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The role of governance mechanisms on the diffusion of innovation in healthcare networks

Okeke, Udonna


Udonna Okeke


This research investigated innovation diffusion in healthcare networks, focusing on the roles of contractual and relational governance mechanisms. The National Health Service (NHS) England is faced with many challenges, including an ageing population, austerity measures, changes in public expectations in terms of quality of healthcare delivery, advances in technology and medicines, and pressure to do more with less resources (Lacobucci, 2017; Wollaston, 2017). Several studies and practitioner reports identify innovation within healthcare networks as a means of dealing with the current challenges in NHS England (see Nicholson, 2011; Ham and Murray, 2015; Parris et al., 2016). Consequently, innovation is now at the heart of the healthcare agenda, with much of the rhetoric focused on the ability of NHS England to diffuse and adopt innovations (Barnett et al., 2011).
Increasingly, studies are highlighting the linkages between innovation diffusion and governance, with many commentators suggesting that governance has an influence on innovation diffusion (Hartley, 2005; Savedoff, 2009; Mikkelsen-Lopez et al. 2011 Barbazza and Tello, 2014). Focusing on healthcare networks, researchers have stressed that governance is a function of mechanisms or processes which are formally and informally used to distribute responsibilities among actors (Kaufmann et al., 1999; WHO, 2007; Siddiqi et al., 2009). Governance affects the organisational environment in which innovation diffusion decisions are made and is typically believed to be represented by contractual and relational rules of exchange between the actors (Vandaele et al., 2007). Existing investigations have recognised that contractual and relational mechanisms play a significant role in networks (Cannon et al., 2000; Poppo and Zenger, 2002; Yang et al., 2012; Cao and Lumineau, 2015), but the nature of such roles and their interplay has not been established in relation to the diffusion of innovation in healthcare networks, particularly where a bottom-up, rather than top-down, approach to innovation has been employed. The bottom-up process of innovation diffusion highlights the key steps taken during diffusion process, whereby opportunities are created for individuals at the low and mid-level of an organisation to own the innovation, share ideas, and take decisions that enhance the diffusion process (Parnaby and Towil, 2008). This is in contrast to top-down diffusion processes, which are characterised by senior management staff developing innovation diffusion pathways that are expected to be embraced by frontline staff.
Building on a review of relevant literature that included innovation diffusion, networks, governance, and contractual and relational governance mechanisms, an initial conceptual framework was developed. The study employed this framework to examine the role of governance mechanisms on the diffusion of innovation in healthcare networks, focusing on NHS England. The research adopted a case study methodology (Yin, 2014) and employed a single case design with multiple embedded sub-units of analysis. The study is part of a large collaborative research programme carried out by a multidisciplinary group of academics drawn from three different universities to evidence the value of an Academic Health Science Network (AHSN). The AHSN represented the single case and this study presents two of the seven embedded sub-units that were selected as projects supported by the AHSN that employed a bottom-up approach to innovation diffusion. The first sub-embedded unit focused on five maternity units and the second on eleven general practices in one English healthcare region. The research data were collected over an eighteen-month period, and incorporated multiple sources of evidence, including semi-structured interviews, observations and secondary data analysis.
The findings indicated that the diffusion of innovation in healthcare networks can be promoted via a bottom-up approach enabled through the parallel use of formal governance mechanisms, in this case contracts, and relational governance mechanisms such as trust, information exchange and reputation. The research study also uncovered the key role played by boundary spanners and gatekeepers in orchestrating the innovation diffusion process through, for instance, the connection of experts and industry partners. Based on these findings, the research suggests that, when employing a bottom-up approach to innovation diffusion in healthcare networks it is important that the interplay between contractual and relational governance mechanisms is carefully managed, and that key actors are identified that can operate as boundary spanners and gatekeepers, supporting and championing the diffusion of innovations throughout the healthcare network.


Okeke, U. The role of governance mechanisms on the diffusion of innovation in healthcare networks. (Thesis). University of the West of England. Retrieved from

Thesis Type Thesis
Publicly Available Date Jun 7, 2019
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