From the abstract to the concrete - Implementation of an innovative tool in home care

Background: The implementation of innovations in practice is a critical factor for change and development processes in health and home care. We therefore analyze how an innovative tool - a mobility agreement to maintain physical mobility of home care clients - was implemented in Finnish home care. Methods: Our study involves ethnographic research of 13 home care visits, two years after the mobility agreement was implemented. We analyze the emergence of contradictions, the motives of the actors and the use of artifacts supporting or inhibiting the implementation. Two in-depth cases illustrate the implementation of the mobility agreement in home care visits. Findings: Our findings show that, first, to achieve practice change and development, the innovation implementation requires the overcoming of contradictions in the implementation process. Second, it calls for the emergence of a shared motive between the actors to transform the abstract concept of an innovation into a concrete practice. Third, artifacts, customary to the clients are important in supporting the implementation process. Fourth, the implementation brings about a modification of the innovation and the adopting social system. Conclusions: Innovation implementation should be seen as a transformation process of an abstract concept into a concrete practice, enabled by the actors involved. Concept design and implementation should be closely linked. In health/home care innovation management, the implementation of innovations needs to be understood as a complex collective learning process. Results can be far reaching - in our case leading to change of home care workers' professional understanding and elderly clients' mobility habits.Peer reviewe

Dialectics of distributed leadership in an interorganizational entrepreneurship hub

Abstract In this study, we widen the understanding of how the dialectics of distributed leadership develop as part of discursive interactions in an interorganizational setting directed at renewal. Using a dialectical perspective, we analyzed developmental meetings of an entrepreneurship hub and identified three dialectics, namely disagreement versus encouragement, organizational dependency versus interorganizational engagement and status quo versus transformation, by which the discussion reached the resolution. Our study widens the current understanding of distributed leadership and offers a nuanced account of how dissent and consent act as equally important forces for the development of the distributed leadership practice, as well as for reaching the collective resolution directed at organizational renewal. Our study also highlights the significance of co-created visual representations for converting complex discursive dialectics into a more tangible form. More generally, our study opens an approach in leadership to study tension-laden organizational dynamics in discursive and processual terms, especially in complex interorganizational contexts

Snellmanin sivistyskäsitys jatkuvan oppimisen ja työorganisaatioiden kehittämisen lähtökohtana ja haasteena

Abstrakti Snellmanilainen sivistyskäsite syventää keskustelua jatkuvasta oppimisesta. Se kuitenkin edellyttää uudenlaisia tutkimusavusteisia menetelmiä ja oppimisympäristöjä, joissa työntekijät, kehittäjät ja johtajat yhdessä kehittävät työtään ja osaamistaan ja tuottavat ratkaisuja ongelmiin

Organizational arrangements as a key to enhancing innovativeness and efficiency:analysis of a restructuring hospital in Finland

Abstract Background: Challenged to innovate and improve efficiency both at the policy level and in everyday work, many health care organizations are undergoing radical change. However, in many earlier studies, the significance of individuals’ perceptions of their organization and its innovativeness and efficiency during restructuring is not well acknowledged. Our study examines how various organizational arrangements; performance-, hierarchy-, tradition-, and leader-focused types, as well as collaborative and fragmented ones, connect to reaching innovativeness and efficiency in health care during restructuring. Methods: We built on previous organization and management research, innovation studies, and on research focusing in health care restructuring, and conducted an exploratory quantitative case study in a public sector hospital in Finland. Data comprising 447 responses from 19 professional groups across the hospital was analyzed using hierarchical regression analysis. Results: Our results demonstrate that multiple, co-existing organizational arrangements can promote innovation and efficiency. The perceptions of the organizational members of the nature of their organization need to be generally positive and reflect future-orientation to show positive connections with efficiency and innovativeness; fragmentation in the members’ perceptions of the character of their organization and their inability to go beyond established organizational traditions pose risks of inefficiency and stagnation rather than fruitful exploration. Our study further shows, somewhat surprisingly, that while collaborative organizational arrangements are positively related to increases in perceived efficiency, the same does not apply to innovativeness. Conclusions: Our study addresses understudied, yet inherently important aspects in providing high-quality health care: the relationships between different organizational arrangements and exploitation and exploration-related outcomes. In particular, examination of individuals’ perceptions (that may have even more weight for the subsequent developments than the actual situation) adds insight to the existing knowledge that has addressed more objective factors. Implications on how to support high levels of performance are drawn for management of professional and pluralistic organizations undergoing restructuring. Our findings also generate information that is useful for policy making concerned with public sector health care

