Beyond evidence: the micropolitics of improvement

Abstract

This paper aims to draw attention to the social and micropolitical dimensions of attempting to implement improvements within healthcare organisations. It is argued that quality improvement initiatives, like other forms of organisational innovation, will fail unless they are conceived and implemented in such a way as to take into account the pattern of interests, values and power relationships that surround them. Drawing on examples, it is suggested that innovators can intervene more successfully if they understand how the benefits and costs of interventions are likely to be distributed among stakeholders within their setting, how different but equally legitimate value sets may structure peoples' understanding of them and how the nature of the interventions themselves (and, in particular, the shape of their hard core and soft periphery) might provide scope for redesigning or adapting interventions in ways that are likely to make them both more effective and politically feasible.

Comparing views about evidence in Ontario public health units: a qualitative descriptive study

“…The analysis revealed similarities and differences with respect to: 1) meanings of evidence; 2) types of evidence guiding practice; 3) process for applying evidence; 4) facilitators of evidence use; and 5) barriers to implementing evidence. The overall finding that there are differences in how public health frontline staff and their managers view, practice and apply evidence support the claim that individuals from different educational backgrounds and/or disciplines, belonging to different value systems, and performing a different set of professional roles tend to perceive evidence differently (Langley and Denis, 2011).…”

“…Ways of perceiving evidence by different health care managers, practitioners, and decision makers is reported to be one of the key factors influencing the process of evidence uptake (Kyratsis et al, 2014). Given that professional groups come from a diverse range of educational backgrounds, belong to a variety of different value systems, and perform a set of specific professional roles, their ways of perceiving evidence are likely to be distinct (Langley and Denis, 2011). However, empirical evidence on how different health care managers, practitioners, and decision makers make sense of evidence is sparse, especially in the context of Ontario's public health system and since the implementation of the OPHS.…”

“…This includes factors related to aspects of: (i) the individuals involved in decision making (Armstrong et al, 2014;Ellen et al, 2014;Grol and Grimshaw, 2003;Huckel Schneider et al, 2014;LaRocca et al, 2012;Orton et al, 2011;Rosella et al, 2013;Zardo and Collie, 2014); (ii) the organization/agency within which decisions are made (Armstrong et al, 2014;Bhattacharyya et al, 2009;Ellen et al, 2013;LaRocca et al, 2012;Laws et al, 2013;Rosella et al, 2013). ; (iii) the research being considered for uptake (Francis et al, 2015;Glasgow and Emmons, 2007;Langley and Denis, 2011;Laws et al, 2013;Wathen et al, 2011;Zardo and Collie, 2014); (iv) the social networks and relationships with relevant stakeholders (Armstrong et al, 2014;Ellen et al, 2013;Ellen et al, 2014;Francis et al, 2015;Huckel Schneider et al, 2014;Wathen et al, 2011); (v) the economic climate (Bhattacharyya et al, 2009;Ellen et al, 2014;Francis et al, 2015;LaRocca et al, 2012;Laws et al, 2013); and (vi) the political environment related to a given public health issue (Armstrong et al, 2014;Grol and Grimshaw, 2003;Huckel Schneider et al, 2014;Laws et al, 2013). Thus, evidence use is a multilevel, complex process that includes some determinants that are amenable to change (e.g., attitudes, skills, infrastructure) and other determinants that are unlikely to change ...…”

Innovation and sustainability in a large-scale healthcare improvement collaborative - seven propositions for achieving system-wide innovation and sustainability

“…This table attempts to characterise the system requirements, structure and underlying processes of large-scale improvement and change collaborative (Langley and Denis, 2011;De Silva, 2014a) and the features of high-performing health systems. The Baker and Denis' (2011a) thematic table was used to gauge the impact, influence, challenges and sustainability needs of the large-scale collaborative in Leeds (LIQH), and lessons drawn from this to inform the development of such collaborative.…”

Evaluating the implementation and sustainability of an evidence-based intervention: delivering Triple P within Indigenous child welfare agencies

“…However, organizations are not closed systems. They operate within a system influenced by the external environment (Langley & Denis, 2011). Further large scale work is warranted to explore systems of care (e.g.…”