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 journalArticlepeer-review

7 Citations (SciVal)
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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 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.

Original languageEnglish
Pages (from-to)654-669
Number of pages16
JournalSociology of Health and Illness
Issue number4
Early online date13 Feb 2018
Publication statusPublished - 1 May 2018


  • Actor-network theory
  • Healthcare innovation
  • NHS
  • Ophthalmology
  • Organisational ethnography
  • Process mapping
  • Resource-based view

ASJC Scopus subject areas

  • Health(social science)
  • Health Policy
  • Public Health, Environmental and Occupational Health


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