Prof Sue Dopson’s presentation for the Medical Innovation lecture series (‘Why is Innovation in the NHS often hard to achieve?’ – 11th February 2009) effectively unpacked the shared, common conceptualisation of innovation in large healthcare organizations as a predominantly rational, linear and planned process. Presenting her research on Evidence-based change in the NHS several important issues emerge that help us to understand the role of innovation in complex healthcare organizations and the barriers therein involved.
Firstly, she noted that different professionals, such as managers, scientists, commissioners and physicians each belong to different communities of practice – or epistemic communities, that share certain ‘cultural’ characteristics. People therefore interpret ‘need’ and in the case of her research, ‘evidence’, differently. Different professional groups have different in-built responses to change, to innovation and to their work practices. This is due to social and cognitive professional boundaries that arise from the education and socialisation process that individuals have to go through to get into their profession. So complex conflicts can occur between the Department of Health, the University, healthcare commissioners, medical practitioners, scientists and technology transfer professionals as each of the groups’ differing socio-cultural perspectives – medicine, biology, social science, policy and management – clash around the shared goal of organizational change and how to achieve it.
Secondly, she noted that ‘context’ is important. We need to understand the history of prior relationships between key actors; the role of opinion leaders as accelerators and facilitators of change; and how professionals engage in networks translating innovations to the local level.
Without a sensitive understanding of the epistemic clashes between different actors in an innovation process and the context of prior historical relationships between these groups, then it is likely that an innovation will fail to be implemented.
Sharing of ideas, and best practices, she posited, will not just happen, you need some people to serve as a bridge between these different communities to recognise and overcome the power differences between communities. This is achievable by ‘getting on the balcony’ and managing conflict.
When the Chairman of the lecture, Trevor Campbell-Davies, asked the audience who are the leaders in the NHS that can achieve this, no-one was able to answer. Whilst curious and amusing that the UK’s largest organization has no identifiable leadership that can serve to facilitate this inter-professional boundary-spanning role, it does highlight a very important point. The people that work effectively across boundaries require an ability to communicate eloquently in several different socio-cultural domains. Their own personal trajectories will require grounding in policy, medicine, research and management. But importantly, they should avoid becoming institutionally affiliated to just one organization, whether the University, the Oxford Radcliffe Hospital or a technology transfer organization, and the socio-cultural baggage that this entails. Where individuals possess the potential to work effectively across boundaries, this should be built in to their job description, perhaps sharing employment between these key institutions. Boundary spanners could work more effectively if employed by, and sharing their time equally between, the Research Centres, the NHS and the technology transfer organizations. The leadership of organizational change and innovation in a complex healthcare setting such as the NHS need not be only from the top of one of these organizations, but also from between the (front) lines and interfaces of these different epistemic communities.