Developing and implementing health care service innovation in glaucoma outpatient clinics: The problem of aligning multiple public and private organisational actors

The role of professional and organisational processes in mediating the implementation of service innovation within health care organisations is well documented. However, studies at the organisational level have tended to focus on intra-organisational processes, such as receptivity of the organisational culture, the nature of clinical-managerial relations, and inter-professional communication. This paper also focuses on organisational interactions in the innovation process, but emphasises the involvement of a wider range of stakeholders, public and private, in the development and implementation of service innovation, including clinicians, operational managers, management consultants, technology organisations, service users, and local clinical commissioning groups. Our argument is based on two case studies of the development of clinical service redesign projects that were focussed on increasing the capacity of outpatient glaucoma clinics within the ophthalmology service of an acute NHS hospital. Semi-structured interviews (22) were conducted with these stakeholders and non-participant observation (33.5 hours) took place of outpatient clinics and service and directorate level meetings in which the projects were discussed. The qualitative study of implementation processes was supported by operational research techniques that were used to map patient flows within the clinics. Drawing upon actor-network theory, socio-technical analysis was used to explore the ways in which these multiple stakeholders shape the implementation of innovation. We found that the need to accommodate stakeholders’ different interests and actions hinders the implementation process.