An Autoethnographic Account of Innovation at the US Department of Veterans Affairs (original) (raw)
Related papers
Journal of Medical Internet Research, 2019
Background: Star defined infrastructure as something other things "run on"; it consists mainly of "boring things." Building on her classic 1999 paper, and acknowledging contemporary developments in technologies, services, and systems, we developed a new theorization of health information infrastructure with five defining characteristics: (1) a material scaffolding, backgrounded when working and foregrounded upon breakdown; (2) embedded, relational, and emergent; (3) collectively learned, known, and practiced (through technologically-supported cooperative work and organizational routines); (4) patchworked (incrementally built and fixed) and path-dependent (influenced by technical and socio-cultural legacies); and (5) institutionally supported and sustained (eg, embodying standards negotiated and overseen by regulatory and professional bodies). Objective: Our theoretical objective was, in a health care context, to explore what information infrastructure is and how it shapes, supports, and constrains technological innovation. Our empirical objective was to examine the challenges of implementing and scaling up video consultation services. Methods: In this naturalistic case study, we collected a total of 450 hours of ethnographic observations, over 100 interviews, and about 100 local and national documents over 54 months. Sensitized by the characteristics of infrastructure, we sought examples of infrastructural challenges that had slowed implementation and scale-up. We arranged data thematically to gain familiarity before undertaking an analysis informed by strong structuration, neo-institutional, and social practice theories, together with elements taken from the actor-network theory. Results: We documented scale-up challenges at three different sites in our original case study, all of which relate to "boring things": the selection of a platform to support video-mediated consultations, the replacement of desktop computers with virtual desktop infrastructure profiles, and problems with call quality. In a fourth subcase, configuration issues with licensed video-conferencing software limited the spread of the innovation to another UK site. In all four subcases, several features of infrastructure were evident, including: (1) intricacy and lack of dependability of the installed base; (2) interdependencies of technologies, processes, and routines, such that a fix for one problem generated problems elsewhere in the system; (3) the inertia of established routines; (4) the constraining (and, occasionally, enabling) effect of legacy systems; and (5) delays and conflicts relating to clinical quality and safety standards. Conclusions: Innovators and change agents who wish to introduce new technologies in health services and systems should: (1) attend to materiality (eg, expect bugs and breakdowns, and prioritize basic dependability over advanced functionality); (2) take a systemic and relational view of technologies (versus as an isolated tool or function); (3) remember that technology-supported work is cooperative and embedded in organizational routines, which are further embedded in other routines; (4) innovate
Survival of the project: A case study of ICT innovation in health care
From twenty years of information and communication technology (ICT) projects in the health sector, we have learned one thing: most projects remain projects. The problem of pilotism in e-health and telemedicine is a growing concern, both in medical literature and among policy makers, who now ask for large-scale implementation of ICT in routine health service delivery. In this article, we turn the question of failing projects upside down. Instead of investigating the obstacles to implementing ICT and realising permanent changes in health care routines, we ask what makes the temporary ICT project survive, despite an apparent lack of success. Our empirical material is based on Norwegian telemedicine. Through a case study, we take an in-depth look into the history of one particular telemedical initiative and highlight how ICT projects matter on a managerial level. Our analysis reveals how management tasks were delegated to the ICT project, which thus contributed to four processes of organisational control: allocating resources, generating and managing enthusiasm, system correction and aligning local practice and national policies. We argue that the innovation project in itself can be considered an innovation that has become normalised in health care, not in clinical, but in management work. In everyday management, the ICT project appears to be a convenient tool suited to ease the tensions between state regulatory practices and claims of professional autonomy that arise in the wake of new public management reforms. Separating project management and funding from routine practice handles the conceptualised heterogeneity between innovation and routine within contemporary health care delivery. Whilst this separation eases the execution of both normal routines and innovative projects, it also delays expected diffusion of technology.
