Changing practices : A practice-based study of cross-disciplinary technology development in hospitals
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AbstractThis study examined why breakthroughs in scientific and technological knowledge may fail to be translated into medical practice. In addition, it supported previous research that has underscored that these failures often are related to their lack of alignment with existing practices, or because they cut across established professional boundaries and power structures. Further, research has demonstrated that establishing practices across heterogeneous groups of actors, i.e. science, politics and industry, can facilitate interactive innovation. This project investigated how this was accomplished in practice. Thus, the main aim of the project was to study how cross-disciplinary technology development in hospitals evolves, and thereby contribute to our understanding of changing practices. The dissertation is based on a longitudinal case study of the Interventional Centre, Rikshospitalet University Hospital, Norway.
The dissertation consists of an introductory section and five papers. There are especially three elements that bind the five papers together. First, they all examine different aspects of changing practice at the Interventional Centre. Second, the research material was collected during the same period by the same researcher(s). Third, all of the papers are positioned within practice-based studies of learning, change and innovation. The first paper addressed the challenges in developing new medical knowing in practice when groups based on different knowledge traditions need to collaborate. The second paper examined the role of artefacts, such as research protocols, in cross-disciplinary knowledge production and innovation. The third paper was a detailed study of an innovation project, focusing on how technology, different professional communities and practice mutually influenced each other. The fourth paper investigated how new practices challenge established power relations within and across communities by examining two projects within the field of laparoscopy. The final paper examined the role of boundary organising for changing practices. The main contribution of the study was to provide rich insights into organising, learning, change and innovation, all of which were developed in the different papers. There were also several specific contributions to theory: The papers drew broadly from different theoretical approaches in order to explain complex phenomena. This was illustrated in the first paper, which was a detailed analysis of how the epistemic cultures of different communities of practice had implications for how and what type of knowledge was produced. Several of the papers also critically addressed the role of communities of practice in innovation, which is an area that thus far has been under-researched. The papers also emphasised the ongoing, multilevel activities that are important for overcoming different boundaries in order to develop and stabilise new medical knowing in practice. The dissertation also fore grounded how power relations both within and across communities of practice become challenged during innovation. In fact, it is argued that during radical innovation, it is no longer given who the master and the apprentice are. Similar to other studies, this study, revealed, that a major and important challenge is that it is insufficient to establish links between different practices if the organizational and institutional context reinforces the tendency to distinguish between these practices. It also pointed out that the linear approach to innovation processes is highly problematic, since these processes are not linear or rational, and an innovation is not a "thing" with a constant characteristic that can easily be moved from one context and to another. Instead, innovations are very dynamic, contingent and political. In order to shed light on these challenges, this dissertation introduced several new concepts to practice-based studies, such as constructing, enacting and packaging innovations, and the concept of boundary organising. Thus, altogether the study has produced interesting insights and implications that can be followed up in future studies of changing practices.
List of papers
I. Conflicting epistemic cultures and obstacles for learning across communities of practice (Mørk, Aanestad, Grisot and Hanseth, 2008a). Process and Knowledge Management, vol.15, no.1, 12-23. This was a major revision of the paper "Knowledge as a barrier to learning – a case study from medical R&D" included in the proceedings of OKLC 2003, the 4rth International Conference on Organizational Knowledge, Learning and Capabilities IESE Business School, Barcelona, Spain, April 13.-14.
II. Artefacts of knowing: A case study of research protocols in medical innovation (Mørk, Aanestad, Hoholm and Ellingsen, 2008b). Resubmitted to an international journal. This was a major revision of the paper "Research Protocols as a vehicle for the (re)production of knowledge" in included the proceedings of OKLC 2004, the 5th International Conference on Organizational Knowledge, Learning and Capabilities, Innsbruck, Austria, April 2.-3.
III. Constructing, enacting and packaging innovations (Mørk, Aanestad and Hoholm, 2006). European Journal of Innovation Management, vol.9, no.4, 444-465. This was a revised version of the paper with the same name included in the proceedings of EGOS 2005, the 21st International Conference EGOS Colloquium in Berlin, Germany, June 30.-July 2.
IV. Challenging expertise: On Power Relations Within and Across Communities of Practice in medical innovation (Mørk, Aanestad, Hoholm, Edwin and Ellingsen, 2008c). Accepted for resubmission to an international journal. This was a major revision of the paper "The greatest barrier for innovation in health care is "the scared old men" – A study of actors’ interpretations of knowledge sharing and innovation" included in the proceedings of OKLC 2005, the 6th International Conference on Organizational Knowledge, Learning and Capabilities, Boston, USA, March 17.-19.
V. Changing practice through boundary organising: A case from medical R&D (Mørk, 2009). Submitted to an international journal. This was a major revision of the paper with the same name included in the proceedings of OLKC 2008, the 3rd International Conference on Organizational Learning, Knowledge and Capabilities, Copenhagen Business School, Denmark, April 28.-30.