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Innovation as emergence in healthcare: Unpacking change from within

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  • Essén, Anna
  • Lindblad, Staffan

Abstract

The contemporary healthcare literature suffers from a disproportionate focus on ‘given’ externally created innovations, and belief in ordered, planned and well-funded implementation processes. As an alternative, the present paper highlights the potential of emergent change processes, using the continuous invention and re-invention of the Rheumatology Quality Registry in Sweden as an example. This 19 year long process, which is still ongoing, does not exhibit the sequential steps that are allegedly determinants of success in the innovation and implementation literature. Yet, it has produced system-wide improvements. We draw on more than 100 informal and formal meetings with practitioners involved in the process studied, observations, documentation analysis and quantitative registry-data. A total of 67 interviews with registry-users and external stakeholders were also performed. The dissipative structures model (complexity theory) was used to analyze the data. The studied process illustrates an ongoing, practice-driven improvement process, which was sparked by abstract and indirect energies that interacted with more concrete innovations such as new drugs. For example, participants tapped new information technologies, changing perspectives and governmental priorities to challenge current ways of working and introduce new ideas. Ideas were realized and spread through various self-organized processes that involved the re-arrangement of existing resources rather than acquisition of new resources. Taken together, these processes brought Swedish rheumatology to new levels of functioning 1992–2011.

Suggested Citation

  • Essén, Anna & Lindblad, Staffan, 2013. "Innovation as emergence in healthcare: Unpacking change from within," Social Science & Medicine, Elsevier, vol. 93(C), pages 203-211.
  • Handle: RePEc:eee:socmed:v:93:y:2013:i:c:p:203-211
    DOI: 10.1016/j.socscimed.2012.08.035
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    References listed on IDEAS

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    1. Henry Mintzberg & James A. Waters, 1985. "Of strategies, deliberate and emergent," Strategic Management Journal, Wiley Blackwell, vol. 6(3), pages 257-272, July.
    2. Wanda J. Orlikowski, 1996. "Improvising Organizational Transformation Over Time: A Situated Change Perspective," Information Systems Research, INFORMS, vol. 7(1), pages 63-92, March.
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    Cited by:

    1. Gillner, Sandra, 2024. "We're implementing AI now, so why not ask us what to do? – How AI providers perceive and navigate the spread of diagnostic AI in complex healthcare systems," Social Science & Medicine, Elsevier, vol. 340(C).
    2. Sarkar, Soumodip & Mateus, Sara, 2022. "Doing more with less - How frugal innovations can contribute to improving healthcare systems," Social Science & Medicine, Elsevier, vol. 306(C).
    3. Janssen, M. & Stoopendaal, A.M.V. & Putters, K., 2015. "Situated novelty: Introducing a process perspective on the study of innovation," Research Policy, Elsevier, vol. 44(10), pages 1974-1984.
    4. Essén, Anna & Oborn, Eivor, 2017. "The performativity of numbers in illness management: The case of Swedish Rheumatology," Social Science & Medicine, Elsevier, vol. 184(C), pages 134-143.
    5. Puertas, Rosa & Marti, Luisa & Guaita-Martinez, José M., 2020. "Innovation, lifestyle, policy and socioeconomic factors: An analysis of European quality of life," Technological Forecasting and Social Change, Elsevier, vol. 160(C).
    6. Thune, Taran & Mina, Andrea, 2016. "Hospitals as innovators in the health-care system: A literature review and research agenda," Research Policy, Elsevier, vol. 45(8), pages 1545-1557.
    7. Sara A. Kreindler, 2019. "The stipulation‐stimulation spiral: A model of system change," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(4), pages 1464-1477, October.

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