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Article
Publication date: 31 October 2018

Susanna Hedborg Bengtsson, Tina Karrbom Gustavsson and Per Erik Eriksson

Innovation is constantly present in the construction industry, however, mainly on a single project level. Initiating and implementing inter-organizational innovation in a…

Abstract

Purpose

Innovation is constantly present in the construction industry, however, mainly on a single project level. Initiating and implementing inter-organizational innovation in a multi-project context such as in urban development entails large complexity, for example, because of the many interdependent projects and users of innovation. The users’ influence on inter-organizational innovation in a multi-project context has not been fully explored. Accordingly, the purpose of this paper is to discuss how users influence inter-organizational innovation in multi-project contexts by mapping the receptiveness for change.

Design/methodology/approach

A single case study approach was used, where empirical material including semi-structured interviews in combination with meeting observations, document studies and participative workshops were gathered. The rich empirical material, studying inter-organizational innovation in an urban development context, was mapped based on the receptive context for change framework.

Findings

A receptive context for change was not present in the studied multi-project context. Communication to develop and implement inter-organizational innovation was not sufficient and the clients’ procurement strategies were to a large extent not developed to facilitate inter-organizational innovation. Findings show differences in users’ possibility and aim to implement inter-organizational innovation.

Originality/value

The mapping of the receptive context to influence inter-organizational innovation widens the knowledge base and provides valuable insights on how inter-organizational innovation may be implemented in the loosely coupled construction industry. Furthermore, the findings broaden the discussion on clients as innovation supporters, and contribute to the debate on clients as innovation supporters, by highlighting the importance of distinguishing between different types of clients.

Details

Construction Innovation, vol. 18 no. 4
Type: Research Article
ISSN: 1471-4175

Keywords

Article
Publication date: 9 December 2011

Steve Willcocks

This paper seeks to explore the relevance of strategy in health and social care. In particular, it aims to look at contrasting perspectives, generally related to either…

1660

Abstract

Purpose

This paper seeks to explore the relevance of strategy in health and social care. In particular, it aims to look at contrasting perspectives, generally related to either planned or emergent change.

Design/methodology/approach

The paper is literature based and conceptual and, as such, makes use of methods associated with a literature review. Evidence is utilised from a general literature search on strategy, alongside policy‐specific and documentation.

Findings

A critical commentary on strategy in health and social care, from an historical perspective, is presented. It suggests that strategy in the context of recent reforms in health and social care is more likely to be characterised as emergent, and processual. It also offers an insight into the leadership implications of different approaches to strategy.

Originality/value

The paper makes a connection between general ideas about strategy and their relevance in a particular context, i.e. health and social care.

Details

Journal of Integrated Care, vol. 19 no. 6
Type: Research Article
ISSN: 1476-9018

Keywords

Open Access
Article
Publication date: 16 August 2019

Rosemary J. Hollick, Alison J. Black, David M. Reid and Lorna McKee

Using a complexity-informed approach, we aim to understand why introduction of a mobile service delivery model for osteoporosis across diverse organisational and country…

1490

Abstract

Purpose

Using a complexity-informed approach, we aim to understand why introduction of a mobile service delivery model for osteoporosis across diverse organisational and country contexts in the UK National Health Service (NHS) met with variable success.

Design/methodology/approach

Six comparative case studies; three prospectively in Scotland using an action research-informed approach; and three retrospectively in England with variable degrees of success. The Non-adoption, Abandonment, Scale-up, Spread and Sustainability framework explored interactions between multi-level contextual factors and their influence on efforts to introduce and sustain services.

Findings

Cross-boundary service development was a continuous process of adaptation and evolution in rapidly shifting healthcare context. Whilst the outer healthcare policy context differed significantly across cases, inner contextual features predominated in shaping the success or otherwise of service innovations. Technical and logistical issues, organisational resources, patient and staff actions combined in unpredictable ways to shape the lifecycle of service change. Patient and staff thoughts about place and access to services actively shaped service development. The use of tacit “soft intelligence” and a sense of “chronic unease” emerged as important in successfully navigating around awkward people and places.

