title: Increasing capacity for innovation in bureaucratic primary care organizations: a whole system participatory action research project.
abstract: OBJECTIVE
  We wanted to identify what organizational features support innovation in Primary Care Groups (PCGs).
  
  
  METHODS
  Our study used a whole system participatory action research model. Four research teams provided complementary insights. Four case study PCGs were analyzed. Two had an intervention to help local facilitators reflect on their work. Data included 70 key informant interviews, observations of clinical governance interventions and committee meetings, analysis of written materials, surveys and telephone interviews of London Primary Care Organizations, interviews with 20 nurses, and interviews with 6 finance directors. A broad range of stakeholders reviewed data at annual conferences and formed conclusions about trustworthy principles. Sequential research phases were refocused in the light of these conclusions and in response to the changing political context.
  
  
  RESULTS
  Five features were associated with increased organizational capacity for innovation: (1) clear structures and a vision for corporate and clinical governance; (2) multiple opportunities for people to reflect and learn at all levels of the organization, and connections between these "learning spaces"; (3) both clinicians and managers in leadership roles that encourage participation; (4) the right timing for an initiative and its adaptation to the local context; and (5) external facilitation that provides opportunities for people to make sense of their experiences. Low morale was commonly attributed to 3 features: (1) overwhelming pace of reform, (2) inadequate staff experience and supportive infrastructure, and (3) financial deficits.
  
  
  CONCLUSIONS
  These features together may support innovation in other primary care bureaucracies. The research methodology enabled people from different backgrounds to make sense of diverse research insights.
authors.affiliation: Thames Valley University and Brent Primary Care Trust, London, UK. paul.thomas@tvu.ac.uk
authors.forename: Paul
authors.initials: P
authors.lastname: Thomas
authors.forename: Juliet
authors.initials: J
authors.lastname: McDonnell
authors.forename: Janette
authors.initials: J
authors.lastname: McCulloch
authors.forename: Alison
authors.initials: A
authors.lastname: While
authors.forename: Nick
authors.initials: N
authors.lastname: Bosanquet
authors.forename: Ewan
authors.initials: E
authors.lastname: Ferlie
mesh_terms: D006123:Group Practice / Q000458:organization & administration*; D006126:Group Processes; D009936:Organizational Innovation; D011320:Primary Health Care / Q000458:organization & administration*