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C. Joseph McCannon, BA; Donald M. Berwick, MD, MPP; M. Rashad Massoud, MD, MPH

JAMA. 2007;298:1937-1939.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Innovation in health care includes important challenges: to find or create technologies and practices that are better able than the prevailing ones to reduce morbidity and mortality and to make those improvements ubiquitous quickly. In many respects in the pursuit of global health, the second challenge—the rapid spread of effective changes—seems to be the greater. Many sound (even powerful) solutions exist, such as new medicines and innovations in health care delivery, but their adoption is unreliable and slow. Often, they remain hidden in pockets around the globe, flourishing locally without reliably reaching those in need elsewhere. Some such solutions come from biomedical research, but even more take shape at the point of care, in settings where local problem solvers create effective new approaches to problems that others who live far away face as well.

Failure to . . . [Full Text of this Article]

Current Prevailing Paradigm

How Does the Potentially Adopting Community Perceive of the Proposed Change?

What Is the Nature of the Social System in the Potentially Adopting Community?

Which Structural Approach to Spreading Better Practice Will Be Used?

Author Affiliations: Institute for Healthcare Improvement, Cambridge, Massachusetts.

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