Innovation in health care: developments in NHS trusts

A TAXONOMY OF INNOVATION: CONFIGURATIONS OF ATTRIBUTES IN HEALTHCARE INNOVATIONS

In spite of the continued importance of an innovation's attributes to research methodologies, and the increasing tendency toward multidimensional conceptualizations, the lack of a theoretically derived and empirically developed classification of innovations, conceived in terms of these perceived characteristics, continues to deter substantive research in the area. The absence of a stable descriptive framework has constrained researchers' facility to develop cross-case and cumulative research. In this paper, in which innovations are conceptualized as complex and multi-dimensional, we report on a mixed-method, exploratory study addressing the question of innovation classification. Data from a rigorous thematic investigation of the literature and four case studies, are synthesized into a descriptive framework incorporating 13 variables (innovation attributes). Following operationalization of the framework, we conduct a cluster analysis of the returns from a post-adoption survey of 310 innovations. Three distinct innovation types are identified: readily-adopted, challenging and under-cover. The attributes disruption, observability, profile and risk were found to be particularly important in distinguishing clusters that offer opportunities for new theoretical development. The UK National Health Service (NHS) forms the context for the study. Implications for theory and practice are examined.

When is the 'right' time to initiate an assessment of a health technology?

There is currently no generally accepted formula for the optimal timing of health technology assessments (HTAs). This paper presents some of the relevant issues and then reviews the existing literature on timing of HTAs. It finds that the literature that specifically addresses these issues is limited. There is a consensus that HTAs should be initiated at an early stage of the development of a new health technology, and repeated during the life cycle of the technology. However, the questions of reliably identifying new technologies at an early stage in their development and of deciding on a detectable critical point for starting evaluation are not resolved. It is proposed that a system of categorization and prioritization of health technologies should be developed to allow decisions to be made as to when a strongly precautionary approach is required and how the limited resources available for HTA could be optimally deployed.

Large-scale organizational and managerial change in health care: a review of the literature

This paper takes an overview of the organizational and managerial literature on recent large-scale change efforts within health care organizations. Such literature refers to issues of enhanced policy significance, as a succession of such changes has swept through health care, at an international level. Interpretive and case study method have been widely employed in this field. While the literature is emergent, key empirical concerns can be identified: (1) Changing roles and relationships, with the rise of management and the challenge to clinical domination; some argue that radical deprofessionalization now is evident, while others take a more nuanced view. (2) The impact of marketization, with health care becoming more of a commodity; various models of a health care 'quasi market' have been formulated. (3) Understanding the process of change in health care organizations, such as the development of a management of change literature. New theoretical frameworks have been developed, notably 'the reform cycle' as a way of understanding progressive cycles of organizational reform, the impact on health care of the rise of the new public management, and examining the demedicalization thesis through the more generic literature on professions. The paper concludes with a discussion of what this research base could contribute to policy-making.