Middlesex University, London, UK.
Middlesex University School of Health and Education, London, UK.
J Health Organ Manag. 2020 Feb 14;34(2):192-206. doi: 10.1108/JHOM-12-2019-0339.
The study presents the findings from a study over a four-year period of the emergence of an integrated healthcare organisation in response to policy changes within the United Kingdom (UK). The aim of the research was to understand the process of healthcare organisation integration through the lens of actor-network theory (ANT).
DESIGN/METHODOLOGY/APPROACH: An instrumental case study approach to data collection was selected. Three methods of data collection were used to trace the healthcare organisation integration process: in depth semistructured interviews using a virtual patient journey across services with 36 purposefully selected informants, document analysis and field observations and notes.
The findings of this study suggest that neither the context nor the actors were the sole determinants of the outcome of the integration. Rather it was the dynamic interplay between the actors, their context, the shared agency and the resources available to them as the change emerged shaped the end result.
The findings denote that organisations need to attend to frontline workers as key contributors to change and development that is meaningful for service users. Methodologically, combining the ANT and constructive case study to understand the integration process provided us with new perspective to understand the trajectory of change process.
ORIGINALITY/VALUE: This original case study fills a gap in information about the role of healthcare professionals in healthcare policy process and the interactive relationship between all stakeholders of policy process including nonhuman actors.
本研究展示了在英国（UK）政策变化背景下，一个综合医疗保健组织出现的四年研究结果。该研究旨在通过行动者网络理论（ANT）的视角理解医疗保健组织整合的过程。
设计/方法/途径：选择了仪器案例研究方法进行数据收集。使用三种数据收集方法来追踪医疗保健组织整合过程：对 36 名有针对性选择的受访者进行深入的半结构化访谈，使用虚拟患者服务旅程，对服务进行文档分析和现场观察及记录。
本研究的结果表明，无论是背景还是参与者，都不是整合结果的唯一决定因素。相反，是参与者、他们的背景、共同的代理机构以及他们在变革出现时可获得的资源之间的动态相互作用，塑造了最终结果。
研究结果表明，组织需要关注一线工作人员，因为他们是对用户有意义的变革和发展的重要贡献者。在方法论上，将 ANT 和建设性案例研究相结合，以了解整合过程，为我们提供了新的视角来理解变革过程的轨迹。
原创性/价值：本原始案例研究填补了有关医疗保健专业人员在医疗保健政策过程中的作用以及政策过程所有利益相关者（包括非人类参与者）之间的互动关系的信息空白。
