Abstract
Surgical innovations are often adopted into clinical practice before being adequately evaluated. Approaches to evaluating surgical innovations such as the IDEAL framework model surgical innovation as ‘stages of innovation’. Determining the stage of innovation may be difficult. There is a need for a better understanding of stage of innovation to facilitate more robust evaluations of surgical innovations, enabling patients to make informed choices about their treatment. The aim of this thesis is to understand the concept of stage of innovation and how it may be informed by sources of information available to surgeons and researchers in real-world contexts.The thesis consists of two parts: a systematic review of literature and an ethnographic case study of a surgical innovation. The systematic review aimed to understand the concept of stage of innovation described in the literature. It revealed that stages of innovation were characterised in terms of ‘indicator’ parameters such as numbers of patients involved. Determining stage of innovation from literature was problematic due to a lack of knowledge of IDEAL, limited availability of information, unclear definitions of stages and confusion surrounding staging individual studies versus the innovation overall.
A case study of aortic valve neocuspidisation with autologous pericardium was conducted to understand how stage of innovation could be determined contemporaneously in a real-world context. Eighteen semi-structured interviews with five surgeons were conducted and thematically analysed. Ten operations were video-recorded and three were analysed using a novel method. Findings from the systematic review, interviews and video-recordings were triangulated. This in-depth study demonstrated how stage-related information could be obtained by interviewing surgeons and video-recording operations. This work supports and enables the use of surgeon interviews and video-recordings as complementary sources of information for determining stage of innovation in real-world practice. These findings will facilitate more robust evaluation of surgical innovations.
| Date of Award | 18 Jun 2024 |
|---|---|
| Original language | English |
| Awarding Institution |
|
| Supervisor | Natalie S Blencowe (Supervisor), Kerry N L Avery (Supervisor), Daisy Elliott (Supervisor) & Sian Cousins (Supervisor) |