Presenters: Susan Halford, Kate Lyle and Rebecca Taylor
The particular challenges facing the healthcare system in England and Wales are well known. Widening health inequalities and comparatively poor health outcomes compared with other Western nations combined with an ageing population, living with complex long-term conditions in a context of severe financial constraint demands a fundamental re-think of the organization and delivery of care (Health Select Committee 2009; Hawkes 2013; ref on need for change). Whilst successive governments have pursued various top-down structural approaches to improving the healthcare and financial performance of the NHS, it is increasingly recognised both in research on organizational change and by government itself that creative solutions to the intransigent problems facing the NHS in England and Wales may lie in the ‘shop-floor’ expertise and practice of its employees, whose knowledge of both patients and organizations might generate ‘employee driven innovation’. This paper explores the tensions between the drive for centralised control and standardisation in the organization and management of the NHS and the possibilities for localised innovation in the delivery of services. Drawing on three ongoing ethnographic case-studies from across acute and primary care, we argue that innovation emerges as practice of ‘bricolage’ whereby clinicians mobilise piecemeal networks from NHS resources, social capital and personal resources to achieve remarkable and transformative outcomes. Nonetheless, it is notable that these innovations have been achieved in the margins of the healthcare system, either in addition to the ‘day job’ or outside the immediate structures of the NHS (for example, thorough social care and/or the third sector). In the concluding section of our paper we consider the implications of these findings in the face of the challenges facing the NHS.
Rebecca Taylor is a Lecturer in Sociology in the department of Sociology, Social Policy and Criminology at the University of Southampton. Prior to this she was a Research Fellow at the Third Sector Research Centre (TSRC) at the University of Birmingham and before that at the Policy Studies Institute in London. Her research interests are in conceptualising work, particularly unpaid forms of work, understanding individuals’ working lives and careers and work in different organisations and sectors. Rebecca has conducted extensive policy- focused research in the areas of older workers, employment services and programmes, and the third sector and its relationship with the market and the state. She has published widely in journals such as Work, Employment and Society, and Policy and Politics and edited the Sociological Review monograph A New Sociology of Work?
Susan Halford is Professor of Sociology and a Director of the Web Science Institute, both at the University of Southampton. A geographer by training and organizational sociologist for many years, her research has focussed on questions of organizational change and the dynamics of power, knowledge and expertise that are involved in this. In recent years she has focussed on digital innovation, not least in the workplace, and has worked on a series of projects around digital organization transformation in healthcare.
Kate Lyle is Research Fellow in the department of Sociology, Social Policy & Criminology at the University of Southampton. She is currently working on the LLAKES project titled Work Organisation, Lifelong Learning and Employee-Driven Innovation in the Health Sector, exploring how employee driven innovation can develop and flourish in the healthcare sector. Prior to this Kate completed PhD at the University of Southampton, focusing on the role on interdisciplinary collaboration in developing healthcare technologies that are appropriate to and workable within specific user settings.