Using theory of diffusion on innovation to explore the implementation of a novel care model in Singapore

The Patient-Centered Medical Home (PCMH) is an advanced primary care model (PC) that has gained popularity in recent years. Such a model addresses the service gaps for complex chronic patients but are known to be time-consuming and costly. Without appropriate change strategies, primary care providers may experience failure and financial losses when implementing reforms.

To understand the processes of PC transformation during the early implementation of a new PCMH in Singapore, this study adopted an exploratory approach. Researchers employed a predominantly grounded theory approach, which is a qualitative methodology that constructs theory based on emerging patterns from empirical data to explain patterns of phenomenon observed. 

This data-driven approach eventually revealed the connection between the realities experienced by providers of the PCMH and the theory of diffusion of innovations—the first study to make such a linkage. By using this theory, the researchers were able to identify innovative components within the PCMH, explain the rationale for using certain change strategies, as well as interpret providers’ experiences and perceptions when encountering implementation challenges.

This study contributes to practice and policy considerations by identifying crucial ingredients for primary care transformation in an Asian context, including time for experimentation, negotiations and adaptations of the innovations; leadership for facilitating and providing clear directions; standardised methods for risk stratification and empanelment; direct communication between innovators and service providers; and awareness-building for the innovations.

The full publication is available online in the Int. J. Environ. Res. Public Health “Early Implementation of a Patient-Centered Medical Home in Singapore: A Qualitative Study Using Theory on Diffusion of Innovations” URL: https://doi.org/10.3390/ijerph182111160.