Ann Casebeer

Identifying, Enabling and Managing Dynamic Capabilities in the Public Sector

In this paper, we examine how a public sector organization developed a new strategic approach based on the identification and use of an internal dynamic capability (learning through experimenting). In response to the need for continual performance improvement in spite of reduced financial resources, this organization engaged in three overlapping phases as they shifted to this strategic approach. First, managers identified appropriate latent dynamic capabilities. Next, they used their leadership skills and built on established levels of trust to enable the use of these dynamic capabilities. Finally, they managed the tension between unrestricted development of local initiatives and organizational needs for guidance and control.

Toward a communicative perspective of collaborating in research: the case of the researcher–decision-maker partnership

In the shift to a post-industrial order, the production and use of knowledge is gaining greater importance in a world beyond science. Particularly in the health sciences, research foundations are emphasising the importance of translating research results into practice and are experimenting with various strategies to achieve this outcome, including requiring practitioners to become part of funded research teams. In this paper, we present a case of a partnership between researchers and decision-makers in Canada who collaborated on an investigation of implementing change in health care organisations. Grounded in this case and recent empirical work, we propose that such research collaborations can be best understood from a communicative perspective and as involving four key elements: relational stance that researchers and decision-makers assume toward each other; purpose at hand that situates occasions for developing and using knowledge; knowledge-sharing practices for translating knowledge; and forums in which researchers and practitioners access knowledge. Our analyses suggest that partnerships are most effective when researchers see the value of contextualising their work and decision-makers see how this work can help them accomplish their purpose at hand.

Predictive value of aspects of the Transtheoretical Model on smoking cessation in a community-based, large-group cognitive behavioral program

OBJECTIVE To evaluate the predictive value of aspects of the Transtheoretical Model (TTM) of behavior change as applied to smoking cessation in a large-group, community-based cognitive-behavioral intervention. RESEARCH APPROACH Cognitive-behavioral intervention followed by 3-month assessment of smoking status. SETTING Regional Outpatient Cancer Centre. STUDY PARTICIPANTS A total of 2069 participants in smoking cessation clinics held between 1992 and 1999. INTERVENTION Eight 90-min sessions over 4 months utilizing education, self-monitoring, a group quit date, and behaviour modification techniques. MAIN OUTCOME MEASURES Cessation rates at 3 months postquit date. Differences between successful and unsuccessful participants on the baseline TTM variables of: stages of change, processes of change, decisional balance and situational temptations, as well as of precessation demographic, smoking history, and smoking behavior variables. RESULTS Nonsmokers at 3 months endorsed using more of only one of the processes of change (Reinforcement Management) more than smokers prior to starting the program. They also endorsed more Cons of Smoking and had a more negative Decisional Balance score. When the variables of tobacco tolerance on the Fagerstrom Test for Nicotine Dependence (FTND), marital status, association with the Cancer Centre, and amount of vigorous exercise were first entered in a logistic regression model, Reinforcement Management and Cons of Smoking continued to be predictive of smoking cessation success, but again none of the other TTM variables added explanatory power. CONCLUSIONS TTM variables measured prior to program attendance added little predictive value for cessation outcome beyond that explained by demographic and smoking history variables. Future studies may benefit from reassessing the TTM variables at the quit date and the 3-month assessment of smoking status to evaluate how the program impacted these variables.

Will it make a difference if I show up and share? A citizens' perspective on improving public involvement processes for health system decision-making

Introduction: Health policy decision-makers are grappling with increasingly complex and ethically controversial decisions at a time when citizens are demanding more involvement in these decision processes. Objectives: To assess and revise a set of guiding principles for the design of public involvement processes generated from a synthesis of public participation design and evaluation frameworks that can be used to inform the design and evaluation of future public participation processes in the health sector. Methods: Six focus groups held in five Canadian provinces comprising citizens with considerable experience of public participation processes. Results and discussion: Our findings suggest that citizen participants are highly critical of, and discerning about, their public participation experiences. Yet, they are optimistic and determined to contribute in meaningful ways to future public policy processes. They are clear about where improvements are needed and give top priority to what information is shared, and how, among participants and decision-makers. The views of experienced citizens mapped well onto most of the prior principles of public involvement with a few modifications. First, participants gave greater emphasis to the content and balance of information for the purposes of building trust and credibility between citizens and decision-makers. Second, participants viewed themselves, as well as decision-makers, as sources of information to be shared through the consultation process. Finally, participants stressed the importance of getting the information and communication principles right over addressing all other principles.

Revisiting interaction in knowledge translation

BackgroundAlthough the study of research utilization is not new, there has been increased emphasis on the topic over the recent past. Science push models that are researcher driven and controlled and demand pull models emphasizing users/decision-maker interests have largely been abandoned in favour of more interactive models that emphasize linkages between researchers and decisionmakers. However, despite these and other theoretical and empirical advances in the area of research utilization, there remains a fundamental gap between the generation of research findings and the application of those findings in practice.MethodsUsing a case approach, the current study looks at the impact of one particular interaction approach to research translation used by a Canadian funding agency.ResultsResults suggest there may be certain conditions under which different levels of decisionmaker involvement in research will be more or less effective. Four attributes are illuminated by the current case study: stakeholder diversity, addressability/actionability of results, finality of study design and methodology, and politicization of results. Future research could test whether these or other variables can be used to specify some of the conditions under which different approaches to interaction in knowledge translation are likely to facilitate research utilization.ConclusionThis work suggests that the efficacy of interaction approaches to research translation may be more limited than current theory proposes and underscores the need for more completely specified models of research utilization that can help address the slow pace of change in this area.

