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To further our insight into the role of networks in health system reform, the purpose of this paper is to investigate how one agency, the NSW Agency for Clinical Innovation (ACI), and the multiple networks and enabling resources that it encompasses, govern, manage and extend the potential of networks for healthcare practice improvement.

This is a case study investigation which took place over ten months through the first author’s participation in network activities and discussions with the agency’s staff about their main objectives, challenges and achievements, and with selected services around the state of New South Wales to understand the agency’s implementation and large system transformation activities.

The paper demonstrates that ACI accommodates multiple networks whose oversight structures, self-organisation and systems change approaches combined in dynamic ways, effectively yield a diversity of network governances. Further, ACI bears out a paradox of “centralised decentralisation”, co-locating agents of innovation with networks of implementation and evaluation expertise. This arrangement strengthens and legitimates the role of the strategic hybrid – the healthcare professional in pursuit of change and improvement, and enhances their influence and impact on the wider system.

While focussing the case study on one agency only, this study is unique as it highlights inter-network connections. Contributing to the literature on network governance, this paper identifies ACI as a “network of networks” through which resources, expectations and stakeholder dynamics are dynamically and flexibly mediated and enhanced.

The co-location of and dynamic interaction among clinical networks may create synergies among networks, nurture “strategic hybrids”, and enhance the impact of network activities on health system reform.

Network governance requires more from network members than participation in a single network, as it involves health service professionals and consumers in a multi-network dynamic. This dynamic requires deliberations and collaborations to be flexible, and it increasingly positions members as “strategic hybrids” – people who have moved on from singular taken-as-given stances and identities, towards hybrid positionings and flexible perspectives.

This paper is novel in that it identifies a critical feature of health service reform and large system transformation: network governance is empowered through the dynamic co-location of and collaboration among healthcare networks, particularly when complemented with “enabler” teams of people specialising in programme implementation and evaluation.

The author feels haunted; troubled by the ethnography that the author conducted some years ago of a new partnership group that was attempting to set up a community learning centre. The author is aware that it doesn’t sound like a particularly alarming research topic, and perhaps that is where some of the issues began. The author did not expect an ethnographic haunting to occur. The partnership recruited the author less than a year into the creation of the project and spent two years as a sort of ‘researcher in residence’. The original idea was that the author would observe the initial development of the project and then, when the community learning centre was established, the author would research the centre’s activities and how they were experienced by village residents. However, fairly soon into the project, problematic dynamics developed within the group, leading to irreconcilable conflict between members. The community learning centre was never established and the author was left to piece together an ethnography of a failed partnership. Researching an increasingly dysfunctional partnership was an emotionally exhausting activity, especially when relationships between members became progressively hostile. Managing data collection and analysis at this time was difficult, but the author was shocked that, a number of months (and now years) later, revisiting the data for publication purposes remained uncomfortable. The author managed to produce the PhD thesis on the back of this study, but the author has not felt able to go back to the data, despite there being findings worthy of publication. This ethnography is in a state of limbo and is at risk of becoming lost forever. In this chapter, the author explores the reasons for this and discusses lessons learned for future projects.

The purpose of this paper is to argue for an improved conceptualisation of health service research, using Stengers' (2018) metaphor of “slow science” as a critical yardstick.

The paper is structured in three parts. It first reviews the field of health services research and the approaches that dominate it. It then considers the healthcare research approaches whose principles and methodologies are more aligned with “slow science” before presenting a description of a “slow science” project in which the authors are currently engaged.

Current approaches to health service research struggle to offer adequate resources for resolving frontline complexity, principally because they set more store by knowledge generalisation, disciplinary continuity and integrity and the consolidation of expertise, than by engaging with frontline complexity on its terms, negotiating issues with frontline staff and patients on their terms and framing findings and solutions in ways that key in to the in situ dynamics and complexities that define health service delivery.

There is a need to engage in a paradigm shift that engages health services as co-researchers, prioritising practical change and local involvement over knowledge production. Economics is a research field where the products are of natural appeal to powerful health service managers. A “slow science” approach adopted by the embedded Economist Program with its emphasis on pre-implementation, knowledge mobilisation and parallel site capacity development sets out how research can be flexibly produced to improve health services.

The embedded researcher is a healthcare-academic partnership model in which the researcher is engaged as a core member of the healthcare organisation. While this model has potential to support evidence translation, there is a paucity of evidence in relation to the specific challenges and strengths of the model. The aim of this study was to map the barriers and enablers of the model from the perspective of embedded researchers in Australian healthcare settings, and compare the responses of embedded researchers with a primary healthcare versus a primary academic affiliation.