Innovation in Public Healthcare Systems: Do We Really Understand Its Potential
management issues in the healthcare system, 2016
This paper explores the concept of innovation and evaluates its relevance to public healthcare services. A comprehensive review of innovation in public healthcare systems was done to identify a source of analysis or commentary. This was done with the intention of exploring important considerations in relation to the progress of innovation within public health services. There are a number of factors in the public healthcare systems that need some tough challenges in implementing innovation; however, the environment is ripe for public health services to implement innovation. Various considerations and strategies for enabling public healthcare organizations and implementing innovation were identified.
Open Innovation: Transforming Health Systems through Open and Evidence Based Health ICT Innovation
2011
For many years the full potential of creating and leveraging integrated health ICT systems such as electronic health records to improve healthcare delivery, reducing its cost and promoting prevention has been elusive. Traditional health ICT business, innovation, development and adoption models have failed to address chronic road blocks to realizing its full potential and have led to many high profile failures. The chronic symptoms include persistent barriers to integration and interoperability, high cost, duplication of effort, and poor, to no support for collaborative, "evidence based" medicine. This paper provides a review of case studies and analysis on how open innovation, or open source processes, can break the grid lock and bring the fundamental paradigm shift needed to exploit the full potential of health ICTs. The paper will discuss how the open innovation model, as applied to health ICT, provides a framework for harnessing the naturally occurring "bottom up" forces and emergent behaviour found in complex adaptive systems such as healthcare. It does this by describing a model and context for collaborative, open, peer reviewed, evidence-based innovation and technology transfer processes. Evidence from case studies are presented on how open ICT innovation in healthcare provides essential feed backloops for supporting, researching, developing and disseminating while driving continuous quality improvement at a global scale.
Building a Culture of Innovation in a Health-Care Organization
Entrepreneurship Education and Pedagogy, 2018
Columbus Regional Health (CRH, hereafter), a nonprofit organization in Columbus, Indiana, evolved from a traditional local hospital to an award-winning regional health-care provider through innovation. As CRH began implementing innovation processes, the city of Columbus was hit by a natural disaster that flooded the hospital's flagship facility forcing it to close its operations and relocate its critical patients to other hospitals in the area. As a result of the closure, CRH's leadership faced daunting challenges, including whether or not to continue paying its employees, how to continue to provide care for its patients and the community, and funding the cost of repairs and renovations to CRH facilities estimated at $180 million. The management's response to these challenges and how a culture of innovation emerged from that can teach us several important lessons. Pertinent questions are as follows: (a) How can we evaluate the innovation process undertaken by CRH? and (b...
Innovation in healthcare: Issues and future trends
Journal of Business Research, 2012
Despite the fact that there has been significant improvement in the healthcare industry, inefficiency still exists and little accomplished in understanding how to overcome those inefficiencies using innovation in healthcare. This study seeks to answer the following research questions. How do executives and practitioners define the term innovation in healthcare? How do healthcare organizations come up with innovative ideas and how do they make those innovative decisions? How do healthcare executives and practitioners roll out those innovative changes in their organizations? What strategies do these organizations apply toward the formulation of innovative decisions? What role does information technology play in the innovative process? The researchers conducted in-depth interviews to answer several research questions. The respondents included 21C-level healthcare executives from 15 healthcare units. Results of the decision-making processes used by these executives concerning innovation conclude with a practical model. Finally, implications for practitioners and policy makers and future trends complete the paper.
Multiple and complex changes within health care The Healthcare field means dealing with multiple, complex challenges: increase in chronic disease, aging population, implementing policies and programmes that deal with new issues, such as health promotion, aging, and social isolation, growing social and territorial inequalities in health access, cost increases in some medical treatments, new expectations for personalized services… and finally growing financial constraints that weigh on the healthcare ecosystem. Innovative responses to these challenges are numerous and include technological innovations of products and services, organisational and managerial innovations (Damanpour & Aravind, 2012), innovations in Business Models, R&D processes, governance, evaluation techniques, public regulations, and embracing new forms of mobilizing stakeholders.