The work of local healthcare innovation: a qualitative study of GP-led integrated diabetes care in primary health care

Foster, Michele, Burridge, Letitia, Donald, Maria, Zhang, Jianzhen and Jackson, Claire (2016) The work of local healthcare innovation: a qualitative study of GP-led integrated diabetes care in primary health care. BMC Health Services Research, 16 1: 11.1-11.11. doi:10.1186/s12913-016-1270-4


Author Foster, Michele
Burridge, Letitia
Donald, Maria
Zhang, Jianzhen
Jackson, Claire
Title The work of local healthcare innovation: a qualitative study of GP-led integrated diabetes care in primary health care
Journal name BMC Health Services Research   Check publisher's open access policy
ISSN 1472-6963
Publication date 2016-01-14
Year available 2016
Sub-type Article (original research)
DOI 10.1186/s12913-016-1270-4
Open Access Status DOI
Volume 16
Issue 1
Start page 11.1
End page 11.11
Total pages 11
Place of publication London, United Kingdom
Publisher BioMed Central Ltd.
Language eng
Abstract Background: Service delivery innovation is at the heart of efforts to combat the growing burden of chronic disease and escalating healthcare expenditure. Small-scale, locally-led service delivery innovation is a valuable source of learning about the complexities of change and the actions of local change agents. This exploratory qualitative study captures the perspectives of clinicians and managers involved in a general practitioner-led integrated diabetes care innovation.
Formatted abstract
Background: Service delivery innovation is at the heart of efforts to combat the growing burden of chronic disease and escalating healthcare expenditure. Small-scale, locally-led service delivery innovation is a valuable source of learning about the complexities of change and the actions of local change agents. This exploratory qualitative study captures the perspectives of clinicians and managers involved in a general practitioner-led integrated diabetes care innovation.

Methods: Data on these change agents' perspectives on the local innovation and how it works in the local context were collected through focus groups and semi-structured interviews at two primary health care sites. Transcribed data were analysed thematically. Normalization Process Theory provided a framework to explore perspectives on the individual and collective work involved in putting the innovation into practice in local service delivery contexts.

Results: Twelve primary health care clinicians, hospital-based medical specialists and practice managers participated in the study, which represented the majority involved in the innovation at the two sites. The thematic analysis highlighted three main themes of local innovation work: 1) trusting and embedding new professional relationships; 2) synchronizing services and resources; and 3) reconciling realities of innovation work. As a whole, the findings show that while locally-led service delivery innovation is designed to respond to local problems, convincing others to trust change and managing the boundary tensions is core to local work, particularly when it challenges taken-for-granted practices and relationships. Despite this, the findings also show that local innovators can and do act in both discretionary and creative ways to progress the innovation.

Conclusions: The use of Normalization Process Theory uncovered some critical professional, organizational and structural factors early in the progression of the innovation. The key to local service delivery innovation lies in building coalitions of trust at the point of service delivery and persuading organizational and institutional mindsets to consider the opportunities of locally-led innovation.
Keyword Service delivery innovation
Diabetes care
Primary health care research
Qualitative research
Normalization Process Theory
Q-Index Code C1
Q-Index Status Provisional Code
Grant ID APP1001157
Institutional Status UQ

 
Versions
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 0 times in Thomson Reuters Web of Science Article
Scopus Citation Count Cited 1 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Mon, 01 Feb 2016, 22:20:46 EST by Dr Letitia Burridge on behalf of School of Medicine