Understanding whole systems change in health care: insights into system level diffusion from nursing service delivery innovations – a multiple case study

2014 ◽  
Vol 10 (3) ◽  
pp. 313-336 ◽  
Author(s):  
Whitney Berta ◽  
Tazim Virani ◽  
Irmajean Bajnok ◽  
Nancy Edwards ◽  
Margo Rowan
2018 ◽  
Vol 18 (1) ◽  
Author(s):  
Elisabeth Holen-Rabbersvik ◽  
Tom Roar Eikebrokk ◽  
Rune Werner Fensli ◽  
Elin Thygesen ◽  
Åshild Slettebø

2020 ◽  
Vol 73 (4) ◽  
Author(s):  
Deborah Correia Duarte ◽  
Selma Maria da Fonseca Viegas ◽  
Fernanda Moura Lanza ◽  
Valéria Conceição de Oliveira

ABSTRACT Objectives: to understand vaccination as a scheduled demand and access to this demand in a day in the life of health services, from the perspective of users. Methods: holistic-qualitative multiple case study, based on the Quotidian Comprehensive Sociology, with 74 users from four health microregions of the Extended Western Region of Minas Gerais State. Results: scheduling vaccination demand in a day in the life of services is compromised by the fragility in data record, by computerized systems underutilization and by the loss of the immunization tracking card, resulting in missed opportunities of immunization and unnecessary revaccinations. The Primary Health Care team’s non-involvement also compromised access to this action. Final Considerations: there is a need for more effort to be dispensed with for the effective use of computerized systems and Permanent Education of professionals in order to take advantage of all the opportunities of orientations and referrals of users to the vaccination room.


2020 ◽  
Author(s):  
◽  
Evgeniya Lupova

This research develops insight into the functioning of self-aware and organised clusters seeing these as ‘context-embedded meta-organisations’. Specifically, it builds a theoretical framework for strategy-making in organised clusters, elaborates on their ‘agentic’ nature and ability to shape their environments. Contrary to a more ‘traditional’, determinist, approach in cluster studies, viewing clusters solely as ‘geographic concentrations’ of organisations, the perspective adopted in this research conceptualises clusters as ‘organisations of organisations’. This suggests a more voluntarist stance where self-aware and organised clusters are perceived as intentional actors within their environments implementing deliberate strategies and pursuing system-level goals. This perspective is rather novel in cluster studies and opens up interesting research directions. This thesis explores two major implications of the ‘meta-organisational’ view of clusters: (1) the deliberate nature of collective strategy-making in these and (2) clusters’ ‘actorhood’ and their interactions with their contexts. First, seeing clusters as ‘organisations of organisations’, suggests that these can be deliberately managed and calls for the application of management studies to the cluster context. However, to date, most strategy tools and frameworks have been developed with an individual firm in mind. As a consequence, these cannot reflect the complexity of the ‘meta-organisational’ setting where a number of interests are at play, and strategy-making is a collective exercise. Thus, the ‘meta-organisational’ perspective on clusters calls for the adaptation of the extant strategy frameworks to account for the specifics of the setting. To answer the need for strategy tools and approaches adapted to the context of clusters seen as meta-organisations, this thesis proposes a novel framework of the ‘cluster business model’. This topic is addressed in Article 1 adopting a design science approach to develop a practical tool for strategy- and decision-making in clusters. The article proposes a model describing value creation in the cluster context, develops a method for its application in practice as well as a visual representation of both. Moreover, as clusters are increasingly seen as drivers of innovations and mechanisms for a transition towards the knowledge economy, this thesis develops a set of interventions for cluster business model design fostering the innovativeness of its members. Article 2 addresses this topic and applies a mixed methodology combining a systematic literature review with a design-oriented synthesis. This allows to uncover the generative mechanisms of cluster innovativeness and formulate a set of interventions aimed at shaping cluster business model elements with a view to fostering its innovativeness. Second, the meta-organisational perspective on clusters raises important questions about their intentionality and ‘actorhood’. Indeed, seeing clusters as ‘organisations of organisations’ implies that these can deliberately act, just as individual organisations. This view, again, has not yet been explored in the cluster studies, still dominated by the ‘traditional’, determinist, approach. Recent research in the field of organisation studies suggests that organisations may display different levels of ‘organisationality’ depending on the extent to which the attributes of formal organisations are present. Applying this knowledge to clusters allows uncovering the yet unexplored mechanisms of cluster ‘actorhood’ and its limitations. Article 3 explores this topic and applies a theory-elaborating multiple case study method to gather insight into the clusters’ ability to shape their environments mediated by their level of ‘organisationality’. The article develops a set of theoretical propositions based on the case studies of two clusters in Australia. It suggests that clusters can deliberately ‘construct’ themselves both as organisations and social actors. However, their ‘organisationality’ design choices influence the locus of their actorhood resulting in more or less collaborative approaches to social action. Finally, and related to the previous point, viewing clusters as intentional actors capable of interaction with their environments, suggests that these can adopt deliberate strategies in response to external pressures. Going further, clusters can be seen as change agents or institutional entrepreneurs in unsupportive institutional settings. Article 4 explores this topic and adopts a theory-elaborating embedded multiple case study method. It studies two clusters in the context of a transition economy (Russia) presenting a range of institutional barriers to innovation. The article uncovers the dual role of clusters as institutional entrepreneurs. It suggests that clusters may both act collectively due to their powerful position grouping a number of players, and, at the same time, these can contribute to creating enabling conditions for the individual acts of institutional entrepreneurship. While this thesis offers a range of implications for research and practice in the cluster field, its most broad and significant contribution lies in the further development of the novel ‘meta-organisational’ perspective on self-aware and organised clusters. This research thus contributes to the consolidation of the ‘meta-organisational’ perspective and coins new language for addressing the topic of ‘managed’ or ‘organised’ clusters. This perspective has not yet drawn wide attention in cluster research and practice but can be valuable for empowering clusters and giving them practical tools to exercise their collective power and shape their environments. In a way, this ‘meta-organisational’ view of clusters might become ‘self-fulfilling’ by contributing to shaping the perception of clusters as deliberate and organised actors, triggering a reflection of cluster practitioners and providing them with adapted conceptual frameworks and practical tools


2019 ◽  
Vol 33 (2) ◽  
pp. 169-176 ◽  
Author(s):  
Isabel Goicolea ◽  
Bruno Marchal ◽  
Anna-Karin Hurtig ◽  
Carmen Vives-Cases ◽  
Erica Briones-Vozmediano ◽  
...  

Health Policy ◽  
2019 ◽  
Vol 123 (8) ◽  
pp. 728-736 ◽  
Author(s):  
Sheena McHugh ◽  
E. Droog ◽  
Conor Foley ◽  
M. Boyce ◽  
O. Healy ◽  
...  

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