When Routines Support or Stifle Innovation: Evidence from Primary Care Practices

Abstract

This study examines how routines advance organizational change, in this case implementation of a health care innovation promoted by U.S. health reform legislation called the patient-centered medical home model of primary care delivery. Through an examination of routine enactment across six medical practices, I find that specific routines play a pivotal part in making this particular innovation successful, thereby helping to recreate these practices as higher quality service deliverers. I also find that other routines hinder medical home implementation, making them enablers of organizational inertia and the status quo. The concepts of “routine bundles” and “facilitating routines” are introduced to describe how routines impact innovation and change. Routine bundles are groups of routines which function similarly to promote the psychological, social, and work-related changes that factor into organizational progress. This makes inter-routine homogeneity an interesting focus for theorizing and inquiry. Facilitating routines do not impact innovation directly but rather through their signaling abilities shape how other routines that do drive or hinder change are enacted by workers on a daily basis. I find this particular effect driven by the ostensive attributes of one set of routines that work unilaterally on other routines, in the process shaping how these subsequent routines are then thought about and performed. Several contextual features such as organizational adaptive reserve and culture are found to play important roles in supporting the sort of routine enactment that impacts innovation. The study proposes new lines of inquiry related to routines and their dynamic involvement in organizational evolution.