From innovation to practice: a qualitative study of the introduction of an internationally developed technique (aortic valve neocuspidisation with autologous pericardium) in a UK centre
Rhiannon C Macefield, Massimo Caputo, Natalie S Blencowe, Darren L Scroggie, Maeve Coyle, Christin Hoffmann, Anni King, Cynthia Ochieng, Jane M Blazeby, Kerry N Avery, Daisy ElliottIntroduction
Innovative surgical procedures undergo modification as they are introduced into clinical practice. Robust evaluation as innovations evolve is crucial to understand safety and efficacy. Little is known, however, about what happens in practice; how/why procedures are modified, the knowledge that is gained or the decision-making processes to continue, adapt or abandon the innovation. This study followed surgical innovation within National Health Service practice. Here, we report on the introduction of aortic valve neocuspidisation with autologous pericardium.
Research design and methods
A qualitative study using semistructured longitudinal interviews. Surgeons’ views on the innovative procedure, experiences and reflections over time were explored.
Setting and participants
Longitudinal interviews were conducted with multiple surgeons performing an innovative procedure in one UK teaching hospital.
Results
19 interviews with five different surgeons (range: 1–7 interviews per surgeon) were conducted. Identified broad themes were: (1) Ozaki as an innovative and promising alternative treatment, (2) confidence in a well-defined procedure and (3) emerging uncertainties. Interviews elicited surgeons’ strong belief in the procedure as the key driver for its introduction into practice. Growing confidence as surgeons gained experience led to wider patient selection. Despite initial perceptions of a relatively standardised procedure, several modifications were described. Reasons were categorised as anatomical, learning from experience and ambition/strive for perfection.
Conclusion
This study demonstrates the value of qualitative research in understanding the complexities and decision-making surrounding the introduction and evolution of an innovative surgical procedure as it is introduced into clinical practice. Findings highlight the dynamic nature of innovation and the rationale for modifications to technique and patient selection. Practical tools to support surgical innovators and researchers are needed to ensure robust, transparent and timely early-phase evaluation of procedures/devices.