Transforming New Ideas into Practice: An Activity Based Perspective on the Institutionalization of Practices

We develop an activity‐focused process model of how new ideas can be transformed into front line practice by reviving attention to the importance of habitualization as a key component of institutionalization. In contrast to established models that explain how ideas diffuse or spread from one organization to another, we employ a micro‐level perspective to study the subsequent intra‐organizational processes through which these ideas are transformed into new workplace practices. We followed efforts to transform the organizationally accepted idea of ‘interdisciplinary teamwork’ into new everyday practices in four cases over a six year time period. We contribute to the literature by focusing on de‐habitualizing and re‐habitualizing behaviours that connect micro‐level actions with organizational level theorizing. Our model illuminates three phases that we propose are essential to creating and sustaining this connection: micro‐level theorizing, encouraging trying the new practices, and facilitating collective meaning‐making.

Performance Measurement in Healthcare: Part I - Concepts and Trends from a State of the Science Review

This analysis uses a consistent pan-Canadian dataset--Canadian CompuScript from IMS Health, Canada--to quantify trends in per capita drug expenditures within each Canadian province over the period of 1998 to 2004. The impacts of changes in six potential determinants of drug expenditure are calculated for every province. Each of the six detailed cost drivers falls into one of three broad categories: volume effects, price effects and therapeutic choices. Despite wide variation in expenditure levels, the rate and causes of provincial expenditure trends over time were roughly comparable. From 1998 to 2004, per capita expenditures on oral solid prescription drugs grew at a rate of over 10% per year in most provinces--several times faster than economic growth over the same period. This rapid expenditure growth has largely been due to increased utilization of medicines and a trend towards prescribing higher-cost drugs over time. Price changes had little impact on drug spending in all provinces.

The process of change related to health policy shift: reforming a health care system

Efforts of governments to adjust the responsiveness and efficiency of their health care systems are evident across the globe. In the seemingly constant search for solutions providing both better health outcomes and manageable costs, the directions and designs for change are neither consistent nor well studied. Opportunities for shared learning concerning what strategies for transforming health care systems lead to effective and sustainable change are being missed. There is an urgent need to study and understand the processes of change initiated by health policy shifts aimed at controlling health care costs, altering health service delivery and influencing outcomes of health care. In partial response to this need, research was initiated to study health policy transition within the Western Canadian province of Alberta. The primary objective of this research was: to identify, describe, compare and contrast the processes of change adopted and implemented in a variety of health authorities as a result of health policy shift. Change processes initiated by a specific health policy shift (the restructuring of Alberta’s health care system) were explored from the perspective of the change agents (individuals managing the health system reforms) in order to discover indicators of effective change and to identify questions for further consideration and testing in relation to change process related to health policy shift. This qualitative exploratory study coincided with real time alteration to the health system via legislated health policy shift. Findings relate changes in the structure, process and outcome of the health policy transition. Additionally, a number of questions linked to the reported findings are highlighted to encourage additional and continuing efforts to improve understanding of change process related to health policy shift.

Managing Change in the Context of Health Reform: Lessons from Alberta

A qualitative field study of health system reform in Alberta was undertaken to identify, describe, compare and contrast the processes of change management adopted and implemented as a result of legislated health policy shift. Chairs and chief executives of the new regional health authorities and provincial leaders managing the change processes within Albertas health care system were interviewed. Components of change strategies important to the structure, process and impact of the health policy shift to a regionalized system of care were identified and analyzed. Stakeholders involved in managing change inside Albertas health care system were able to consistently identify a range of issues important to beginning and sustaining health policy shift. These issues and insights did not come from the literature, but rather from experience. To test and share this experience further, it will be important to study more consciously the management of change in relation to expected outcomes. With so many natural experiments altering health care systems across Canada and beyond, a window of opportunity exists for researching both the quality and quantity of such change, comparing and sharing findings over time and, eventually, linking process to outcome.

Legitimizing new practices in primary health care.

Background: Finding ways to reinvent primary health care is imperative. One way is to change practices from a physician-focused model to an interdisciplinary team approach where other health professionals (nurses, nurse practitioners, dieticians, rehabilitation therapists, and other qualified primary care providers) collectively take on much stronger roles—often providing services instead of the physician. Health care policy makers and professionals agree that these new practices are a good idea, and yet they have not been widely adopted. Purpose: Our goal was to understand how new interdisciplinary practices became legitimized as the new accepted working standards. Methodology: We conducted a qualitative, longitudinal comparative case study of 8 primary health care innovation sites established to provide services through interdisciplinary teams. We followed changes in practices over a 3-year period by conducting 150 interviews with professionals and managers across the 8 sites. Findings: At the end of 3 years, new practices were adopted in 5 of the sites, but in 3 sites, they were not. We explain the differences by identifying a series of strategies used by managers in the successful sites and compare them with those used in the other 3 sites. Strategies used in the successful sites were (a) gaining full engagement, (b) enticing people to try new practices, (c) encouraging structured disagreement, and (d) staying focused on overall goals. Practice Implications: Managers of health care change initiatives must gain buy-in from professionals, but that is not enough. They must also facilitate trying the new practices as soon as possible. Open disagreement should be carefully encouraged, but any concerns must also be successfully addressed. Finally, managers must keep professionals focused on the overall goals of change rather than allowing paralysis in response to external events.