SAID BUSINESS SCHOOL

WWW.SBS.OXFORD.EDU

EDUCATING LEADERS FOR 800 YEARS

Getting knowledge into action.

Professor Sue Dopson

Approaches to Change

1. Establish sense of urgency

2. Form guiding coalition

3. Create a vision

4. Communicate Vision

5. Empower people to act on vision

6. Create ‘short-term’ wins

7. Consolidate improvements to

produce further change

8. Institutionalise new approaches

Unfreeze

Movement

Refreeze

Lewin 1951; Kotter 19952 Prof Sue Dopson

Focus of Studies:

ROGERS, E. (1995) “Diffusion of Innovations” 4th ed. New York, Free Press.

“we should increase our understanding of the motivations for adopting an innovation. Strangely, such ‘why’ questions about adopting an innovation have rarely been probed by diffusion researchers...” (p. 109)

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The data base for reflection on EBM

Seven studies have been brought together,

These comprise 49 separate case studies.

In total, more than 1400 interviews with clinical professionals and managers in health care in the U.K.

Across the acute & primary care sectors

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Findings on Evidence…..

• No such thing as ‘the evidence’, but competing bodies of evidence

• Credibility of evidence is based on source

• Hierarchies of evidence exist

• Different professional groups have different views on scientific evidence

• Limited data to show inter-professional sharing of evidence

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Findings on Evidence….

Social & cognitive professional boundaries :

• The source of differences between professional groups lies in education and socialisation into the profession;

• Cognitive boundaries have rarely been recognised;

• Many decisions about innovations and adoption are taken in uni-professional ‘communities of practice’

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The Influence of Context

History of prior relationships is critical

Diffusion is impeded when organizational structures are complex

ThereforeOnly context sensitive diffusion processes will be

effective;Sound ideas always need customizing to local context;

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Roles of Actors and Interactions

Opinion Leaders as Accelerators and Facilitators

of Change

similar pattern across contexts opinion leaders account for differential speed of adoption opinion leaders perform a range of roles e.g. technical

champion opinion leaders play a key role in translation to local level

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Case Study: The Genetic Knowledge Path Idea

“[The idea for GKPs] appeared very late in the drafting of the NHS plan, virtually just a sentence, just a throw away sentence that took everyone by surprise & when [the then Health Secretary] was questioned what it was, he said, ‘You tell me.’ We then had to develop some themes.”

Funded GKPs as a “reaction to lobbying”

Unclear specification of what GKPs should do

Prof Sue Dopson 9

OGKP (Conception: 2001)OGKP (Conception: 2001)

NHS Hospital

Old UniversityOld University

Dept of Dept of HealthHealth

NHS Science LabsNHS Science Labs

Genetics Prof

Epidemiology Prof

Social Science Institute

Ethics Prof

Medical Director

Genetics Prof

Pathology Prof

Lab Director

Cardiology Prof

Dept of Trade Dept of Trade & Industry& Industry

Genetics Prof

Research Institute

Genetics Prof

ScienceMedicineSocial scienceManagement / policy

Other GKPsOther GKPs

Lab Director

Civil servant

Health Secretary

Civil servant

Senior civil servant

Senior civil servant

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Community Affiliations

Community Institutional Affiliation Epistemic Affiliation

Medical Scientists University Medicine

NHS Medical Scientists NHS Hospital Medicine

Research Scientists University Biomedicine

NHS Scientists NHS Labs Biomedicine

Social Scientists University Social Science

Policy Community DH (& various) Policy (various)

Commissioning NHS PCT Management

Prof Sue Dopson 11

OGKP (end 2007)OGKP (end 2007)

NHS Hospital

NHS Hospital

Old University

DoHDoH

NHS Science LabsNHS Science Labs

Network Network DirectorDirector

Genetics Prof

Genetics Prof (PI WP2) Social Science

Institute

Prof Ethics

Medical Director

Genetics Prof

Pathology Prof

Lab DirectorLab Director

Cardiology Prof(PI WP1)

Genetics Prof (OGKP Chair)

Commissioners Commissioners (SHA)(SHA)

DTIDTI

AGGRAGGR

Research InstScientist (New PI WP3)

Scientist

Genetics Prof (Old PI WP3)

OtherOther UniversityUniversity

Consultant Geneticist

Economist

Business School

Commissioner

GIG - PatientsGIG - Patients

Innovation UnitInnovation UnitVCsVCs

Primary CarePrimary Care

Sociologist

Misunder-

standingOther GKPsOther GKPs

Other Other LabsLabs

Lawyer

ScienceMedicineSocial science Management / policy

Conflict

Conflict

Civil Servant

Executive Committee in boldGKP Supervisory Board underlined

Com

petitive

pressure

Consultant Consultant GeneticistGeneticist

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Epistemic Clash Science vs. Social Science

Economist able to communicate with scientists (shared quantitative epistemology) & helped to prove SCD test as cost-effective (producing further funding)

Sociologist’s work weird & of no benefit

“Our world is very black & white so when a sociologist talks to me about barriers in networks it does not mean much to me.” Research Scientist

“These weird sort of sociology people… we were just providing material for them to write interesting papers.” NHS Scientist

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Why is knowledge ‘Sticky’ ?

SPATIAL BOUNDARIES

ORGANIZATIONAL BOUNDARIES

INTER-ORGANIZATIONAL BOUNDARIES

PROFESSIONAL BOUNDARIES

BOUNDARIES BETWEEN ‘COMMUNITIES OF PRACTICE’ KNOWLEDGE TRANSPOSITION PROCESSES AND

KNOWLEDGE LEADERSHIP

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Processes for sharing across boundaries

SHARING WILL NOT ‘JUST HAPPEN’

ORGANIZATIONAL; INTER-ORGANIZATIONAL & PROFESSIONAL BOUNDARIES NEED PLANNED FACILITATION TO OVERCOME;

BRIDGING ROLES

RECOGNISE THE POWER DIFFERENCES

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The Challenge of Change

• Do different kind of challenges require different kind of change?

1. Critical Challenges: Commander

2. Tame Challenges: Management

3. Wicked Challenges: Leadership

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The challenge of ‘engagement’ and the role of leadership

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‘Technical Challenge’

Set goal and task

Tell why

Explain what and how

Give instruction

Motivate

Measure and monitor

‘Adaptive challenge’

Set the context

‘Get on the balcony’

Describe a view of the future

‘Give the work to the people’

Manage conflict

Encourage, coach, challenge

Prof Sue Dopson

Sir Geoffrey Vickers

Prof Sue Dopson 18

Background

(a) Victoria Cross, Classics at Oxford, City Solicitor, Director of Economic Intelligence, Board of National Coal Board (800,000 employees)

(b) Para-academic, prolific writer, Visiting Professor at Lancaster University, aged 85

Approach

‘I have spent my life in practising the law and helping to administer public and private affairs; and I have thus had opportunity to observe and take part in the making of policy. The more I have seen of this, the more insistent has been the challenge to understand it both as a mental activity and as a social process, for it seems strange and dangerous that something so familiar and apparently important should remain so obscure. My enquiry into it has led me further than I expected. I have had to question sciences in which I am not professionally qualified and sometimes to supply my own answers, when theirs seems so ambiguous, inconsistent or absent. I present the result with humility but without apology. Even the dogs may eat of the crumbs which fall from the rich man’s table; and in these days, when the rich in knowledge eat such specialized food at such separate tables, only the dogs have a chance of a balanced diet’.