Martin, Graham P., Currie, Graeme, Finn, Rachael and McDonald, Ruth. (2011) The medium-term sustainability of organisational innovations in the National Health Service. Implementation Science, Vol.6 (No.19). ISSN 1748-5908

Preview

PDF WRAP_Curries_medium_term_sustainability.pdf - Requires a PDF viewer such as GSview, Xpdf or Adobe Acrobat Reader Download (261Kb)

Abstract

Background: There is a growing recognition of the importance of introducing new ways of working into the UK’s National Health Service (NHS) and other health systems, in order to ensure that patient care is provided as effectively and efficiently as possible. Researchers have examined the challenges of introducing new ways of working–’organisational innovations’–into complex organisations such as the NHS, and this has given rise to a much better understanding of how this takes place–and why seemingly good ideas do not always result in changes in practice. However, there has been less research on the medium- and longer-term outcomes for organisational innovations and on the question of how new ways of working, introduced by frontline clinicians and managers, are sustained and become established in day-to-day practice. Clearly, this question of sustainability is crucial if the gains in patient care that derive from organisational innovations are to be maintained, rather than lost to what the NHS Institute has called the ‘improvement-evaporation effect’. Methods: The study will involve research in four case-study sites around England, each of which was successful in sustaining its new model of service provision beyond an initial period of pilot funding for new genetics services provided by the Department of Health. Building on findings relating to the introduction and sustainability of these services already gained from an earlier study, the research will use qualitative methods–in-depth interviews, observation of key meetings, and analysis of relevant documents–to understand the longer-term challenges involved in each case and how these were surmounted. The research will provide lessons for those seeking to sustain their own organisational innovations in wide-ranging clinical areas and for those designing the systems and organisations that make up the NHS, to make them more receptive contexts for the sustainment of innovation. Discussion: Through comparison and contrast across four sites, each involving different organisational innovations, different forms of leadership, and different organisational contexts to contend with, the findings of the study will have wide relevance. The research will produce outputs that are useful for managers and clinicians responsible for organisational innovation, policy makers and senior managers, and academics.

[error in script] [error in script]

