Abstract
The development and implementation of innovation by healthcare providers is understood as a multi-determinant and multi-level process. Theories at different analytical levels (i.e. micro and organisational) are needed to capture the processes that influence innovation by providers. This article combines a micro theory of innovation, actor-network theory, with organisational level processes using the 'resource based view of the firm'. It examines the influence of, and interplay between, innovation-seeking teams (micro) and underlying organisational capabilities (meso) during innovation processes. We used ethnographic methods to study service innovations in relation to ophthalmology services run by a specialist English NHS Trust at multiple locations. Operational research techniques were used to support the ethnographic methods by mapping the care process in the existing and redesigned clinics. Deficiencies in organisational capabilities for supporting innovation were identified, including manager-clinician relations and organisation-wide resources. The article concludes that actor-network theory can be combined with the resource-based view to highlight the influence of organisational capabilities on the managementof innovation. Equally, actor-network theory helps to address the lack of theory in the resource-based view on the micro practices of implementing change.
Highlights
A multi-level theory of innovation 655Following the 2008 financial crisis, many health systems are seeking ways to reduce the cost of care while improving service quality and population health
The Institute for Healthcare Improvement’s ‘Triple Aim’ programme aims to improve health, care and cost, but many of the 141 organisations enrolled have found pursuing all three aims challenging (Whittington et al 2015). These challenges echo those found in the healthcare innovations literature on barriers and facilitators to service improvement
To explain why particular innovations are implemented, we suggest that actor-network theory (ANT)’s focus on the dynamic interplay between social and technical change can be combined with analysis of organisations’ innovation capabilities, using resource based view of the firm’ (RBV)
Summary
A multi-level theory of innovation 655Following the 2008 financial crisis, many health systems are seeking ways to reduce the cost of care while improving service quality and population health To reduce cost while improving services, various innovation initiatives have been introduced, including the ‘Quality, Innovation, Productivity and Prevention’ (QIPP) programme to encourage innovation through service redesign (DoH 2011) and new organisational models of care (NHS England 2014). The Institute for Healthcare Improvement’s ‘Triple Aim’ programme aims to improve health, care and cost, but many of the 141 organisations enrolled have found pursuing all three aims challenging (Whittington et al 2015). These challenges echo those found in the healthcare innovations literature on barriers and facilitators to service improvement. Little is known about the ways in which innovations are influenced by processes at different organisational levels (e.g. managerial and service level), and how the interplay between levels affect their implementation
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