Examining sustainability of health service innovation

Introduction: Health service reform initiatives are being implemented globally in an attempt to meet increased health care demand due to the ageing population, increased incidence of chronic disease and a shrinking health care workforce. Expanding the scope of practice of health care professionals and blurring the boundaries between roles has been one approach to meeting the growing demand for efficient, cost effective health care. Nurse practitioner services are one of the most frequently implemented service delivery models in Australian emergency departments. The fiscal commitment required to implement programs is substantial however, sustainability of many of these innovations has not been evaluated. This research examined factors influencing sustainability of this innovative service delivery model. Objectives: The aim of the research was to identify factors that influence sustainability of health service innovation. In particular, emergency department nurse practitioner services and to operationalise and test a theoretical framework to examine innovation sustainability. The results will inform health policy development and guide the implementation and evaluation of health service innovation. Methodology: This research used case study methodology. The single case design was emergency nurse practitioner service, and the embedded units of analysis were emergency department staff, emergency nurse practitioners (ENPs) and documents relating to nurse practitioner services. The data collection methods included survey, one-on-one interviews, document analysis and telephone survey. Results: This research indicates that the innovation of emergency nurse practitioner (ENP) service only partially complies with factors of sustainability as described in the Sustainability of Innovation1 theoretical framework. Emergency department staff were confident that ENP services were safe, effective and met patient needs but they were not kept informed or included in decision making processes. ENPs feel isolated, have limited input into decisions and the service is poorly utilised. ENPs reported marginal organisational support and documents examined reinforced a lack of service reform support at the organisational level. Conclusion: The implementation of health service innovation is costly for an already strained health care budget. Understanding the factors that influence sustainability of innovation is essential for health service delivery into the future. This research has broken new ground by operationalising a theoretical framework to evaluate health service innovation sustainability and identifying factors that may be influencing sustainability of emergency nurse practitioner service. Reference 1. Fox, A. R., Gardner, G. and Osborne. 2015