Practical implications

“Chronic unease” and “soft intelligence” can be used to help individuals and organisations “tame” complexity, identify hidden threats and opportunities to achieving change in a particular context, and anticipate how these may change over time. Understanding how patients think and feel about where, when and how care is delivered provides unique insights into previously unseen aspects of context, and can usefully inform development and sustainability of patient-centred healthcare services.

Originality/value

This study has uniquely traced the fortunes of a single service innovation across diverse organisational and country contexts. Novel application of the NASSS framework enabled comparative analysis across real-time service change and historical failures. This study also adds to theories of context and complexity by surfacing the neglected role of patients in shaping healthcare context.

Details

Journal of Health Organization and Management, vol. 33 no. 7/8
Type: Research Article
ISSN: 1477-7266

Keywords

Article
Publication date: 21 September 2015

Iestyn Williams

The purpose of this paper is to take forward consideration of context in health care priority setting and to offer some practical strategies for priority setters to…

Abstract

Purpose

The purpose of this paper is to take forward consideration of context in health care priority setting and to offer some practical strategies for priority setters to increase receptiveness to their work.

Design/methodology/approach

A number of tools and methods have been devised with the aim of making health care priority setting more robust and evidence based. However, in order to routinely take and implement priority setting decisions, decision makers require the support, or at least the acquiescence, of key external parties. In other words, the priority setting process requires a receptive context if it is to proceed unhindered.

Findings

The priority setting process requires a receptive context if it is to proceed unhindered.

Originality/value

This paper develops the concept of legitimacy in the “authorising environment” in priority setting and describes strategies which might help decision makers to create a receptive context, and to manage relationships with external stakeholders.

Details

Journal of Health Organization and Management, vol. 29 no. 6
Type: Research Article
ISSN: 1477-7266

Keywords

Article
Publication date: 16 March 2015

David J. Hunter, Jonathan Erskine, Adrian Small, Tom McGovern, Chris Hicks, Paula Whitty and Edward Lugsden

The purpose of this paper is to examine a bold and ambitious scheme known as the North East transformation system (NETS). The principal aim of the NETS is the achievement…

3810

Abstract

Purpose

The purpose of this paper is to examine a bold and ambitious scheme known as the North East transformation system (NETS). The principal aim of the NETS is the achievement of a step-change in the quality of health services delivered to people living in the North East region of England. The paper charts the origins of the NETS and its early journey before describing what happened to it when the UK coalition government published its proposals for unexpected major structural change in the NHS. This had a profound impact on the leadership and direction of the NETS and resulted in it taking a different direction from that intended.

Design/methodology/approach

The research design took the form of a mixed methods, longitudinal 3.5-year study aimed at exploring transformational change in terms of content, context, process and outcomes. The sample of study sites comprised 14 NHS trusts in the North East region chosen to provide geographical coverage of the area and to reflect the scale, scope and variety of the bodies that formed part of the NETS programme. The qualitative component of the research, which the paper draws upon, included 68 semi-structured interviews, observational studies and focus groups. Data analysis made use of both deductive and inductive frameworks. The deductive framework adopted was Pettigrew et al.’s “receptive contexts for change” and four of the eight factors stood out as especially important and form the basis of the paper.

Findings

The fate of the NETS was shaped and influenced by the eight factors comprising the Pettigrew et al. receptive contexts for change framework but four factors in particular stood out as being especially significant: environmental pressure, quality and coherence of policy, key people leading change, supportive organisational culture. Perhaps the most significant lesson from the NETS is that achieving whole systems change is particularly vulnerable to the vicissitudes of politics especially where that system, like the UK NHS, is itself subject to those very same pressures. Yet, despite having an enormous influence on health policy, the political context is frequently avoided in research or not regarded as instrumental in determining the outcomes in respect of transformational change.

Research limitations/implications

The chief limitation is the credibility and authenticity of the interviews captured at particular points in time. These formed the datebase for subsequent analysis. The authors sought to guard against possible bias by supplementing interviews with observational studies and focus groups as well as running two dissemination events at which emerging findings from the study were subjected to independent external scrutiny and comment. These events provided a form of validation for the key study findings.

