
specialised nurses, for instance in trauma care and in
the regional integration of emergency services. One
interesting outcome of this study is that the trauma
care innovation illustrates that top-down innovations
happen to be successful when there are local enthusi-
astic professionals to support them.
California P4P plan
The California Pay-for-Performance (P4P) plan is
declared to be the largest non-governmental physi-
cian incentive program in the United States. Founded
in 2001, it is controlled by the Integrated Healthcare
Association (IHA) on behalf of eight health plans
representing 10 million insured persons (Integrated
Healthcare Association, 2011). IHA staff members
undertake various tasks including collecting data,
deploying a common measure set, and reporting re-
sults for approximately 35,000 physicians in 221 phy-
sician groups.
The P4P plan, where bonuses between 5% and 10%
above normal tariff, represents a successful experience
in California; however, it is not guaranteed that it
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would work elsewhere (Reece, 2007). California has a
population of nearly 35 million and more than 70,000
physicians, and it has always been a leader in restruc-
turing its health system, in the managed care and
capitation movements. Nonetheless, a survey of 252
Health Maintenance Organizations (HMOs) in 41
metropolitan areas showed more than 50% of the
HMOs, representing more than 80% of individuals
enrolled, used P4P in their physician contracts. A
number of health plans with P4P contracts included
about 90% of them had programs for physicians and
38% had programs for hospitals (Rosenthal et al.,
2006).
Shortell, dean of the School of Public Health at the
University of California−Berkeley, was reported to
support P4P and illustrate the lack of quality in U.S.
health care: “The largest limiting factor is not lack of
money or technology or information, but rather the
lack of an organizing principle that can link money,
people, technology and ideas into a system that is
more cost-effective (i.e., more value) than current
arrangements” (Mongan et al., 2006). In the same
report, Shortell viewed that the goal of P4P plan is to
provide “a compelling set of incentives to drive
breakthrough improvements in clinical quality and
patient experience through a common set of measure-
ments, a public scorecard, and health payments.”
The California IHA plan’s P4P seems to achieve its
goal with the following measurable outcomes:
 Widespread improvements, with 87% of clinics
improving their ratings by an average of 5.3%
 A 65% improvement in patient experience
 A 34% improvement in IT systems in clinic
settings (Mongan et al., 2006).
Shortell stressed that in order to make P4P successful,
a set of criteria must be satisfied:
 Building and maintaining trust among physi-
cians and health plans
 Securing physician group participation
 Securing health plan participation
 Collecting and aggregating data in a neutral
fashion
The P4P plan definitely corrects a major flaw in the
existing fee-for-service system, which compensates
providers without focusing on the quality of care or
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efficiency of their services, and therefore offers them
no financial incentive to enhance their health services.
In addition, it should include evidence showing the
impact on patients’ outcomes such as quality of life is
improving (Maynard, 2012). Unfortunately this was
not the case in the UK where the Quality and Out-
comes Framework (QOF) was introduced to enhance
transparency and performance. The QOF bonuses
were paid to each GP practice to increase incentives
and collective behaviour. An evaluation of the NHS
QOF illustrated a number of cases were being inade-
quately related to patients’ outcomes (Fleetcroft and
Cookson, 2006).
The P4P plan is not being selected in the rest of the
United States, and it is treated with some cynicism. A
common remark shared among many health care
professionals who happen to not endorse the P4P
plan mentioned that it was inappropriate to reward
doctors for quality because simply it is part of their
job. However, the current P4P plan is not perfect and
hence needs to be enhanced to avoid pitfalls such as:
 What to reward and how to implement it need
to be standardized?
 How to measure performance?
 How to make sure that healthcare organizations
and physicians would not avoid treating chal-
lenging cases?
Integrated and dedicated healthcare facilities
Hospital executives have to recognize the competitive
environment is moving towards specialty-based out-
patient practices. Healthcare leaders must act quickly
to promote those specialists who contribute most to
the hospital’s bottom line and engage them in discus-
sions about win-win partnerships. For example,
“smart hospital” is a concepts developed by Health
Care Management Directions (HCMD) in Nashville,
Tennessee (USA). This entity dedicates itself to devel-
oping and managing technologically advanced acute-
care “smart” hospitals which have about 40 to 60
beds, advanced information technology systems cus-
tomized for greater efficiency, patient safety focused,
and very high-quality care. HCMD could be viewed
as a consultant unit that provides superior customer
service and management expertise (Reece, 2007).
