1. 1 ‘Understanding Organisational Change in Health Care: Reconceptualising the Active Role of Context’ Sue Dopson KU05 Melbourne

2. 2 Role of Context in Organisational Change Long debate in generic and health care specific organisational literatures Often a static view of context Needs to be reconceptualised in a more active and interactive direction Draws on large UK based qualitative data set (case studies of the enactment of evidence based health care – Dopson and Fitzgerald, 2005)

3. 3 Context and Organisational Studies Literature Contingency theory and its critics Organisational configurations and institutionalism Social constructionism More interactive views (Giddens; Pettigrew) Pettigrew et al 1992 – receptive contexts for change in health care organisations

4. 4 A Misleading Layered View of Context NHS Policy Agencies Intermediate Tier eg Regions The Hospital Hospital Team Individual Clinicians

5. 5 5 Key Findings i)multi-faceted and extended aspects of ‘context’ ii)professional roles, relations and boundaries: ‘macro structure’ iii)variation in local history, the quality of prior inter-professional roles and ‘absorptive capacity’ influence of past contexts and current configuration or organisational components

6. 6 “What makes me change – it’s not scientific, but when I know what my peers are doing. We meet, we talk, we look at publications.”

7. 7 “Surgical decisions are almost exclusively surgeons – usually consultant-centred. That is to say a professional colleague from a non-surgical area would only have limited decision-making powers – usually only where the two decisions overlap.” (Consultant)

8. 8 Key Findings iv)action – the availability and engagement of local, credible and skilled opinion leaders v)Using aspects of context – linking structure and action – under conditions of excessive bombardment

9. 9 “Doctors’ own views of their clinical world…are shaped by a strong sense of their own autonomy to develop practice in accordance with their experiences, in which they include encounters with literature, research, opinion-formers and seniors, but none of these is seen as dominant over – or in a sense separate from their experience.”

10. 10 ‘ There wasn’t strong evidence but it didn’t matter, the perception of need was important’ (Project PACE Health Promotion Advisor)

11. 11 Conclusion and Contribution Building a more sophisticated notion of ‘context’ in organisational change in health care Overall configuration of forces Macro and micro, structure and action Strong local path dependence Cognitive enactment of ‘integrated contexts’ Context not just a backcloth to action, but an interacting element in the diffusion process

12. 12 Ultimately, the behaviour of the stakeholders and the features e.g. context are interlocked. The combination of multilayered, two-way influences and multiple stakeholders with interpretative schemes and innovation-seeking ? by individuals and groups and differing absorptive capacity in organisation, produces a situation in which context is an actor.

13. 13 Reference Dopson, S. and Fitzgerald, L. (2005) ‘Knowledge to Action?’ Oxford: Oxford University Press