Martin Graham P, Weaver Simon, Currie Graeme, Finn Rachael, McDonald Ruth
Department of Health Sciences, University of Leicester, Leicester, UK.
Health Serv Manage Res. 2012 Nov;25(4):190-9. doi: 10.1177/0951484812474246.
The need for organizational innovation as a means of improving health-care quality and containing costs is widely recognized, but while a growing body of research has improved knowledge of implementation, very little has considered the challenges involved in sustaining change - especially organizational change led 'bottom-up' by frontline clinicians. This study addresses this lacuna, taking a longitudinal, qualitative case-study approach to understanding the paths to sustainability of four organizational innovations. It highlights the importance of the interaction between organizational context, nature of the innovation and strategies deployed in achieving sustainability. It discusses how positional influence of service leads, complexity of innovation, networks of support, embedding in existing systems, and proactive responses to changing circumstances can interact to sustain change. In the absence of cast-iron evidence of effectiveness, wider notions of value may be successfully invoked to sustain innovation. Sustainability requires continuing effort through time, rather than representing a final state to be achieved. Our study offers new insights into the process of sustainability of organizational change, and elucidates the complement of strategies needed to make bottom-up change last in challenging contexts replete with competing priorities.
组织创新作为提高医疗质量和控制成本的一种手段，其必要性已得到广泛认可。然而，尽管越来越多的研究增进了我们对实施过程的了解，但很少有研究考虑到维持变革所涉及的挑战，尤其是由一线临床医生 “自下而上” 引领的组织变革。本研究填补了这一空白，采用纵向、定性的案例研究方法来理解四项组织创新的可持续发展路径。它强调了组织背景、创新性质与实现可持续发展所采用策略之间相互作用的重要性。它讨论了服务领导者的地位影响、创新的复杂性、支持网络、融入现有系统以及对不断变化的情况的积极应对如何相互作用以维持变革。在缺乏有效性的确凿证据的情况下，可以成功地援引更广泛的价值观念来维持创新。可持续性需要长期持续的努力，而不是代表一个要实现的最终状态。我们的研究为组织变革的可持续发展过程提供了新的见解，并阐明了在充满相互竞争的优先事项的具有挑战性的背景下，使自下而上的变革持续下去所需的补充策略。
