Building the case for Project ECHO®: From Inception to Implementation Success factors for adopting new innovation

Document Type

Other

Publication Date

1-24-2025

Abstract

Healthcare organisations are susceptible to economic pressures and as a result are prone to continuous and transformational change (Melder et al., 2018; Mundy & Hewson, 2019; Nicholson et al., 2014). This global landscape for healthcare organisations has contributed to a climate that is ripe for innovative change and new approaches to investment (Day-Duro et al., 2020; Lewis, 2010). Opportunistic and motivated employees working within organisations, known as intrapreneurs (Antoncic & Hisrich, 2003), can be catalysts for this change. Intrapreneurial employees are a scarce commodity, representing approximately < 5% of the workforce (Bosma et al., 2010), and characteristically pursue new innovations which can address the evolving needs of their organisations (Neessen et al., 2019).

For large-scale healthcare organisations to respond to economic pressures, executive decision-makers must understand how intrapreneurs can successfully implement innovation within their organisations (Falola et al., 2018). The overarching aims of this thesis are to understand the process by which new innovations are adopted in organisations and how the implementation success of these innovations can be measured. The thesis investigates these aims through the lens of an innovation called Project ECHO® (Extension for Community Healthcare Outcomes). In doing so, this thesis addresses a knowledge gap about how, and under what circumstances Project ECHO® is successfully implemented and measured within large-scale organisations. Project ECHO® is a licensed telementoring model designed to virtually support workforce capacity and capability building at scale (Arora, Thornton, et al., 2011; ECHO Institute, 2020a). Despite significant increases in global rates of adoption, no previous research has been undertaken to investigate how intrapreneurs successfully initiate, implement, and evaluate the adoption of Project ECHO® as a new innovation.

This thesis employed a mixed methodology approach across four iterative yet distinct studies to address the above overarching research aims:

1. Study 1 (qualitative, semi-structured interviews) investigated the decision-making process and financial investment of executives to pilot Project ECHO® to achieve more integrated healthcare in Queensland, Australia.

2. Study 2 (qualitative, semi-structured interviews) investigated the key learnings, strategies and tactics of an intrapreneurial project team who implemented the first Project ECHO® hub in a healthcare organisational context in Queensland.

3. Study 3 (quantitative e-Delphi study) harnessed an e-Delphi consensus methodology to comprehensively identify indicators that could be used to measure the implementation success factors of Project ECHO® globally. These indicators were derived from a panel of global experts who had experience in implementing Project ECHO®.

4. Study 4 (quantitative and qualitative, cross-sectional study using indicators that were derived in Study 3) adopted a cross-sectional approach to identify and examine the current state of implementation success by measuring 54 indicators in a variety of global organisations which had adopted Project ECHO®.

Resultant from these empirical studies, this thesis presents four significant findings:

1. Study 1 identified five key themes that influenced executive decision-making processes to invest in Project ECHO® as a new innovation: (i) personal experiences, (ii) benefits, (iii) risks, (iv) partnerships, and (v) timing. Executives’ reflections explored how their decision-making processes considered the capability of the intrapreneurial project team as an indicator of future sustainability of the innovation.

2. Study 2 found the implementation of the Project ECHO® pilot harnessed intrapreneurial strategies and tactics throughout the implementation to establish the innovation as a new business unit within the organisation. The learnings derived from the organisational context and workforce characteristics described how intrapreneurs implemented the innovation.

3. Study 3 identified 54 success indicators, derived from an international panel of experts across the healthcare, education, and university sectors who had adopted Project ECHO® – that were identified as salient implementation success factors of Project ECHO® globally.

4. Study 4 measured the success indicators identified in Study 3 across thirteen Project ECHO® hub organisations globally. This study uncovered areas of diversity amongst organisations which have successfully implemented the ECHO model™. Several areas of success and opportunities for improvement were further highlighted.

The first half of this thesis supports the critical role intrapreneurial champions play in encouraging executive decision-makers to invest in innovation pilots, and the further role they play in harnessing strategic and tactical approaches to support implementation success. This provides new knowledge for other intrapreneurial teams planning to adopt and embed new innovations within organisational contexts. The second half of this thesis describes the development of an implementation success framework and describes the global cross-sectional examination of implementation success for Project ECHO® implementations. The framework provides a practical tool that is acceptable to Project ECHO® implementation teams to measure the indicators of implementation success in their local context. The final cross-sectional study indicates that Project ECHO® has sustained broad adoption by organisations globally, particularly within the healthcare sector and is experiencing growth across other sectors.

As global diffusion of innovations like Project ECHO® continue, this thesis provides consolidated new knowledge for executive decision-makers, academics and intrapreneurial teams alike to harness. Finally, this thesis advances Diffusion of Innovation Theory (Rogers, 2003) and the concept of intrapreneurship (Antoncic & Hisrich, 2001, 2003) by establishing the positive connection between intrapreneurs and implementation success of Project ECHO®, leveraging empirical evidence regarding how intrapreneurs successfully implemented the model as a new innovation within large-scale organisations globally.

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