Preparing educators for inclusive bilingual education:a boundary crossing laboratory between professional groups

Abstract Teacher education programs prepare candidates for bilingual, English as a second language, or special education as separate professionals. This creates challenges when teaching bilingual children with disabilities. There is a need to cross boundaries combining expertise and preparing teachers for children’s uniqueness. Responding to this need, the researchers organized a change laboratory with 14 professors and two State Department of Education consultants. The study explored boundary expressions and their relationship to the larger activity. It also looked at the learning that took place during boundary crossing efforts. Boundaries were identified around bilingual teacher preparation, cross-disciplinary programmatic, and paradigmatic aspects. While boundary crossing at the intrapersonal level and at the interpersonal level were important, the need to engage multiple institutions was centered. In addition, the discussion manifested that for inclusive bilingual education teacher preparation, there was a need to go beyond the institutional level to reach to policy makers and address the sociopolitical resistance against bilingual education. Throughout the study, participants engaged primarily in the epistemic learning actions of analyzing and modeling. Through volitional actions, the participants realized a renewed object for their activity. This study widens the understanding of possibilities for taking shared educational responsibility through boundary crossing between professionals in preparation programs

Decidedly undecided change:producing spielraum for organizational periphery

Abstract Extant strategy practice and process studies highlight the duality of change and stability, regarding strategic change as an accomplishment of both movement and recursiveness, which are also displayed by the observed difference in strategy-making between the organizational centre and its periphery. In this study, we examine the emergence of new strategic themes and related organizing in two research universities’ organizational peripheries. By adopting a systems-theoretical view and drawing on Luhmannian organizational analysis, we are able to examine the co-existence of stability and change in each communication event, aiming to reduce complexity but also giving rise to novel complexities, providing ‘spielraum’ for peripheral development activities. The study contributes to the SAPP-oriented stream of studies on strategic change in general and emergent strategy studies in particular by providing an alternative theoretical viewpoint on the centre-periphery dynamics in strategic change and showing how organizations un/decide on new strategic themes, and through what dynamics they might become introduced and organized in established organizations

Activity theory in health professions education research and practice

Abstract This chapter describes activity theory (AT) and its emerging role within health professions education (HPE). We outline AT’s historical roots, before exploring its concepts and theoretical models in detail. We then describe its practical applications in HPE, in both analysis and intervention, before concluding with a discussion of its rich future possibilities

Getting palliative medications right across the contexts of homes, hospitals and hospices:protocol to synthesise scoping review and ethnographic methods in an activity theory analysis

Abstract Introduction: Prescribing and medication use in palliative care is a multistep process. It requires systems coordination and is enacted through activities of patients, informal carers and professionals. This study compares practice to idealised descriptions of what should happen; identifying when, how and why process disturbances impact on quality and safety. Our objectives are to: 1. Document an intended model (phase 1, scoping review). 2. Refine the model with study of practice (phase 2, ethnography). 3. Use the model to pinpoint ‘hot’ (viewed as problematic by participants) and ‘cold’ spots (observed as problematic by researchers) within or when patients move across three contexts-hospice, hospital and community (home). 4. Create learning recommendations for quality and safety targeted at underlying themes and contributing factors. Methods and analysis: The review will scope Ovid Medline, CINAHL and Embase, Google Scholar and Images—no date limits, English language only. The Population (palliative), Concept (medication use), Context (home, hospice, hospital) framework defines inclusion/exclusion criteria. Data will be extracted to create a model illustrating how processes ideally occur, incorporating multiple steps of typical episodes of prescribing and medication use for symptom control. Direct observations, informal conversations around acts of prescribing and medication use, and semistructured interviews will be conducted with a purposive sample of patients, carers and professionals. Drawing on activity theory, we will synthesise analysis of both phases. The analysis will identify when, how and why activities affect patient safety and experience. Generating a rich multivoiced understanding of the process will help identify meaningful targets for improvement. Ethics and dissemination: Ethical approval granted by the Camden & Kings Cross NHS Regional Ethics Committee (21/LO/0459). A patient and public involvement (PPI) coinvestigator, a multiprofessional steering group and a PPI engagement group are working with the research team. Dissemination of findings is planned through peer-reviewed publications and a stakeholder (policymakers, commissioners, clinicians, researchers, public) report/dissemination event