Foster Michele, Burridge Letitia, Donald Maria, Zhang Jianzhen, Jackson Claire
School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Qld, 4072, Australia.
School of Human Services and Social Work, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Qld, 4131, Australia.
BMC Health Serv Res. 2016 Jan 14;16:11. doi: 10.1186/s12913-016-1270-4.
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.
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.
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.
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.
服务提供创新是应对慢性病负担日益加重和医疗保健支出不断攀升的核心举措。小规模、由地方主导的服务提供创新是了解变革复杂性和地方变革推动者行动的宝贵知识来源。这项探索性定性研究收集了参与由全科医生主导的糖尿病综合护理创新的临床医生和管理人员的观点。
通过在两个基层医疗点进行焦点小组讨论和半结构化访谈，收集了这些变革推动者对地方创新及其在当地背景下如何运作的观点数据。对转录的数据进行了主题分析。归一化过程理论提供了一个框架，用于探讨在地方服务提供背景下将创新付诸实践所涉及的个人和集体工作的观点。
12名基层医疗临床医生、医院医学专家和医疗机构管理人员参与了该研究，他们代表了两个地点参与创新的大多数人员。主题分析突出了地方创新工作的三个主要主题：1）信任并融入新的专业关系；2）同步服务和资源；3）协调创新工作的实际情况。总体而言，研究结果表明，虽然由地方主导的服务提供创新旨在应对地方问题，但说服他人信任变革并管理边界紧张关系是地方工作的核心，特别是当它挑战既定的做法和关系时。尽管如此，研究结果还表明，地方创新者能够并且确实以自主和创造性的方式推动创新。
归一化过程理论的运用在创新进程早期就揭示了一些关键的专业、组织和结构因素。地方服务提供创新的关键在于在服务提供点建立信任联盟，并说服组织和机构的思维方式考虑由地方主导的创新机会。
