Related Experiment Video
Updated: Feb 13, 2026
The Participant-Reported Implementation Update and Score PRIUS: A Novel Method for Capturing Implementation-Related Data Over Time
Published on: February 19, 2021
The influence of formal and informal policies and practices on health care innovation implementation: A mixed-methods
Lisa D DiMartino1, Sarah A Birken, Laura C Hanson
1Lisa D. DiMartino, PhD, MPH, is Implementation Scientist, RTI International. E-mail: ldimartino@rti.org. Sarah A. Birken, PhD, is Assistant Professor, Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill. Laura C. Hanson, MD, MPH, is Professor, Division of Geriatric Medicine, Center for Aging and Health, UNC Palliative Care Program, Chapel Hill, North Carolina. Justin G. Trogdon, PhD, is Associate Professor, Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill. Alecia S. Clary, MSW, is Doctoral Candidate, Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill. Morris Weinberger, PhD, is Professor and Chair, Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill. Katherine Reeder-Hayes, MD, MBA, MSc, is Assistant Professor, Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill. Bryan J. Weiner, PhD, is Professor, Department of Health Services, School of Public Health, University of Washington; Department of Global Health, School of Public Health, University of Washington.
Background:
The implementation science literature has contributed important insights regarding the influence of formal policies and practices on health care innovation implementation, whereas informal implementation policies and practices have garnered little attention. The broader literature suggests that informal implementation policies and practices could also influence innovation use.
Purpose:
We used the Organizational Theory of Innovation Implementation to further understand the role of formal and informal implementation policies and practices as determinants of implementation effectiveness. We examined their role within the context of initiatives to increase palliative care consultation in inpatient oncology.
Methods:
We used a case study design in two organizational settings within one academic medical center: medical and gynecologic oncology. We completed semistructured interviews with medical (n = 12) and gynecologic (n = 10) oncology clinicians using questions based on organizational theory. Quantitative data assessed implementation effectiveness, defined as aggregated palliative care consult rates within oncology services from 2010 to 2016. Four palliative care clinicians were interviewed to gain additional implementation context insights.
Results:
Medical oncology employed multiple formal policies and practices including training and clinician prompting to support palliative care consultation and a top-down approach, yet most clinicians were unaware of the policies and practices, contributing to a weak implementation climate. In contrast, gynecologic oncology employed one formal policy (written guideline of criteria for initiating a consult) but also relied on informal policies and practices, such as spontaneous feedback and communication; they adopted a bottom-up approach, contributing to broader clinician awareness and strong implementation climate. Both services exhibited variable, increasing consult rates over time.
Practice Implications:
Informal policies and practices may compensate or substitute for formal policies and practices under certain conditions (e.g., smaller health care organizations). Further research is needed to investigate the role of formal and informal policies and practices in shaping a strong and sustainable implementation climate and subsequent effective innovation implementation.
Related Concept Videos
02:42Formal Charges
01:21Interdisciplinary Care: The Health Care Team-I
Physicians
The physician's primary responsibility is to diagnose illness and direct the medical or surgical treatment of the condition. The authority to admit patients to a healthcare agency or institution and practice care within that setting is granted to physicians by the healthcare agency or institution...
01:18Interdisciplinary Care: The Health Care Team-II
Physical Therapist
A physical therapist (PT) aims to restore function or prevent additional impairment in a patient following an injury or disease. Massage, heat, cold, water, sonar waves, exercises, and electrical stimulation are some treatments used by PTs to treat...
01:18Introduction To Health Care Delivery System
The Institute of Medicine (IOM) advocates for a patient-centered, effective, safe, timely, equitable, and effective healthcare system. The National Priorities...
01:26Traditional Level Of Health Care System
The preventive healthcare service includes tests for screening. Preventive health care services include identifying and reducing disease risk...
02:19Lewis Structures and Formal Charges