Abstract
BackgroundService delivery innovation is at the heart of efforts to combat the growing burden of chronic disease and escalating healthcare expenditure. Small-scale, locally-led service delivery innovation is a valuable source of learning about the complexities of change and the actions of local change agents. This exploratory qualitative study captures the perspectives of clinicians and managers involved in a general practitioner-led integrated diabetes care innovation.MethodsData on these change agents’ perspectives on the local innovation and how it works in the local context were collected through focus groups and semi-structured interviews at two primary health care sites. Transcribed data were analysed thematically. Normalization Process Theory provided a framework to explore perspectives on the individual and collective work involved in putting the innovation into practice in local service delivery contexts.ResultsTwelve primary health care clinicians, hospital-based medical specialists and practice managers participated in the study, which represented the majority involved in the innovation at the two sites. The thematic analysis highlighted three main themes of local innovation work: 1) trusting and embedding new professional relationships; 2) synchronizing services and resources; and 3) reconciling realities of innovation work. As a whole, the findings show that while locally-led service delivery innovation is designed to respond to local problems, convincing others to trust change and managing the boundary tensions is core to local work, particularly when it challenges taken-for-granted practices and relationships. Despite this, the findings also show that local innovators can and do act in both discretionary and creative ways to progress the innovation.ConclusionsThe use of Normalization Process Theory uncovered some critical professional, organizational and structural factors early in the progression of the innovation. The key to local service delivery innovation lies in building coalitions of trust at the point of service delivery and persuading organizational and institutional mindsets to consider the opportunities of locally-led innovation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1270-4) contains supplementary material, which is available to authorized users.
Highlights
Service delivery innovation is at the heart of efforts to combat the growing burden of chronic disease and escalating healthcare expenditure
This form of innovation requires a good understanding of the complexities and nuances of local service delivery innovation as local ‘change work’ which evolves incrementally in unique practice settings [12]
We report on focus groups with medical and non-medical primary health care professionals and interviews with hospital-based specialists and managers about their perceptions and experiences of a general practitioners (GP)-led integrated diabetes care innovation in primary health care
Summary
Service delivery innovation is at the heart of efforts to combat the growing burden of chronic disease and escalating healthcare expenditure. Bottom-up service delivery innovation in professional organizations such as primary care is complicated by the reliance on frontline change agents working collectively rather than individually [10] and organizational processes to support this collective work [15]. This form of innovation requires a good understanding of the complexities and nuances of local service delivery innovation as local ‘change work’ which evolves incrementally in unique practice settings [12]
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