title: Implementing organisation and management innovations in Swedish healthcare: lessons from a comparison of 12 cases.
abstract: OBJECTIVE
  The purpose of this paper is to compare the implementation of 12 different organisation and management innovations (OMIs) in Swedish healthcare, to discover the generic and specific factors important for successful healthcare improvement change in a public health system.
  
  
  METHODS
  Longitudinal cross-case comparison of 12 case studies was employed, where each case study used a common framework for collecting data about the process of change, the content of the change, the context, and the intermediate and final outcomes.
  
  
  RESULTS
  Clinical leaders played a more important part in the development of these successful service innovations than managers. Strategies for and patterns of change implementation were found to differ according to the type of innovation. Internal organisational context factors played a significant role in the development of nearly all, but external factors did not. "Developmental evolution" better described the change process than "implementation".
  
  
  CONCLUSIONS
  The 12 cases were all of relatively successful change processes: some unsuccessful examples would have provided additional testing of the hypotheses about what would predict successful innovation which were used in the case comparison. The cross-case comparative hypothesis testing method allows systematic comparison if the case data are collected using similar frameworks, but this approach to management research requires considerable resources and coordination.
  
  
  CONCLUSIONS
  Management innovations that improve patient care can be carried out successfully by senior clinicians, under certain circumstances. A systematic approach is important both for developing and adapting an innovation to a changing situation. A significant amount of time was required for all involved, which could be reduced by "fast-tracking" approval for some types of change.
  
  
  CONCLUSIONS
  This is the first empirical report comparing longitudinal and contextualised findings from a number of case studies of different organisational and management healthcare innovations. The findings made possible explanations for success factors and useful practical recommendations for conditions needed to nurture such innovation in public healthcare.
authors.affiliation: The Medical Management Centre, Karolinska Institutet, Stockholm, Sweden. jovret@aol.com
authors.forename: John
authors.initials: J
authors.lastname: Øvretveit
authors.forename: Magna
authors.initials: M
authors.lastname: Andreen-Sachs
authors.forename: Jan
authors.initials: J
authors.lastname: Carlsson
authors.forename: Helena
authors.initials: H
authors.lastname: Gustafsson
authors.forename: Johan
authors.initials: J
authors.lastname: Hansson
authors.forename: Christina
authors.initials: C
authors.lastname: Keller
authors.forename: Susana
authors.initials: S
authors.lastname: Lofgren
authors.forename: Pamela
authors.initials: P
authors.lastname: Mazzocato
authors.forename: Sara
authors.initials: S
authors.lastname: Tolf
authors.forename: Mats
authors.initials: M
authors.lastname: Brommels
mesh_terms: D004059:Diffusion of Innovation; D058016:Health Facility Administration; D008137:Longitudinal Studies; D019982:Organizational Case Studies; D011634:Public Health; D011785:Quality Assurance, Health Care; D013222:State Medicine / Q000458:organization & administration*; D013548:Sweden