Shaping innovation and coordination of healthcare delivery across boundaries and borders: A comparative case study

Rosemary J Hollick* (Corresponding Author), Alison J Black, David M Reid, Lorna McKee

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)
12 Downloads (Pure)


Using a complexity-informed approach, we aim to understand why introduction of a mobile service delivery model for osteoporosis across diverse organisational and country contexts in the UK National Health Service (NHS) met with variable success.

Six comparative case studies; three prospectively in Scotland using an action research-informed approach; and three retrospectively in England with variable degrees of success. The Non-adoption, Abandonment, Scale-up, Spread and Sustainability framework explored interactions between multi-level contextual factors and their influence on efforts to introduce and sustain services.

Cross-boundary service development was a continuous process of adaptation and evolution in rapidly shifting healthcare context. Whilst the outer healthcare policy context differed significantly across cases, inner contextual features predominated in shaping the success or otherwise of service innovations. Technical and logistical issues, organisational resources, patient and staff actions combined in unpredictable ways to shape the lifecycle of service change. Patient and staff thoughts about place and access to services actively shaped service development. The use of tacit “soft intelligence” and a sense of “chronic unease” emerged as important in successfully navigating around awkward people and places.

Practical implications
“Chronic unease” and “soft intelligence” can be used to help individuals and organisations “tame” complexity, identify hidden threats and opportunities to achieving change in a particular context, and anticipate how these may change over time. Understanding how patients think and feel about where, when and how care is delivered provides unique insights into previously unseen aspects of context, and can usefully inform development and sustainability of patient-centred healthcare services.

This study has uniquely traced the fortunes of a single service innovation across diverse organisational and country contexts. Novel application of the NASSS framework enabled comparative analysis across real-time service change and historical failures. This study also adds to theories of context and complexity by surfacing the neglected role of patients in shaping healthcare context.

Original languageEnglish
Pages (from-to)849-868
Number of pages20
JournalJournal of Health Organization & Management
Issue number7-8
Early online date5 Aug 2019
Publication statusPublished - 7 Nov 2019


  • complexity
  • Comparative case studies
  • osteoporosis
  • mobile bone density scanning services
  • patient care
  • innovation
  • Healthcare context


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