Analysing barriers to service improvement using a multi-level theory of innovation: the case of glaucoma outpatient clinics

Simon Turner, Christos Vasilakis, Martin Utley, Paul Foster, Aachal Kotecha, Naomi J. Fulop

Research output: Contribution to journalArticle

Abstract

The development and implementation of innovation by health care providers is widely understood as a multi-determinant and multi-level process. Theories at different analytical levels (i.e. both micro and organisational) are needed in order to capture the processes that influence innovation by health care providers. This paper combines a micro theory of innovation, actor-network theory, with organisational level processes using the “resource based view of the firm”, to examine the influence of, and interplay between, innovation-seeking teams (micro) and underlying organisational capabilities (meso) during the development and implementation of service innovation. The study is based on two examples of service innovation in relation to ophthalmology services run by a specialist English NHS Trust at multiple locations in a large city. We conducted interviews (28) with stakeholders within and outside the Trust and non-participant observation (40.5 hours) of outpatient clinics and service and board level meetings. Operational Research techniques were used to map the care process in the clinics and establish the theoretical improvement possible through service redesign. In practice, innovation at the micro service level was constrained by the complexity of and strain on existing outpatient clinics. Deficiencies in organisational capabilities for supporting innovation were identified, including the nature of manager-clinician relations and organisation-wide resources. The study concludes that actor-network theory can be combined with the resource-based view to highlight the influence of organisational capabilities on the management of innovation. Equally, actor-network theory helps to address the lack of theory in the resource-based view on the micro practices of implementing change.
LanguageEnglish
Pages654-669
JournalSociology of Health and Illness
Volume40
Issue number4
Early online date13 Feb 2018
DOIs
StatusPublished - 1 May 2018

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outpatient clinic
Ambulatory Care Facilities
Health Personnel
Glaucoma
innovation
Ophthalmology
Ambulatory Care
actor-network-theory
Research Design
Observation
Interviews
resources
health care
large city
research method
stakeholder
manager
determinants
firm
lack

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Analysing barriers to service improvement using a multi-level theory of innovation: the case of glaucoma outpatient clinics. / Turner, Simon; Vasilakis, Christos; Utley, Martin; Foster, Paul; Kotecha, Aachal; Fulop, Naomi J.

In: Sociology of Health and Illness, Vol. 40, No. 4, 01.05.2018, p. 654-669.

Research output: Contribution to journalArticle

Turner, Simon ; Vasilakis, Christos ; Utley, Martin ; Foster, Paul ; Kotecha, Aachal ; Fulop, Naomi J. / Analysing barriers to service improvement using a multi-level theory of innovation: the case of glaucoma outpatient clinics. In: Sociology of Health and Illness. 2018 ; Vol. 40, No. 4. pp. 654-669.
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