Promoting and Embedding Innovation

Organisational theory
There is no single, definitive account of how
health care organisations are structured and
constituted. However, it is increasingly agreed
that health care organisations are complex and
multi-level and involve the interaction of a
range of groups (Fitzgerald et al 2002, Pope et
al 2006, Dopson 2007). There is also a
growing consensus that different
organisational forms – measured in terms of,
for example, structure, scale, culture and
practices – are an important consideration in
creating the context for innovation and
improvement (Fitzgerald et al, 2002). This
represents an important reorientation towards
the issue of how to create a micro-climate that
is conducive to change and innovation. Here
„organisational form‟ is taken to mean the
underpinning structures which are manifest in
work processes, expectations and taken-forgranted
assumptions of staff. The primary
strength of this approach is its attention to the
means by which we might address the
organisational determinants of innovation
which restrict the flow of evidence and inhibit
the embracing of innovation by individuals.
Actor–network theory
Actor-network theory draws attention to the
existence of heterogeneous actors connected
through a diversity of networks and social
relationships (Fitzgerald et al, 2002). From
this perspective the diffusion of ideas and
practices is mediated by the configuration of
networks within a given context. The value of
this model is in highlighting the non-linear and
dynamic nature of change processes and the
need to appreciate the local specificity of each
micro-context. It also foregrounds notions of
negotiation and settlement between networks
and the need to „make sense‟ of new practices
before they can be successfully introduced.
So for example, successful adoption will
depend on the capacity of individuals to buy
into a changed organisational narrative with
each innovation that is introduced (Peck &
Dickinson, 2008).
Social movements
Whereas diffusion of innovation informed
much of the work of the Modernisation
Agency, the NHS Institute is based more on
the social movements approach which
focusses less on engaging exceptional
individuals and more on widespread
stakeholder engagement (Bate et al 2004,
Bate et al 2004a). Key to this approach is the
shift from top-down approaches to (in this
case) innovation adoption and spread, towards
a bottom-up, grassroots, approach in which
change is shaped and owned by the
individuals charged with implementation
(Dickinson & McLeod, 2006).
47 Learning from experience