Dimitrios Spyridonidis

Patient and Public Involvement in Healthcare Quality Improvement: How organizations can help patients and professionals to collaborate

Abstract Citizens across the world are increasingly called upon to participate in healthcare improvement. It is often unclear how this can be made to work in practice. This 4-year ethnography of a UK healthcare improvement initiative showed that patients used elements of organizational culture as resources to help them collaborate with healthcare professionals. The four elements were: (1) organizational emphasis on non-hierarchical, multidisciplinary collaboration; (2) organizational staff ability to model desired behaviours of recognition and respect; (3) commitment to rapid action, including quick translation of research into practice; and (4) the constant data collection and reflection process facilitated by improvement methods.

Interpretation of Multiple Institutional Logics on the Ground: Actors’ Position, their Agency and Situational Constraints in Professionalized Contexts

Our study examines how interdependent actors in a professionalized context interpret the co-occurrence of a professional logic and a policy-driven logic. The empirical setting comprises two hospitals in the English National Health Service. Two issues stand out. First, our study shows that any logic is variegated and ambiguous, so policymakers and organizational managers cannot assume that they are easily blended. Second, it shows how nurse consultants exhibit agency in blending these two logics in pursuit of positional gain in professional and managerial organization. They can do so because of their ambiguous status level: in comparison to doctors, their status as nurses is low; within the nursing profession their status is high. Theoretically, by focusing upon interpretation of multiple institutional logics at the micro level, our study renders visible the agency of interpreting actors, interdependency of actors, their interpretation of institutional logics, situational context, and the effect of, and upon, social position of actors.

Are new forms of professionalism emerging in medicine? The case of the implementation of NICE guidelines

Abstract Scientific-bureaucratic medicine (SBM) has been the dominant discourse on evidence-based medicine in the English National Health System (NHS). It has being claimed that SBM has led to new forms of medical professionalism with an emphasis on organisational values and the control of autonomy. This paper explores the medical professions’ response to SBM, where SBM is manifested in the form of National Institute of Health and Clinical Excellence (NICE) guidelines. Seventy-four face-to-face informal interviews were carried out with clinicians and managers between 2007 and 2009. Three major themes emerged from the analysis each of which was linked to doctors’ receptiveness to NICE guidelines implementation. The first emphasised organisational values, which accounted for conditional acceptance of NICE guidelines. The second was proactive professionalism or entrepreneurial professionalism, which was linked to the rejection of NICE guidelines and the emergence of alternative forms of introducing new ideas for the expansion of their clinical practice. The third was related to the prominence of clinical autonomy linked with doctors’ resistance to the use of NICE guidelines. It is argued that this evidence does not reflect a significant emergence of new forms of professionalism but the development of multiple occupational identities.

Leadership for Knowledge Translation The Case of CLAHRCs

Calls for successful knowledge translation (KT) in health care have multiplied over recent years. The National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) program is a policy initiative in the United Kingdom aimed at speeding-up the translation of research into health care practice. Using multiple qualitative research methods and drawing on the ongoing processes used by individuals to interpret and contextualize information, we explore how new organizational forms for KT bridge the gap between research and practice. We pay particular attention to the relationship between the organization and practices of KT and leadership. Our empirical data demonstrate how the relationship between leadership and KT shifted over time from a push model where the authoritarian top-down leadership team set outcome measures by which to judge KT performance to one which aimed to distribute leadership capacity across a wide range of stakeholders in health and social care systems. The relationship between the organization and practices of KT and leadership is affected by local contextual influences on policies directed at increasing the uptake of research in clinical practice. Policy makers and service leaders need to recognize that more dispersed type of leadership is needed to accommodate the idiosyncratic nature of collective action.

The Translational Role of Hybrid Nurse Middle Managers in Implementing Clinical Guidelines: Effect of, and upon, Professional and Managerial Hierarchies

Our study uses qualitative and interpretative design to analyse what hybrid nurse middle managers do in their managerial practice, what affects this, and to what effect, focusing upon implementing policy-driven guidelines on the clinical frontline. Examining two comparative hospital cases and drawing upon Scandinavian institutionalism, we conceive their role as one of ‘translation’. On the one hand, they exhibit strategic agency. On the other hand, their managerial role not only influences, but is influenced by, professional and managerial hierarchies. In both hospitals, in the short term we see how hybrid nurse middle managers are able to mediate professional and managerial hierarchies and implement clinical guidelines through translational work. However, in one case, they less effectively accommodate policy-driven, managerial pressure towards compliance with government regulations and financial parsimony. In this case, the outcome of their translational work is not sustained in the longer term, as professional and managerial hierarchies reassert themselves. Drawing upon the example of their managerial role in healthcare, we highlight that hybrid middle managers enact a strategic translational role and outline situational constraints that impact this more strategic role.

Adoption and Diffusion of Innovations in Health Care

This chapter discusses the theory and practice of adoption and diffusion of innovation. It has a healthcare sector emphasis and is aimed for readers who are new to the field of innovation. The chapter offers a broad overview of the literature on the adoption of complex organizational and technological innovations in health systems. In doing so, it summarizes the most commonly used perspectives that explain the factors that determine the fate of the innovation process, namely the characteristics of the innovation, the adopter characteristics and health care system and innovation context characteristics. The strategic importance of these perspectives in determining successful diffusion of innovation is discussed in detail. A framework is constructed that offers guidance and support to those responsible for managing innovation projects.