6 RISAI 2012 | Vol 3 | Num 1
Loisance (2011) argues that the extensive range of
clinical presentations of cardiac failure (acute or
chronic) and of therapeutic approaches (medical or
surgical) urges the cardiologists and other medical
specialists to take a necessary action to integrate their
services under the same structure. The proposed
model includes four stages: (1) high risk with no
symptoms; (2) structural heart disease, no symptoms;
(3) structural disease previous or current symptoms;
and (4) refractory symptoms requiring special inter-
vention. The worst scenario in managing a cardiac
failure patient, as discussed in this report, is when a
late decision is made in the therapeutic strategy and
then an aggressive treatment would be suggested.
Hence, a collaborative approach including many spe-
cialists is required to select the appropriate therapy at
the right time, and it also results in minimizing the
overall treatment cost.
Bousquet et al. (2011) reported an innovative inte-
grated care to fight chronic non-communicable dis-
eases (NCDs) such as including cardiovascular,
chronic respiratory, metabolic, rheumatologic and
neurological disorders and cancers. They suggested a
challenging strategy to deliver comprehensive patient-
centered integrated care to treat NCDs as a common
group of diseases. This model helps to implement the
predictive, preventive, personalized and participatory
(P4) medicine which embraces a holistic approach
when dealing with diseases. It exploits the commonal-
ities of the NCDs and provides enhanced health care
for patients such as:
 A framework that lead to translate research into
clinical medicine for NCDs
 Enhanced prevention and treatment capabilities
 Innovative healthcare systems with implemen-
tation of follow-up procedures installed at the
patients’ homes
 Slowing down the rising costs of health care
 Improved interdisciplinary training curricula
A center for integration of medicine and innovative
technologies (CIMIT) was founded in 1998 to address
the necessity of translating research into clinical med-
icine for unmet needs in patient care through pro-
ductive collaboration and not harsh competition. The
founders of CIMIT included Massachusetts General
Hospital, the Brigham and Women’s Hospital, Massa-
chusetts Institute of Technology, and the Charles

Stark Draper Laboratory; however, it did grow to
include 13 of the top clinical, research, and academic
institutions in the greater Boston area such as Har-
vard Medical School, Children’s Hospital Boston, and
Boston University. Researchers at CIMIT use the
available funds and the cutting edge technologies to
efficiently and effectively provide new health care
services and tools for patients. The expected outcomes
from CIMIT innovative clinicians, scientists, engi-
neers and physical scientists should not be just incre-
mental advances but rather transformative improve-
ments (CIMIT, 2011).
CIMIT conducted a clinical impact study (CIS) in
2009 to measure its outcomes and improve its current
methodology. This study investigated about 362 pro-
jects from a pool of 117 different project clusters that
CIMIT supported between 1998 and 2006. The results
of this study included not only a wealth of knowledge
represented by a set of publications and project re-
ports but also experiences with clinical adoption and/
or commercialization such as:
 Clinical adoption: >20% of project clusters have
achieved approval for human use.
 Commercialization: >30% of project clusters
have been licensed to an established company
Figure 3. Causes and outcomes of medical/clinical malpractices
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or enabled a start-up company (Brenan, 2011).
Reducing medical malpractice and negligence
Conducting high-risk operations and prescribing
inappropriate drugs constitute the main causes of
medical malpractice and negligence which occasional-
ly lead to hospital deaths (see figure 3). A spectacular
innovation in health care was proposed by Donald
Berwick (2005) who suggested six keys to reduce hos-
pital deaths, developed by the Institute for Health
Improvement (USA) during 100,000 Lives Campaign.
On June 14, 2006, Berwick announced that the cam-
paign set to decrease lethal errors and unnecessary
deaths in the nation’s hospitals had saved an estimat-
ed 122,300 lives in the previous 18 months. This pro-
ject included 3100 hospitals sharing mortality data
and conducting study-tested procedures that prevent
infections and mistakes. The list of safety keys are as
follows:
1. Prevent ventilator-associated pneumonia
(VAP): such as the process of elevating the head
of the hospital bed and regularly cleaning the
patient’s mouth, may reduce or even eradicate
VAP.
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2. Prevent intravenous (IV)-catheter infections:
Set an environment where doctors and nurses
can wash their hands between patients, simplify
the procedures for changing bandages around
catheters, and make sure that catheters do not
remain in a vein 1 hour longer than needed.
3. Stop surgical-site infections: Give the right anti-
biotic at the right time during operation, and
avoid shaving surgery site before the surgery
because clipping hair avoid irritating the skin
and is safer.
4. Respond quickly to early warning: Set up spe-
cial rapid-response teams would help to never
miss urgent calls by visitors or nurses.
