Centre for Health Leadership & Enterprise

Service Innovation in Healthcare

Service Innovation in Healthcare: Multidisciplinary Teams and Service Innovation

Michael Barrett, Eivor Oborn, Sandra Dawson

Clinical teams are increasingly working to deliver services in novel ways involving multidisciplinary working. We are examining how knowledge and practice develop in multidisciplinary cancer teams, with a focus on the dynamic relationship between collaborative learning and effective teamwork and the role of IT in the process. Data was collected from multidisciplinary teams of surgeons, oncologists, radiologists, pathologists, nurses and managers. Research findings concern mechanisms of learning across disciplinary groups, influence of power and identity in the development of knowledge. An extension of this project, done in collaboration with colleagues at University of Hawaii is examining the implementation of electronic patient records in an MDT clinical setting.


Oborn, E., Barrett, M. and Davidson, E. (2010) "Building unity in diversity: electronic patient record use in multidisciplinary practice." Information Systems Research (forthcoming)

Oborn, E. and Dawson, S. (2011) "Learning across multiple communities of practice: an examination of multidisciplinary work." British Journal of Management (forthcoming)

Oborn, E. and Dawson, S. (2011) "Knowledge and practice in multidisciplinary teams: struggle, accommodation and privilege." Human Relations (forthcoming)

Barrett, M. and Oborn, E. (2010) "Challenges of using IT to support multi-disciplinary team decision making." In Nutt, P. and Wilson, D. (eds.): Blackwell handbook of decision making. Oxford: Blackwell, pp.403-430

Oborn, E. (2008) Processes of knowing in multidisciplinary team practice: a study of specialist cancer care in England. Saarbrucken: VDM Verlag Dr Muller Aktiengesellschaft.

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Service Innovation in Healthcare: Service Restructuring - Comparative Study of Canada and UK Stroke Care

Michael Barrett, Eivor Oborn

The rapid development and sharing of knowledge internationally is enabling new forms of healthcare delivery. However, the ability to manage the service restructuring process and facilitate knowledge diffusion is fraught with difficulty. We are examining the restructuring process associated with current stroke services, subsequent to the London Review recommendations and National Policy guidelines. Data collection points include SHA management team, clinical leaders of change (primarily stroke physicians), and stakeholder engagement events. Our goal is to advance knowledge in understanding how to enable organisational learning across healthcare pathways. In so doing, a key component of this project is to comparatively assess the UK and Canadian healthcare systems. Funded by the International Opportunity Fund, SSHRC in Canada, we are collaborating with colleagues at Queen's University (Canada) to examine institutional barriers to knowledge transfer in service restructuring.


Barrett, M., Oborn, E., Komporozos-Athanasiou, A. and Chan, Y. (2011) "Discourses in healthcare policy: comparing UK and Canada." In: Dickinson, H. and Manion, R. (eds.): In the reform of healthcare: shaping, adapting and resisting policy developments. Basingstoke: Palgrave MacMillan.

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Service Innovation in Healthcare: Digitally Enabled Service Innovation

Michael Barrett, Eivor Oborn

Robots and digital technology are increasingly pervasive in healthcare, and can fundamentally influence the way care is delivered and how clinicians work together. This point was reinforced by clinical colleagues in the department of surgery at Imperial College who were seeking to implement new techniques (e.g. minimally invasive surgery) subsequent to technology innovation. We are collaborating on a project concerned with the adoption and use of robot technology and the implications for workplace boundaries. This CMI-BT funded project was set up to look at the future of RFID tagging technology in the supply chain management of pharmaceuticals, with a particular focus on service delivery to patients as end consumers in hospitals. With collaborators from Sloan Management School, MIT this work draws on a sociomaterial perspective and boundary theory, to examine digitally enabled innovation and changes in work practice.


Barrett, M., Oborn, E., Orlikowski, W. and Yates, J. (2011) "Reconfiguring boundary relations: robotic innovations in pharmacy work." Organization Science (forthcoming)

Oborn, E., Barrett, M. and Darzi, A. (2011) "Robots and service innovation in healthcare". Journal of Health Service Research and Policy (forthcoming)

Oborn, E. and Barrett, M. (2008) "The adoption of dispensing technology: an occasion for restructuring hospital pharmacy work." International Journal of Pharmacy Practice, 16(2): 109-114 (DOI: 10.1211/ijpp.16.2.0008)

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Service Innovation in Healthcare: Regional Restructuring and Policy Process

Michael Barrett, Eivor Oborn

Working with Professor Lord Ara Darzi, we have been involved in studying the restructuring of services in the metropolitan region of London. Whilst examining the development of recent policy in 'A Framework for Action' we compare it to other regional strategies for London (Tomlinson report 1992, Turnberg 1998). Data collection points include members of parliament, senior civil servants, senior clinicians, management consultants, senior managers as well as archived documents. Our goal is to advance current thinking in policy entrepreneurship and healthcare strategy formulation.


Oborn, E., Barrett, M. and Exworthy, M. (2009) "Policy entrepreneurship in the development of public sector strategy." IRSPM, 6-8 April 2009, Copenhagen, Denmark

Darzi, A., Oborn, E. and Howitt, P. (2007) "Building healthcare strategy: cradle to grave." British Journal of Healthcare Management, 13(12): 468-472

Oborn, E. (2008) "Legitimacy of hospital reconfiguration: the controversial downsizing of Kidderminster Hospitals." Journal of Health Service Research and Policy, 13(2): 11-18

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Institutional Innovation in Health Care: Public-Private Hybrid Organisations in the Italian National Health Service (SSN, Sistema Sanitario Nazionale)

Giulia Cappellaro, Sandra Dawson, Paul Tracey

Recent trends in public health sector reform have promoted mechanisms for bridging and blending different, often competing, ideologies or logics at the organisational level. The proclaimed rationale behind these strategies includes knowledge generation, access to resources and interdependencies, and improved performance. However, comparatively less attention has been devoted to how populations of public private hybrid organisations emerge in a national health care system and how the public private coexistence is interpreted within organisational boundaries.

We are examining the process of institutional creation of pluralistic organisational forms in health care, with specific reference to public-private organisations for the delivery of core health services in the Italian National Health Service. The programme entails three research streams: (i) a population ecology analysis of the emergence of the organisational form at national level; (ii) a multilevel study on the evolution of the organisational form at the regional level; (iii) an organisational ethnography to examine how the public-private coexistence is "inhabited" in the actions, interactions and interpretations of organisational individual members. The first stream is conducted in collaboration with the Centre for Research on Health and Social Care Management (CERGAS) at Bocconi University and sponsored by the Italian Ministry for Health.

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