[Show abstract][Hide abstract] ABSTRACT: In healthcare there is a long held wisdom that 'champions' are a key aspect of organizational change. Drawing on organizational management theory, we examine the role of champions in three health and social care organizations in England as they attempt to move services to a remote model of delivery, 'telecare'. The delivery of remote care is a significant policy in the U.K. and elsewhere, but its introduction has been challenging. Over three years ethnographic methods (observations, informed discussions and interviews) were used to analyze the role of organizational champions in implementing remote care. Cases were local authorities and associated primary care trusts. Participants were champions and organizational members involved in implementation. Our study shows that organizational champions are highly effective in the first phase of adoption, when change is contained within distinct sub-sets of practice. Moving beyond local contexts the effectiveness of the champions varied. Identification centered on the remote care work. This identification enabled the champions to motivate others and move beyond their normally prescribed roles, contributing to innovation ideas, processes and practices. When required to shift their work organization-wide, and share ideas outside their professional culture, some champions responded with resistance, resulting in a lack of innovation spread. These results caution against allowing change to become positioned within the remit of a few individuals. Whilst this strategy may be initially beneficial, the role of champion may be less useful, even detrimental to progress, in the later stages of implementation, particularly if identification with the new circumstances is not established.
Social Science [?] Medicine 03/2011; 74(3):348-55.
[Show abstract][Hide abstract] ABSTRACT: This paper is motivated by a desire to clarify the definition of ‘openness’ as currently used in the literature on open innovation, and to re-conceptualize the idea for future research on the topic. We combine bibliographic analysis of all papers on the topic published in Thomson's ISI Web of Knowledge (ISI) with a systematic content analysis of the field to develop a deeper understanding of earlier work. Our review indicates two inbound processes: sourcing and acquiring, and two outbound processes, revealing and selling. We analyze the advantages and disadvantages of these different forms of openness. The paper concludes with implications for theory and practice, charting several promising areas for future research.
[Show abstract][Hide abstract] ABSTRACT: In this paper we examine managed service in the information and communication technology (ICT) sector, characterized by the polarization between an infrastructure service that is growing in scale and increasingly becoming a commodity and customized or even one-of-a-kind projects. We refer to the approaches taken by three highly innovative advanced service companies, IBM, Ericsson, and Cable & Wireless, to package and deliver ICT service on a more industrialized basis. We identify the six-stage process that describes their journeys to date. We also describe some of the challenges they faced on that journey as well those currently facing them as they move to a higher degree of industrialization. To address these challenges, we propose a model with three axes: offering development, service delivery, and go to market. The model demonstrates how the increasing industrialization of managed service requires an approach integrating all three of these dimensions. We also show that strong governance is required to address the impacts of technological evolution, marketplace dynamics, and corporate culture.
[Show abstract][Hide abstract] ABSTRACT: To describe progress and perceived challenges in implementing the NHS information and technology (IT) programme in England.
Case studies and in-depth interviews, with themes identified using a framework developed from grounded theory. We interviewed personnel who had been interviewed 18 months earlier, or new personnel in the same posts.
Four NHS acute hospital trusts in England.
Senior trust managers and clinicians, including chief executives, directors of IT, medical directors, and directors of nursing.
Interviewees unreservedly supported the goals of the programme but had several serious concerns. As before, implementation is hampered by local financial deficits, delays in implementing patient administration systems that are compliant with the programme, and poor communication between Connecting for Health (the agency responsible for the programme) and local managers. New issues were raised. Local managers cannot prioritise implementing the programme because of competing financial priorities and uncertainties about the programme. They perceive a growing risk to patients' safety associated with delays and a loss of integration of components of the programme, and are discontented with Choose and Book (electronic booking for referrals from primary care).
We recommend that the programme sets realistic timetables for individual trusts and advises managers about interim IT systems they have to purchase because of delays outside their control. Advice needs to be mindful of the need for trusts to ensure longer term compatibility with the programme and value for money. Trusts need assistance in prioritising modernisation of IT by, for example, including implementation of the programme in the performance management framework. Even with Connecting for Health adopting a different approach of setting central standards with local implementation, these issues will still need to be addressed. Lessons learnt in the NHS have wider relevance as healthcare systems, such as in France and Australia, look to realise the potential of large scale IT modernisation.
[Show abstract][Hide abstract] ABSTRACT: We have conducted a systematic review of home telecare for frail elderly people and for patients with chronic conditions. We searched 17 electronic databases, the reference lists of identified studies, conference proceedings and Websites for studies available in January 2006. We identified summaries of 8666 studies, which were assessed independently for relevance by two reviewers. Randomized controlled trials of any size and observational studies with 80 or more participants were eligible for inclusion if they examined the effects of using telecommunications technology to (a) monitor vital signs or safety and security in the home, or (b) provide information and support. The review included 68 randomized controlled trials (69%) and 30 observational studies with 80 or more participants (31%). Most studies focused on people with diabetes (31%) or heart failure (29%). Almost two-thirds (64%) of the studies originated in the US; more than half (55%) had been published within the previous three years. Based on the evidence reviewed, the most effective telecare interventions appear to be automated vital signs monitoring (for reducing health service use) and telephone follow-up by nurses (for improving clinical indicators and reducing health service use). The cost-effectiveness of these interventions was less certain. There is insufficient evidence about the effects of home safety and security alert systems. It is important to note that just because there is insufficient evidence about some interventions, this does not mean that those interventions have no effect.
Journal of Telemedicine and Telecare 02/2007; 13(4):172-9.
[Show abstract][Hide abstract] ABSTRACT: This paper aims to examine how firms are organizing to provide integrated solutions: a business model for the supply of capital goods based on the provision of products and services as integrated solutions to individual customer's needs. The industrial marketing literature suggests that the origins of this business model can be traced back to early 1960s when firms adopted strategies and organizations for ‘systems selling’. The marketing literature helps us to identify two contrasting types of organizations: (1) the vertically-integrated systems seller that produces all the product and service components in a system; and (2) the systems integrator that coordinates integration of components supplied by external firms. The paper uses these two ideal types to analyse the strategies and organizations of five case study firms that have recently attempted to move into the provision of integrated solutions. It argues that there is no evidence to support the continuing dominance of the systems seller or a simple transition from systems selling to systems integration. A more complex pattern of organizational forms is emerging, combining elements of both systems selling (i.e. vertical integration into services) and systems integration.
[Show abstract][Hide abstract] ABSTRACT: ‘Telecare’ is the use of information and communication technology to facilitate health and social care delivery to individuals in their own homes. Governments around the world are seeking to introduce telecare partly to help address the challenges posed by an ageing society. Telecare is inherently complex to implement and operate because it involves combination of technological and organisational innovation in an environment of diverse stakeholders.Using research on two telecare schemes in the UK, the paper explores the way project complexity, organisational context and project management approach interacted during the planning and implementation phases. The paper discusses how insights from research in related areas, including medical technology and service sector innovation in general, could help to explain why mainstream telecare delivery has been difficult and draws conclusions on the role of project management in the implementation of innovation.
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