5. Make heart attack care reliable: Take appropri-
ate measure like aspirin and beta blocker on
cardiac patients on arrival and a stent or clot
buster right after administration.
6. Stop medication errors: These errors can be
prevented by, for example, reconciling medica-
tions whenever patients need to see different
doctors, or move to different clinics.
The list of six safety keys recommends that for doc-
tors to be more productive and deliver high quality
care, safety is a key issue. Hospitals and healthcare
organizations should educate their medical staff about
how to avoid clinical procedural mistakes that cause
the most problems, and to manage patient expecta-
tions though, for example, the use of available inter-
active videos.
The success of the above campaign (Institute of
Healthcare Improvement, 2006) has influenced simi-
lar campaigns such as the one conducted by the NHS
(National Patient Safety Agency, 2008), and another
one focused on hand hygiene (Whitby et al., 2006). In
another study, Woodward et al. (2010) investigated
various interventions to reduce medical errors includ-
ing:
 Educate patients to remind hospital staff to
wash hands: this initiative is turning into a
strategy in the UK to improve hand hygiene.
 Pre-discharge advice on medication for elderly
patients: reduces readmission rates in elderly
patients
 Self-management of oral anticoagulation: re-
duces deaths from both hemorrhage and
8 RISAI 2012 | Vol 3 | Num 1
thromboembolism
 Simulation training for laparoscopic cholecys-
tectomy: helps trainee surgeons to conduct real
operations safely and efficiently
 Crew Resource Management (CRM) Training
Program: improve understanding of teamwork
and shared-decision making.
 Multifaceted systems interventions including
the use of a checklist: reduces in catheter-
related bloodstream infections
 Surgical safety checklist: reduces mortality and
improves health care outcomes.
Computer-based information systems are also being
used to improve patient safety (Committee on Quali-
ty of Health Care in America, Institute of Medicine
2001; Smith, 2004) including decision support sys-
tems for improving the decision making process
(Evans et al., 1998; Tomaszewski et al., 2011), com-
puterized prescriber order entry systems to reduce
medication errors (Bates et al., 1999; Riedmann et al.,
2011), bar coding to verify correct identification dur-
ing the blood transfusion process (Davies et al., 2006),
smart pumps to provide clinical decision support to
the medical staff to administer IV medications (Elias
and Moss, 2011), and electronic health records
(Murphy, 2010).
Concluding remarks
This paper discussed various alternatives and ap-
proaches in promoting innovation in health care.
Even though most of these cases are contextualized,
they could be adapted to local healthcare settings.
Other widespread innovative approaches which help
to improve patient care and achieve clinical benefits
would include: (1) develop healthcare services closer
to home, particularly post-acute rehabilitation; (2)
incorporate advanced training for nursing staff to
broaden their skills and specialist expertise, and offer
them prospects for career progression.
Apparently, the dissemination of innovation in
healthcare organizations is a very slow process that
could take up to 17 years in the USA (Balas, 2000).
Similarly, Woods (2002), reporting to the Scottish
government, did a literature study on national health
care reforms in Western countries. He concludes:
“There are few right answers to the problems of struc-

turing health care systems, but there are many theo-
ries, ideas, prejudices, ideologies and experiences on
which to draw. A practical approach would be to ex-
periment, to evaluate and to learn. We finish this
article with expressing the hope that many studies
will be carried out to evaluate pragmatic dissemina-
tion processes of health care innovations.”
Management consultants recognize, in Peter Druck-
er’s language, “systematic innovation consists of the
purposeful and organized search for changes and in
the systematic analysis of the opportunities such
changes might offer economic or social innova-
tion” (Drucker, 1985). These are the changes health
care organizations and health care stakeholders have
to develop through innovation if they are to thrive.
Subsequently, these changes are usually grasped better
by management consultants than the stakeholders
because of their broad view of society and industry.
To increase the likelihood of adopting an innovation
and making it a health care policy, healthcare organi-
zations need the processes and skills which can deal
with all emergent and unpredictable aspects of the
innovation implementation process that inevitably
arise. Research shows that for an innovation to get
diffused to achieve wide-spread acceptance, there is a
significant amount of negotiation, modification and
customization involved to suit the specific context.
Innovation in healthcare organizations is a must and
hence it requires a transparent culture, leadership,
and infrastructure towards making innovation as a
way forward. It is driven by the partnership between
various disciplines and lives at the point of service. In
addition, it joins to building an evidentiary, infor-
mation-driven foundation for health care practice
including safer and better practice, better-coordinated
and integrated health outcomes, and impacts on the
social health of a community as well as a nation.
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(1999). The impact of computerized physician order entry on
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