Discovery - University of Dundee - Online Publications

Library & Learning Centre

Addressing complex healthcare problems in diverse settings

Standard

Addressing complex healthcare problems in diverse settings : insights from activity theory. / Greig, G.; Beech, N.; Entwistle, Vikki A.

In: Social Science and Medicine, Vol. 74, No. 3, 01.02.2012, p. 305-312.

Research output: Contribution to journalArticle

Harvard

Greig, G, Beech, N & Entwistle, VA 2012, 'Addressing complex healthcare problems in diverse settings: insights from activity theory' Social Science and Medicine, vol 74, no. 3, pp. 305-312., 10.1016/j.socscimed.2011.02.006

APA

Greig, G., Beech, N., & Entwistle, V. A. (2012). Addressing complex healthcare problems in diverse settings: insights from activity theory. Social Science and Medicine, 74(3), 305-312. 10.1016/j.socscimed.2011.02.006

Vancouver

Greig G, Beech N, Entwistle VA. Addressing complex healthcare problems in diverse settings: insights from activity theory. Social Science and Medicine. 2012 Feb 1;74(3):305-312. Available from: 10.1016/j.socscimed.2011.02.006

Author

Greig, G.; Beech, N.; Entwistle, Vikki A. / Addressing complex healthcare problems in diverse settings : insights from activity theory.

In: Social Science and Medicine, Vol. 74, No. 3, 01.02.2012, p. 305-312.

Research output: Contribution to journalArticle

Bibtex - Download

@article{be4b5fc0fd6c4f5f84c966e754eda22e,
title = "Addressing complex healthcare problems in diverse settings: insights from activity theory",
keywords = "Scotland, Activity theory, Management practice, Primary healthcare, Hospital admissions, Policy, UK",
author = "G. Greig and N. Beech and Entwistle, {Vikki A.}",
year = "2012",
doi = "10.1016/j.socscimed.2011.02.006",
volume = "74",
number = "3",
pages = "305--312",
journal = "Social Science and Medicine",
issn = "0277-9536",

}

RIS (suitable for import to EndNote) - Download

TY - JOUR

T1 - Addressing complex healthcare problems in diverse settings

T2 - insights from activity theory

A1 - Greig,G.

A1 - Beech,N.

A1 - Entwistle,Vikki A.

AU - Greig,G.

AU - Beech,N.

AU - Entwistle,Vikki A.

PY - 2012/2/1

Y1 - 2012/2/1

N2 - In the UK, approaches to policy implementation, service improvement and quality assurance treat policy, management and clinical care as separate, hierarchical domains. They are often based on the central knowledge transfer (KT) theory idea that best practice solutions to complex problems can be identified and ‘rolled out’ across organisations. When the designated ‘best practice’ is not implemented, this is interpreted as local – particularly management – failure. Remedial actions include reiterating policy aims and tightening performance management of solution implementation, frequently to no avail. We propose activity theory (AT) as an alternative approach to identifying and understanding the challenges of addressing complex healthcare problems across diverse settings. AT challenges the KT conceptual separations between levels of policy, management and clinical care. It does not regard knowledge and practice as separable, and does not understand them in the commodified way that has typified some versions of KT theory. Instead, AT focuses on “objects of activity” which can be contested. It sees new practice as emerging from contradiction and understands knowledge and practice as fundamentally entwined, not separate. From an AT perspective, there can be no single best practice. The contributions of AT are that it enables us to understand the dynamics of knowledge-practice in activities rather than between levels. It shows how efforts to reduce variation from best practice may paradoxically remove a key source of practice improvement. After explaining the principles of AT we illustrate its explanatory potential through an ethnographic study of primary healthcare teams responding to a policy aim of reducing inappropriate hospital admissions of older people by the ‘best practice’ of rapid response teams. Article in Press, Corrected Proof - Please refer to the 'Note to users' via the DOI link.

AB - In the UK, approaches to policy implementation, service improvement and quality assurance treat policy, management and clinical care as separate, hierarchical domains. They are often based on the central knowledge transfer (KT) theory idea that best practice solutions to complex problems can be identified and ‘rolled out’ across organisations. When the designated ‘best practice’ is not implemented, this is interpreted as local – particularly management – failure. Remedial actions include reiterating policy aims and tightening performance management of solution implementation, frequently to no avail. We propose activity theory (AT) as an alternative approach to identifying and understanding the challenges of addressing complex healthcare problems across diverse settings. AT challenges the KT conceptual separations between levels of policy, management and clinical care. It does not regard knowledge and practice as separable, and does not understand them in the commodified way that has typified some versions of KT theory. Instead, AT focuses on “objects of activity” which can be contested. It sees new practice as emerging from contradiction and understands knowledge and practice as fundamentally entwined, not separate. From an AT perspective, there can be no single best practice. The contributions of AT are that it enables us to understand the dynamics of knowledge-practice in activities rather than between levels. It shows how efforts to reduce variation from best practice may paradoxically remove a key source of practice improvement. After explaining the principles of AT we illustrate its explanatory potential through an ethnographic study of primary healthcare teams responding to a policy aim of reducing inappropriate hospital admissions of older people by the ‘best practice’ of rapid response teams. Article in Press, Corrected Proof - Please refer to the 'Note to users' via the DOI link.

KW - Scotland

KW - Activity theory

KW - Management practice

KW - Primary healthcare

KW - Hospital admissions

KW - Policy

KW - UK

UR - http://www.scopus.com/inward/record.url?scp=84856219631&partnerID=8YFLogxK

U2 - 10.1016/j.socscimed.2011.02.006

DO - 10.1016/j.socscimed.2011.02.006

M1 - Article

JO - Social Science and Medicine

JF - Social Science and Medicine

SN - 0277-9536

IS - 3

VL - 74

SP - 305

EP - 312

ER -

Documents

Library & Learning Centre

Contact | Accessibility | Policy