Transitions and Boundaries in the Coordination and Reform of Health Services: Building Knowledge, Strategy and Leadership

Preface: Studying Coordination, Specialisation and Complexity in Health Systems
Introduction
Contents
Editors and Contributors
List of Figures
List of Tables
Part I Coordinating Care Across Organisational and Sectoral Boundaries
1 Implementing the New Care Models in the NHS: Reconfiguring the Multilevel Nature of Context to Make It Happen
	List of Abbreviations
	Introduction
	Implementation, Context, and Change: Towards a Multilevel Contextual Analysis
	Understanding the Implications of New Care Models
	New Care Models in Practice
		Negotiating Uncertainty Around Policy and Government Targets
		Legitimating Return on Investment and Measuring Performance
		Managing Different Structures and Governance Arrangements Across Care Settings
		Reconfiguring Inter-organisational Relations and Practices
		Building Capacity and Resources
		Securing Commitment and Engagement
	Implications of the Enactment of New Care Models
	Appendix A—Vanguard Sites
	References
2 Coordinating Compassionate Care Across Nursing Teams: The Implementation Journey of a Planned Intervention
	Introduction
	Gauging Perspectives on a Planned Intervention
	Enacting the Planned Intervention
		Coherence: CLECC as a Limited Set of Concrete Practices Versus as an Underpinning Philosophy
		Cognitive Participation: Staff Keen to Participate but Not Sure Who Should Drive It Forward
		Collective Action: Participation Shaped by Organizational Context
		Reflexive Monitoring: Valued by Staff but Challenging to Sustain
	Implications for Compassionate Care of Planned Intervention
	Conclusion
	References
3 Driving Change Across Boundaries: Eliminating Crusted Scabies in Northern Territory, Australia
	Introduction
		The One Disease Crusted Scabies Elimination Programme
	Cross-Boundary Working in the Elimination of Crusted Scabies
	Understanding Change Across Boundaries
	Collaborative Efforts for Cross-Boundary Change
		Contested Boundaries
		Ways of Working Across Boundaries
	Sustaining Change Across Boundaries
	Conclusions
	References
4 Bridging the Safety Net: A Case Study of How the MAP Clinics Use Collaboration to Meet the Needs of Vulnerable Patients
	Introduction
	The Map Clinic Case Study
		Description of the MAP Clinics
		A Partnership Model
	Understanding Clinics’ Efforts to Support Vulnerable Patients
		Case Study Research
		Sampling Methods
		Data Collection
		Data Analysis
	Factors Shaping the Collaborative Potential of Academic-Practice Partnerships
		Engagement
		Collaboration
		Ongoing Challenges
	Collaborative Structures and Processes to Support Vulnerable Patients
	Conclusion
	References
Part II Reaching Across Ideological, Learning and Practice Boundaries
5 Making Sense of System Boundaries: Critical Realism and Healthcare Policy Design
	Introduction
	Systems in Health Care
		Systems in Policy-Making: Policy Advisory Systems
		Making Sense of Systems: Critical Realism
		The Core of a French Policy Advisory System: The Welfare Elite
		Collecting Empirical Clues on a Closed Policy Advisory System
		Hypothesizing a Generative Mechanism: Boundary Control
	The Emergence of a Mechanism: Causal Powers of Structures and Agents
		Politicization and Externalization of Policy Advice
		France’s Knowledge Regime and Politico-administrative System
		Fragmentation as a Key Factor
		Critical Realism in Practice: Consequences of Boundary Control
	Understanding Complex Systems: A Critical Realist Point of View
	References
6 Governmentality as a Relevant Idea for the Study of Healthcare Networks: A Scoping Review
	Introduction
		Background
	Accessing and Assessing Research Related to Governmentality
		Identifying the Research Question
		Identifying Relevant Studies
		Study Selection
		Charting the Data
	Scopes, Definitions, Use, and Concepts of Governmentality
		Study Characteristics
		Countries
		Definitions of Governmentality
		Use of Governmentality
		Key Concepts of Governmentality
	Past and Future Contributions of Governmentality to Healthcare Networks
		Limitations
	Conclusion
	Appendix
	References
7 Public Health Policy to Tackle Social Health Inequalities: A Balancing Act Between Competing Institutional Logics
	Introduction
	Logics in Governance of Public Health
		The Individualist Logic
		The Collectivist Logic
		Understanding the Logics of Public Health
	National Public Health Agendas from 2003 to 2017
		Interweaving Logics of Public Health
	References
8 Beyond Hybridity in Organized Professionalism: A Case Study of Medical Curriculum Change
	Introduction
	Professionalism, Managerialism and Hybridization
	Understanding Hybridity in Medical Curricula
	Influences on Clinician-Managerial Identity
		Social and Organizational Influences on Professional Identity
		Individual Influences
	Implication—Beyond Hybridity—Of Organized Professionalism
		Social/Professional Conditions
		Organizational Conditions
		Individual/Relational Conditions
		Material/Epistemic Conditions
	References
Part III Leadership as Boundary-Spanning Between Strategy, Identity, Knowledge and Change
9 Scoping the Contribution of Middle Managers to the Strategic Change Process in Healthcare Organizations
	Introduction
	Objectives
	Understanding How Middle Managers Contribute to Strategic Change Processes
		Search Strategy
		Parameters of Search
			Inclusion and Exclusion Criteria
		Screening for “Mid-level Managers”
		Outcome of Search
			Data Charting
	The Engagement of Middle Managers in Strategic Change Processes
		Study Characteristics
		Defining the Population
		Thematic Analysis
		What are the Critical Activities that MM Engage in Throughout the Strategic Change Process?