104 embedded researchers from Australian healthcare organisations completed an online survey. Both purposive and snowball sampling strategies were used to identify current and former embedded researchers. This paper reports on responses to the open-ended questions in relation to barriers and enablers of the role, the available support, and recommendations for change. Thematic analysis was used to describe and interpret the breadth and depth of responses and common themes.

Key barriers to being an embedded researcher in a public hospital included a lack of research infrastructure and funding in the healthcare organisation, a culture that does not value research, a lack of leadership and support to undertake research, limited access to mentoring and career progression and issues associated with having a dual affiliation. Key enablers included supportive colleagues and executive leaders, personal commitment to research and research collaboration including formal health-academic partnerships.

To support the embedded researcher model, broader system changes are required, including greater investment in research infrastructure and healthcare-academic partnerships with formal agreements. Significant changes are required, so that healthcare organisations appreciate the value of research and support both clinicians and researchers to engage in research that is important to their local population.

This is the first study to systematically investigate the enablers and challenges of the embedded researcher model.

This paper aims to consider the opportunities for embedded methodologies for research into children’s social care and the ethics of this method.

This study draws upon embedded research from a two-year study into developing children’s social work approaches to extra-familial risk. Findings draw upon personal reflections from field notes, case reviews, practice observations and reflections.

Two findings are presented. Firstly, that embedded research provides numerous opportunities to develop child protection systems and practice. Secondly, a number of ethical questions and challenges of the methodology are presented.

This paper draws upon personal reflections from one study and is not intended to be representative of all approaches to embedded research methods.

Two practical recommendations are presented. Firstly, this paper outlines a number of recommendations to university researchers and host organisations on the facilitative attributes for embedded researchers. Secondly, questions are raised to support university ethics boards to assist ethical frameworks for embedded research.

This paper contributes original empirical data to the limited literature on embedded research in children’s services.

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.

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.

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.

“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.

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.

The purpose of this paper is to present a case study tracking the development and engagement of a group of experts by experience (The Independent Futures (IF) Group) who provided a lived experience voice to the Bristol Golden Key (GK) partnership within the Fulfilling Lives programme. The case study reports the genesis and impact of the group, as well as the facilitators of impact and experiences of the group members and those they worked in partnership with.

The research adopted an iterative approach drawing on multiple data sources over an eight-year period. An inductive ethnographic analysis of stakeholder and partnership meetings was combined with documentary analysis and thematic analysis of interviews with experts by experience and service providers.

The voice of lived experience provided by the IF group contributed to the GK partnership through various channels. Evidence of this contribution and its impact was found at programme, city-wide and national levels of the service ecosystem. Furthermore, IF members recognised the value of the group in contributing to systems change and service improvement, but also for themselves.

This case study serves to illustrate the impact of the lived experience voice on services and systems change, specifically the provision of that voice from a formalised advisory group. The successes and challenges of the group and the experiences of its members are reported with a view to sharing learning that may influence future co-production initiatives with experts by experience and service provision for those experiencing multiple disadvantage.

The insights provided by the longitudinal observation of the group as it was formed and evolved, coupled with insights provided by the experts by experience, have important implications for facilitating and supporting sustainable lived experience input.

The aim of this study is to document and analyze experiences with building a new hospital guided by lean-led hospital design (LLHD) (Grunden and Hagood, 2012) and to investigate key mechanisms enhancing healthcare professionals' participation and collaboration in implementing this innovative approach.

An in-depth case study of the implementation of LLHD in a Dutch hospital was performed based on multiple data sources. The case hospital presented a unique opportunity since there was embedded access to the data by the first author.

Three mechanisms supporting participation and collaboration of staff for implementing LLHD were identified. (1) Freedom in translating a concept enables managers to balance it with variations in practice at the organizational level. (2) A set of key principles governing the design process appeared an important anchor on a managerial level in a changing environment. (3) Creation of a supportive attitude toward lean and lean facility design, with co-creation as a key element of LLHD.

By using the emerging mechanisms, managers/change agents can enlarge collaboration and participation of hospital staff when implementing organization-wide innovations.

This case study delivers a unique inside view on the dynamics evolving in the complex change processes at organizational, managerial and personal levels involved in implementing LLHD.