The report is a product of the VA/HSR Evidence Synthesis Program.

Creating a Culture of Innovation in Healthcare Settings: A Systematic Review

Organizational culture plays a critical role in shaping healthcare delivery environments and service quality. Organizational culture may be defined as shared basic assumptions, values, and beliefs that characterize a setting and influence practices, routines, and priorities. Cultures that value and support innovation can foster innovative behaviors, which, in turn, are associated with positive staff and patient outcomes in a healthcare setting. One such culture is a culture of innovation. This systematic review sought to answer three Key Questions:

• How is culture of innovation defined in literature related to healthcare settings?
• What metrics are used to capture culture of innovation in healthcare settings?
• What are the key characteristics and outcomes of programs designed to improve or establish a culture of innovation in healthcare settings?

Investigators with VA’s Evidence Synthesis Program (ESP) Center in West Los Angeles, CA searched Web of Science, Ovid Medline, and PsycINFO from inception to 9/18/2020. Investigators sought literature that had real-world applications of culture of innovation measurement or intervention, thus publications were required to use some specified measure or metric for culture of innovation, and/or describe an intervention or program to improve or establish a culture of innovation. After reviewing 480 potentially relevant citations, they included 4 publications that focused on programs and metrics, and 26 articles that targeted metrics only.

Summary of Findings

Key Question 1

Investigators found several ways in which terminology and definition captured the concept of “culture of innovation” within a healthcare setting. Various terms and phrases were used to define or describe a culture of innovation, with the following used in more than two studies: “innovative behavior,” “innovative culture,” “innovative organizational culture,” “culture for innovation,” and “support for innovation.” There were 18 additional terms used by the included studies, many of which used variants of the same key words.

The articles included for review also revealed some common themes for a “culture of innovation,” including: a shared set of beliefs between people that supported improvement or change, resources to support innovation, and an acceptance of change.

Key Question 2

Investigators found 26 different instruments used in 27 studies to measure some version of the construct “culture of innovation”. Only 6 instruments were used in more than 1 study to measure this construct, making cross-study interpretations of the data more challenging. Ten studies administered a single instrument without adaptation, 7 studies modified or truncated an existing instrument, 2 studies developed “homegrown” instruments, and 8 studies incorporated a mix of adapted, homegrown, and/or instrument without modifications. Two additional instruments were identified among 3 studies that did not directly measure “culture of innovation;” instead, these studies described organizational culture using pre-specified categories. While some instruments were developed in a healthcare setting, others were adapted from other disciplines such as management and economics.

Key Question 3

Four studies described programs that reported outcomes using a quantitative measure of culture of innovation. One publication, which described a leadership program in the United Kingdom, treated innovation climate as a primary outcome. The other three studies included culture of innovation as either a secondary outcome or one of a few various outcomes. However, while four studies with culture of innovation outcomes were identified, their small scale or low response rates and variable details provided about the components of each intervention limited the conclusions that could be drawn.

Implications for VA

None of the identified literature came from VA, but there is increasing interest in the concept of culture of innovation and measurement within the VA healthcare system. A culture of innovation in a healthcare organization may have implications for quality of care, population health outcomes, cost of care, and employee satisfaction. More work is needed to understand how to build a culture of innovation in any healthcare setting, including VA, to harness the benefits of a culture of innovation as the link between effective organizational practice and high-quality healthcare, thereby improving system, clinical, and patient outcomes.

Research Gaps/Future Research

Investigators were able to identify a moderate amount of literature defining and quantitatively measuring a ‘culture of innovation’ in healthcare settings, but this area of research has yet to see rigorous evaluations of intervention work or process of changing culture. Such studies would require multi-site studies with large sample sizes and may build from the early work in this area to focus on interpersonal dynamics, leadership, and/or quality improvement collaboratives. Another area of interest for future research is to examine how teams can improve and sustain innovative culture over time – and what impact innovative culture has on system, clinical, and patient outcomes. Also of interest is how to evaluate and assess effectiveness of programs and interventions implemented to improve or cultivate a culture of innovation.

Mak S, Fenwick K, Myers B, Shekelle PG, Begashaw M, Severin J, Miake-Lye IM. Creating a Culture of Innovation in Healthcare Settings: A Systematic Review. Evidence Synthesis Program, Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs. VA ESP Project #05-226; 2021.

To view the full report, go to: http://vaww.hsrd.research.va.gov/publications/esp/culture-innovation.cfm (If you have intranet access, copy and paste the URL into your browser).

ESP is currently soliciting review topics from the broader VA community. Nominations will be accepted electronically using the online Topic Submission Form. If your topic is selected for a synthesis, you will be contacted by an ESP Center to refine the questions and determine a timeline for the report.

This Management e-Brief is provided to inform you about recent HSR&D findings that may be of interest. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. If you have any questions or comments about this Brief, please email CIDER. The Center for Information Dissemination and Education Resources (CIDER) is a VA HSR&D Resource Center charged with disseminating important HSR&D findings and information to policy makers, managers, clinicians, and researchers working to improve the health and care of Veterans.

This report is a product of VA/HSR&D's Evidence Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers –; and to disseminate these reports throughout VA.

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