			Downward Communication
			Upward Communication
		What are MM’s Needed Skills and Capabilities to Influence the Strategic Change Process in Healthcare Organizations?
			Skill-Building Capacity
		What are the Contextual Barriers and Facilitators related to MM and Strategic Change?
			Empowerment
	Current and Future Contributions of Middle Managers to Strategic Change Processes
		Limitations
	Conclusion
	Appendix A: PRISMA Flow Chart
	Appendix B: Table . Study Characteristics
	References
10 Tempered Tenacity: The Leadership Required to Work Across Boundaries
	The Health Context: The Need for Leading Across Boundaries
		The Context for This Research
	Literature on Leadership and Boundaries
		Machine Thinking Versus Complexity Thinking: Implications for Leadership
		Acting: The Power of Small Gestures
	Examining Leadership in Organizational Contexts
	The Boundary Work of Leaders
		Mental Models of Organizations and Leading
		Behavioural Gestures and Moves
		Moments of Judgement
	Conceptualizing Tempered Tenacity
	Conclusion and Critique
	References
11 The Chain of Codified Knowledge: Organisational Enactment of Evidence-Based Health Care in Four High-Income Countries
	Introduction
	Evolution of Evidence-Based Health Care
		Expansion of the Notion of “Evidence”
		Institutionalisation of Evidence-Based Practice
		Spread of Evidence-Based Practice Across Disciplines and Countries
	Gaps in Our Understanding of Knowledge and Evidence
	The Credibility of Knowledge as Evidence
		Forms of Codified Knowledge Seen as Credible Evidence
		The Impact of Codified Knowledge on Evidence-Based Nursing
		Variability in the Circulation of Codified Knowledge Across the Four Countries
	Evidence-by-Proxy in the Chain of Codified Knowledge
		Professional Stratification and Detachment of Rank-and-File Nurses from Clinical Guidelines
		The Influence of Macro-Level Context on the Chain of Codified Knowledge
	Conclusion
	References
Part IV Enacting Boundary Capabilities
12 A Qualitative Exploration of Sustainability Processes for Improvement: The Role of Structured Sustainability Tools
	Introduction
		Prospective Exploration of Sustainability
		Influencing Sustainability with a Structured Tool
	Understanding Efforts Towards Sustainable Quality Improvement
	Context and Cases
	Sustainable Improvement Through the Long Term Success Tool
		Processes and Mechanisms to Sustain Improvement
	The Role of Structured Tools for Sustainable Improvement
	Conclusion
	References
13 The Means Not the End: Stakeholder Views of Toolkits Developed from Healthcare Research
	Introduction
		Knowledge Mobilisation
		Toolkits
		Boundary Objects
		Understanding Stakeholder Perspective on Toolkits
	Structures and Processes of Knowledge Mobilisation in Health Care
		Participants
			Process
	Toolkits as Boundary Objects
		Toolkits at the Boundary Between Researcher and Practitioner
		Toolkits at the Boundary Between Researcher and Research Subject
		Toolkits at the Boundary Between Researcher and Funder
		Implications
	Conclusion
	References
14 Building Transformative Capacities by Expanding the Academic Mission Across the Care Continuum: A Realist Evaluation
	Introduction
		Theoretical Framework
	Realistic Evaluation of Institutional Work Across the Care Continuum
		Setting
			Design
			Data Collection and Analysis
			Realist Evaluation Research Process
	Processes and Products that Expand the Academic Mission of Academic Health Centres
		CIMO Configurations
			CIMO 1: Betting on Restructuring; Unleashing Power Relations
			CIMO 2: Navigating Distributed Governance and Structural Ambiguity
			CIMO 3: Capitalizing on Relationships to Accelerate Change
			CIMO 4: Managing the Tension Between Perceived Value and Operational Capacity
			CIMO 5: Crossing Boundaries: Reconciling the Good and the Messy
			CIMO 6: From Inertia to Improvement: Starting with Relationships
	Transformative Capacities of Academic Health Centres
		Structural Work
		Operational Work
		Conceptual Work
		Relational Work
	Conclusion
	Appendix A: Detailed CIMO Configurations
	References
15 Developing Pragmatic Boundary Capabilities: A Micro-Level Study of Boundary Objects in Quality Improvement
	Conceptualising Knowledge and Boundaries for Quality Improvement
		Boundary Objects for Pragmatic Work
	Understanding Boundary Capabilities for Quality Improvement
		Cases and Context
	The Role of Boundary Objects in Quality Improvement Interventions
		Tool 1—Action Effect Method: Developing a Shared Aim and Outlining a Programme Theory
		Tool 2—The Long Term Success Tool: Developing a Shared Understanding to Plan for Sustainability of Improvement Initiatives
		Supporting Pragmatic Boundary Practices: The Nature of Object Co-creation
		Resistance to and Adaptation of Boundary Objects for Pragmatic Work
	The Systemic Contribution of Micro-Level Interactions to Boundary Capabilities
		Limitations
	Conclusion
	References
Conclusion: Learning Health Systems: Complexity, Coordination & Integration
Index