Practical implications

The research findings demonstrate the importance of context for the likely outcome and success of complex transformational change initiatives. These require time to become embedded and demonstrate results especially when focused on changing culture and behaviour. But, in practice, allowing sufficient time during which the organisation may remain sufficiently stable to allow the change intervention to run its course and become embedded and sustainable is highly problematic. The consequence is that bold and ambitious efforts like the NETS are not given the space and stability to prove themselves. Too often, politics and external environmental pressures intrude in ways that may prove dysfunctional and negative.

Social implications

Unless a different approach to transformational change and its leadership and management is adopted, then changing the NHS to enable it to appear more responsive to changing health care needs and expectations will remain a cause for concern. Ultimately the public will be the losers if the NHS remains insensitive to changing needs and expectations. The patient experience was at the centre of the NETS programme.

Originality/value

The study is original insofar as no other has sought to evaluate the NETS independently and over a reasonable time period. The research design, based on a mixed-methods approach, is unusual in evaluations of this nature. The study’s conclusions are not so original but their value lies in largely confirming and reinforcing the findings from other studies. It perhaps goes further in stressing the impact of politics on health policy and the negative consequences of constant organisational change on attempts to achieve deep change in the way the NHS is organised and led.

Details

Journal of Health Organization and Management, vol. 29 no. 1
Type: Research Article
ISSN: 1477-7266

Keywords

Article
Publication date: 1 June 1998

Stephen Willcocks

The article examines and comments on the development of clinical management at an NHS hospital Trust. It utilises a qualitative case study methodology to collect data from…

896

Abstract

The article examines and comments on the development of clinical management at an NHS hospital Trust. It utilises a qualitative case study methodology to collect data from key stakeholders at this Trust. The data suggest some of the reasons why doctors may be receptive or non‐receptive to the notion of clinical management. It recommends that attention is focused on the specialty context as a key factor in influencing the development of clinical management. It also suggests there may be other important factors, for example: training; the role of change agents; structure of clinical directorates; and individual factors such as cognition, attitudes and motivation.

Details

Journal of Management in Medicine, vol. 12 no. 3
Type: Research Article
ISSN: 0268-9235

Keywords

Open Access
Article
Publication date: 27 October 2020

Michelle Myall, Carl May, Alison Richardson, Sarah Bogle, Natasha Campling, Sally Dace and Susi Lund

The purpose of this paper is to explore what happens when changes to clinical practice are proposed and introduced in healthcare organisations. The authors use the…

1266

Abstract

Purpose

The purpose of this paper is to explore what happens when changes to clinical practice are proposed and introduced in healthcare organisations. The authors use the implementation of Treatment Escalation Plans to explore the dynamics shaping the translational journey of a complex intervention from research into the everyday context of real-world healthcare settings.

Design/methodology/approach

A qualitative instrumental collective case study design was used. Data were gathered using qualitative interviews (n = 36) and observations (n = 46) in three English acute hospital trusts. Normalisation process theory provided the theoretical lens and informed data collection and analysis.

Findings

While each organisation faced the same translational problem, there was variation between settings regarding adoption and implementation. Successful change was dependent on participants' ability to manage and shape contexts and the work this involved was reliant on individual capacity to create a new, receptive context for change. Managing contexts to facilitate the move from research into clinical practice was a complex interactive and iterative process.

Practical implications

The paper advocates a move away from contextual factors influencing change and adoption, to contextual patterns and processes that accommodate different elements of whole systems and the work required to manage and shape them.

Originality/value

The paper addresses important and timely issues of change in healthcare, particularly for new regulatory and service-oriented processes and practices. Insights and explanations of variations in implementation are revealed which could contribute to conceptual generalisation of context and implementation.

Details

Journal of Health Organization and Management, vol. 35 no. 9
Type: Research Article
ISSN: 1477-7266

Keywords

Article
Publication date: 1 October 2005

Liz Matykiewicz and Dave Ashton

The purpose of this paper is to introduce Essence of Care, a benchmarking tool for health care practitioners and an integral part of the UK National Health Service (NHS…

2288

Abstract

Purpose

The purpose of this paper is to introduce Essence of Care, a benchmarking tool for health care practitioners and an integral part of the UK National Health Service (NHS) Clinical Governance agenda. It focuses on how one NHS Community Health Trust has attempted to introduce organisation‐wide benchmarking by using a workshop programme to raise awareness and act as a catalyst to initiate implementation. An evaluation of progress made six months after the workshops were delivered is described.