Item Type:	Journal Article
Subjects:	H Social Sciences > HD Industries. Land use. Labor R Medicine > RA Public aspects of medicine
Divisions:	Faculty of Social Sciences > Warwick Business School > International Centre for Governance & Public Management Faculty of Social Sciences > Warwick Business School
Library of Congress Subject Headings (LCSH):	Organizational change, Great Britain. National Health Service -- Case studies, Medical care -- Great Britain -- Case studies
Journal or Publication Title:	Implementation Science
Publisher:	BioMed Central Ltd.
ISSN:	1748-5908
Date:	14 March 2011
Volume:	Vol.6
Number:	No.19
Identification Number:	10.1186/1748-5908-6-19
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access
Funder:	National Institute for Health Research (Great Britain) (NIHR)
Grant number:	09/1001/40 (NIHR)
References:	1. Rogers E: Diffusion of innovations. Fifth edition. New York: The Free Press; 2003. 2. Denis JL, Hebert Y, Langley A, Lozeau D, Trottier LH: Explaining diffusion patterns for complex health care innovations. Health Care Management Review 2002, 27:60-73. 3. Bate P: Changing the culture of a hospital: from hierarchy to networked community. Public Administration 2000, 78:485-512. 4. Fitzgerald L, Ferlie E, Wood M, Hawkins C: Interlocking interactions, the diffusion of innovations in health care. Human Relations 2002, 55:1429-1449. 5. Dopson S, FitzGerald L, Ferlie E, Gabbay J, Locock L: No magic targets! Changing clinical practice to become more evidence based. Health Care Management Review 2002, 27:35-47. 6. Buchanan DA, Addicott R, Fitzgerald L, Ferlie E, Baeza JI: Nobody in charge: distributed change agency in healthcare. Human Relations 2007, 60:1065-1090. 7. Neath A: Layers of leadership: hidden influencers of healthcare. In The sustainability and spread of organizational change. Edited by: Buchanan D, Fitzgerald L, Ketley D. London: Routledge; 2007:150-168. 8. Martin GP, Currie G, Finn R: Leadership, service reform, and public-service networks: the case of cancer-genetics pilots in the English NHS. Journal of Public Administration Research & Theory 2009, 19:769-794. 9. Martin GP, Finn R, Currie G: National evaluation of NHS genetics service investments: emerging issues from the cancer genetics pilots. Familial Cancer 2007, 6:257-263. 10. Ferlie E, Fitzgerald L, Wood M, Hawkins C: The nonspread of innovations: the mediating role of professionals. Academy of Management Journal 2005, 48:117-134. 11. Jones J: Sustaining and spreading change: the patient booking case experience. In The sustainability and spread of organizational change. Edited by: Buchanan D, Fitzgerald L, Ketley D. London: Routledge; 2007:126-149. 12. Pettigrew A, Ferlie E, McKee L: Shaping strategic change London: Sage; 1992. 13. Martin GP, Currie G, Finn R: Reconfiguring or reproducing intraprofessional boundaries? Specialist expertise, generalist knowledge and the ‘modernization’ of the medical workforce. Social Science & Medicine 2009, 68:1191-1198. 14. Sibthorpe BM, Glasgow NJ, Wells RW: Emergent themes in the sustainability of primary health care innovation. Medical Journal of Australia 2005, 183:S77-S80. 15. Fitzgerald L, Buchanan D: The sustainability and spread story: theoretical developments. In The sustainability and spread of organizational change. Edited by: Buchanan D, Fitzgerald L, Ketley D. London: Routledge; 2007:227-248. 16. Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O: Diffusion of innovations in service organizations: Systematic review and recommendations. Milbank Quarterly 2004, 82:581-629. 17. NHS Institute: Sustainability and its relationship with spread and adoption Coventry: NHS Institute for Innovation and Improvement; 2007. 18. May C, Finch T, Mair F, Ballini L, Dowrick C, Eccles M, Gask L, MacFarlane A, Murray E, Rapley T, Rogers A, Treweek S, Wallace P, Anderson G, Burns J, Heaven B: Understanding the implementation of complex interventions in health care: the normalization process model. BMC Health Services Research 2007, 7:148. 19. Eisenhardt KM: Building theories from case study research. Academy of Management Review 1989, 14:532-550. 20. Pollitt C: Hospital performance indicators: how and why neighbours facing similar problems go different ways - building explanations of hospital performance indicator systems in England and the Netherlands. In New public management in Europe: adaptation and alternatives. Edited by: Pollitt C, van Thiel S, Homburg V. Basingstoke: Palgrave Macmillan; 2007:149-164. 21. Lawrence TB, Suddaby R: Institutions and institutional work. In The Sage handbook of organization studies. Edited by: Clegg SR, Hardy C, Lawrence TB, Nord WR. London: Sage; 2006:215-254. 22. Reay T, Golden-Biddle K, Germann K: Legitimizing a new role: small wins and microprocesses of change. Academy of Management Journal 2006, 49:977-998. 23. Buchanan D, Fitzgerald L: Improvement evaporation: why do successful changes decay? In The sustainability and spread of organizational change. Edited by: Buchanan D, Fitzgerald L, Ketley D. London: Routledge; 2007:22-40. 24. Martin G, Currie G, Finn R: Bringing genetics into primary care: findings from a national evaluation of pilots in England. Journal of Health Services Research and Policy 2009, 14:204-211. 25. Martin GP: Whose health, whose care, whose say? Some comments on public involvement in new NHS commissioning arrangements. Critical Public Health 2009, 19:123-132. 26. Martin GP, Finn R: Patients as team members: opportunities, challenges and paradoxes of including patients in multi-professional health-care teams. Sociology of Health & Illness . 27. Currie G, Suhomlinova O: The impact of institutional forces upon knowledge sharing in the UK NHS: the triumph of professional power and the inconsistency of policy. Public Administration 2006, 84:1-30. 28. Yin RK: Case study research: design and methods London: Sage; 2003. 29. Ritchie J, Spencer L: Qualitative data analysis for applied policy research. In Analyzing qualitative data. Edited by: Bryman A, Burgess RG. London: Routledge; 1994:173-194.
URI:	http://wrap.warwick.ac.uk/id/eprint/34586

Data sourced from Thomson Reuters' Web of Knowledge

Request changes to a record

Actions (login required)

View Item