Eliana Barrenho¹, Marisa Miraldo¹, Carol Propper¹, Brendan Walsh²

1 Imperial College London

2 The Economic and Social Research Institute (ESRI) Dublin

Despite substantial research documenting extensive variations in healthcare delivery and rates of innovation, relatively little is known about what drives physicians’ decisions.

The proposed research builds on the literature on adoption of innovation and practice variation aiming to understand the role of physician and environment-specific factors in the adoption behaviour.  Particularly, we propose to assess how factors such as “school of thought” affect adoption of innovations.  Moreover, we will assess how these decisions are shaped by environment-specific factors, in particular, competition and collaboration.  Through collaborative practice we might expect practice spillovers across organizations to contribute to decreased variability in the technology adoption across practice settings. Under competition hospitals might engage in a “medical arms race” to attract more patients, leading to technology usage differences across providers.

Qualitative research carried out through interviews to experts informs us which factors affect the uptake of laparoscopic surgery in colorectal cancer treatment.  We test the hypotheses generated by this process by assembling a rich dataset based on hospital administrative records and information on clinicians’ career path. We use patient level data for all colorectal cancer surgeries performed between 2000 and 2014 by 3,522 consultants and across 200 publicly funded hospitals in England. We match information on clinicians’ training and job experience back to 1992. The choice of colorectal cancer relates to its rapid innovation and high incidence, the associated costs for taxpayers, and the fact that there are guidelines intended to reduce variation but in which the UK lags behind European counterparts in survival rates.

Our descriptive analysis shows a typical S-shaped diffusion curve. In 2000 less than 1 percent of the elective colorectal cancer surgeries were undertaken laproscopically. By 2006, the year in which the guidelines were introduced, this proportion had risen to 15 percent. And by 2014 this proportion had risen to 65 percent.  Analysis of the sample variance shows that consultant level characteristics persistently explain more than 40% of uptake variation, even if we consider different exposures to guidelines and technological environment.

Our results suggest that physician-specific factors, namely the “innate talent” are key drivers of the early adoption of laparoscopic techniques. Moreover, both encouragement and pressure from peers play a significant role on innovation adoption. We further show that clinical guidelines are generally regarded as a “tool” to persuade trusts to diffuse an innovation, rather than a determinant of innovation adoption.