Monday, October 27, 2014

The Role of Health Care Professionals in Health Service Innovation

On Friday 24th October 2014 we held a Public Management and Governance Special Interest Group workshop on the Role of Health Care Professionals in Health Service Innovation at the British Academy of Management (BAM) office in London. The workshop was funded by BAM Researcher Development Grant as part of our research project on CCGs and telehealth. Panel discussions with eminent experts in the field triggered engaging and productive discussions among all participants. As we know health care professionals are faced with challenges in the innovation of the health service  to increase efficiencies and improve patients’ outcomes. Their valuable set of skills and pool of knowledge can contribute towards workable solutions in health service innovation. Yet, health care professionals are very busy people, overstretched with resources. They require will, effort, breaking cultural barriers and changing routines to implement and make health service innovations work effectively. The workshop offered the opportunity to learn about recent advancements in professional studies of health service innovation and share and discuss research experience and ideas on how to advance research agenda in the field. The workshop discussions focused on three main themes: the implications of IT-enabled integrated care for inter- and intra-professional collaboration; how knowledge sharing across professional boundaries within and outside the health sector (e.g. universities) can contribute to health service innovation; the role of professional power and identities in health service innovation. Many ideas were discussed in the workshop and this post just summarizes a few.

Starting with integration, one theme that emerged in the discussion is that of a socio-collaborative approach to integration where integration is seen as a socio-technical infrastructure with any one working on it knowing not only their bit but also how the whole integrated system works. The cost-driver of integration does not seem to bring any good to the cause. Driving integration with a focus on patients' needs can be more effective. A debatable issue was that of the role of professional integration vs. organizational integration. In other words, are barriers to health care integration mainly organizational (e.g. competition among health care professionals, fragmented patients pathways)? Or is poor inter-professional collaboration due to strong boundaries between health care professionals one of the major challenges to health care integration?

Moving to knowledge sharing across professional boundaries, the discussion opened with a focus on the collaboration between academia and health care organisations in co-producing innovation and research sponsored by such programs as the National Institute of Health Research (NIHR) Knowledge Mobilization Research Fellowship Scheme and Collaboration for Leadership in Applied Health Research and Care (CLAHRC). It came out that misaligned incentive schemes and interests between professionals and academics constitute one of the major barriers to their collaboration. While a Clinical Commissioning Group (CCG) may be interested in collaborating with a researcher for the evaluation of a telehealth project, researchers may question whether the type of data collected in an evaluation can be worth good academic publications. Difficulties in collaboration also exist between clinical and social researchers, the former more interested in the effectiveness of an innovation and less interested than social researchers in the social and normative dimension of an innovation. Brokers with multiple background of experience emerged to play a significant role in  bridging healthcare with academic communities. In this respect, the broker does not necessarily need to be a senior person. Fundamental is the role of interconnected brokers that engage in boundary work by communicating with other brokers in other teams. There were mixed opinions about whether more collaboration and knowledge sharing opportunities could lead to increased innovation. Co-production models can work, they produce innovation but at a very low pace. By contrast, Multidisciplinary Teams (MDTs) have not always proven very effective in terms of knowledge sharing and innovation. These teams may take the form of institutional rational myths because of the use that one group would do to direct and plan other members action. These considerations have led to question the role of organizations and institutions in limiting boundary work and co-production of innovation across professions. Taking the example of the UK, most innovation and change management programs in the NHS are driven by the top-management. Very little is done at the top, whereas professionals are not empowered and entrusted to do more. This top-down approach stifles innovation from the grassroots  and bars clinical ownership. 

Finally, talking about professional power and identities in relation to health service innovation, we discussed new collaborative and hybrid forms of professionalism matching clinical and managerial roles. Public reporting of performance has gained the legitimacy among health care professionals as ways of proving their clinical excellence to their peers and secure public trust without losing their autonomy. One question is whether these mechanisms of professional accountability can work as a catalyst of innovation or, by contrast, may have the opposite effect of stifling innovation. For example, excessive reporting may have the downside effect of diverting time away from creativity. Linked to this, it is worth questioning whether and how new hybrid forms of professionalism can be conducive of innovation in the health sector. This is particularly important in relation to those episodes where health care professionals can challenge innovation if they feel it can threaten their identity. Can clinical managers overcome these resistances? The importance of health care professional identities is even stronger in those circumstances where the implementation of one innovation does not lead to variation but uniformity across multiple sites, such as diverse hospitals. Not everyone in the health sector views innovation as a threat to their professional identity and social status. There are also instances where innovation can be perceived as a source of empowerment. IT systems like EPRs (Electronic Patients Records) can enlarge the role of nurses, for example, by giving them more clinical tasks and responsibilities. IT-enabled changes in professional practice relate to the extent to which an IT innovation fits in the professional culture of a specific category  of staff.