Design/methodology/approach

The paper outlines the case study approach taken and describes the qualitative methods used in the small scale evaluation, namely interviews and focus groups with the decision makers and implementers of Essence of Care across the case study site.

Findings

The evaluation highlights that whilst raising awareness is relatively straightforward, putting Essence of Care into practice is more difficult to achieve, especially when happening at a time of significant organisational change. The discussion considers the need for a receptive context for change when implementing benchmarking for service improvement and reviews whether Essence of Care benchmarking could be a practical framework for developing an improvement culture within an organisation.

Originality/value

The empirical findings from this research will contribute to the knowledge and understanding of using benchmarking for service improvement within the NHS.

Details

Benchmarking: An International Journal, vol. 12 no. 5
Type: Research Article
ISSN: 1463-5771

Keywords

Open Access
Article
Publication date: 17 March 2020

Gregory Maniatopoulos, David J. Hunter, Jonathan Erskine and Bob Hudson

Following publication of a new vision for the English National Health Service (NHS) in 2014, known as the NHS Five-Year Forward View, a Vanguard programme was introduced…

2851

Abstract

Purpose

Following publication of a new vision for the English National Health Service (NHS) in 2014, known as the NHS Five-Year Forward View, a Vanguard programme was introduced by NHS England charged with the task of designing and delivering a range of new care models (NCMs) aimed at tackling deep-seated problems of a type facing all health systems to a greater or lesser degree. Drawing upon recent theoretical developments on the multilevel nature of context, we explore factors shaping the implementation of five NCM initiatives in the North East of England.

Design/methodology/approach

Data collection was based on semi-structured interviews (66 in total) between December 2016 and May 2017 with key informants at each site and a detailed review of Trusts' internal documents and policies related to the implementation of each NCM. Our analysis explores factors shaping the implementation of five NCM pilot sites as they touched on the multiple levels of context ranging from the macro policy level to the micro-level setting of workforce redesign.

Findings

It is far too early to conclude with any confidence that a successful outcome for the NCM programme will be forthcoming although the NHS Long-Term Plan seeks to build on the earlier vision set out in the Five-Year Forward View. Early indications show some signs of promise, especially where there is evidence of the ground having been prepared and changes already being put in place prior to the official launch of NCM initiatives. At the same time our findings demonstrate that all five pilot sites experienced, and were subject to, unrealistic pressure placed upon them to deliver outcomes.

Originality/value

Our findings demonstrate the need for a deeper understanding of the multilevel nature of context by exploring factors shaping the implementation of five NCMs in the North East of England. Exploring the wider national policy context is desirable as well as understanding the perceptions of front-line staff and service users in order to establish the degree of alignment or, conversely, to identify where policy and practice are at risk of pushing and pulling against each other.

Details

Journal of Health Organization and Management, vol. 34 no. 3
Type: Research Article
ISSN: 1477-7266

Keywords

Article
Publication date: 1 December 1997

Antonina Z. Mathie

The introduction of clinical care pathways into one acute hospital trust provided the opportunity to investigate reasons why doctors behave the way they do, and to…

Abstract

The introduction of clinical care pathways into one acute hospital trust provided the opportunity to investigate reasons why doctors behave the way they do, and to identify receptive and non‐receptive factors for change. A multi‐method research strategy was used to obtain primary data, both quantitative and qualitative material, namely responses to a questionnaire and interviews. The questionnaire was distributed to 70 consultants from a variety of medical and surgical specialties, and 42 questionnaires were returned (60 per cent response rate). Reports some of the findings and shows that consultant behaviour and the factors that influence that behaviour are affected by their own characteristics, specifically age and specialty, although all specialties agreed that non‐financial incentives would influence their behaviour. Characteristics of opinion leaders were also found to be specialty‐specific in their degree of influence. Concludes that the multi‐method research approach was effective in identifying factors which influence consultant behaviour, and further studies should be carried out in this area.

Details

Journal of Management in Medicine, vol. 11 no. 6
Type: Research Article
ISSN: 0268-9235

Keywords

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