Innovation sustainability in challenging health-care contexts : embedding clinically led change in routine practice

The need for organizational innovation as a means of improving health-care quality and containing costs is widely recognized, but while a growing body of research has improved knowledge of implementation, very little has considered the challenges involved in sustaining change – especially organizational change led ‘bottom-up’ by frontline clinicians. This study addresses this lacuna, taking a longitudinal, qualitative case-study approach to understanding the paths to sustainability of four organizational innovations. It highlights the importance of the interaction between organizational context, nature of the innovation and strategies deployed in achieving sustainability. It discusses how positional influence of service leads, complexity of innovation, networks of support, embedding in existing systems, and proactive responses to changing circumstances can interact to sustain change. In the absence of cast-iron evidence of effectiveness, wider notions of value may be successfully invoked to sustain innovation. Sustainability requires continuing effort through time, rather than representing a final state to be achieved. Our study offers new insights into the process of sustainability of organizational change, and elucidates the complement of strategies needed to make bottom-up change last in challenging contexts replete with competing priorities

An Act to Provide for the Nomination of Candidates of Political Parties by Primary Elections

Subtitle: Adopted by the qualified voters of the State of Maine at a special election held on the eleventh day of September, A.D. 1911, and on the twenty-eighth day of September, A.D. 1911 proclaimed by the Governor and to take effect thirty days after said proclamation.https://digicom.bpl.lib.me.us/books_pubs/1157/thumbnail.jp

Voter Information Pamphlet for the June 8th Special Election on Legislative Referendum 111

Voter information pamphlet for the June 8th, 1993 special election on Legislative Referendum 111.https://scholarworks.umt.edu/montanaconstitution/1060/thumbnail.jp

Voter Information Pamphlet, 2002

Voter information pamphlet for the general election, November 5, 2002.https://scholarworks.umt.edu/montanaconstitution/1065/thumbnail.jp

Tennessee Secretary of State: The TN Quarterly Business and Economic Indicators, Second Quarter 2017

https://digitalcommons.memphis.edu/govpubs-tn-sos-economic-indicators/1021/thumbnail.jp

Voter Information Pamphlet, Your Guide to the 2012 General Election Ballot Issues

Voter information pamphlet for the general election, November 6, 2012.https://scholarworks.umt.edu/montanaconstitution/1070/thumbnail.jp

Mississippi Blue Book. Biennial report of the Secretary of State to the Legislature of Mississippi. [1933-1935]

https://egrove.olemiss.edu/sta_msblubk/1002/thumbnail.jp

2021 Facts & Figures

https://digitalcommons.memphis.edu/govpubs-tn-sos-facts-figures/1001/thumbnail.jp

Tennessee Secretary of State: The TN Quarterly Business and Economic Indicators, Second Quarter 2015

https://digitalcommons.memphis.edu/govpubs-tn-sos-economic-indicators/1029/thumbnail.jp

The TN Quarterly Business and Economic Indicators, Second Quarter 2023

https://digitalcommons.memphis.edu/govpubs-tn-sos-economic-indicators/1000/thumbnail.jp