title: The work of local healthcare innovation: a qualitative study of GP-led integrated diabetes care in primary health care.
abstract: BACKGROUND
  Service delivery innovation is at the heart of efforts to combat the growing burden of chronic disease and escalating healthcare expenditure. Small-scale, locally-led service delivery innovation is a valuable source of learning about the complexities of change and the actions of local change agents. This exploratory qualitative study captures the perspectives of clinicians and managers involved in a general practitioner-led integrated diabetes care innovation.
  
  
  METHODS
  Data on these change agents' perspectives on the local innovation and how it works in the local context were collected through focus groups and semi-structured interviews at two primary health care sites. Transcribed data were analysed thematically. Normalization Process Theory provided a framework to explore perspectives on the individual and collective work involved in putting the innovation into practice in local service delivery contexts.
  
  
  RESULTS
  Twelve primary health care clinicians, hospital-based medical specialists and practice managers participated in the study, which represented the majority involved in the innovation at the two sites. The thematic analysis highlighted three main themes of local innovation work: 1) trusting and embedding new professional relationships; 2) synchronizing services and resources; and 3) reconciling realities of innovation work. As a whole, the findings show that while locally-led service delivery innovation is designed to respond to local problems, convincing others to trust change and managing the boundary tensions is core to local work, particularly when it challenges taken-for-granted practices and relationships. Despite this, the findings also show that local innovators can and do act in both discretionary and creative ways to progress the innovation.
  
  
  CONCLUSIONS
  The use of Normalization Process Theory uncovered some critical professional, organizational and structural factors early in the progression of the innovation. The key to local service delivery innovation lies in building coalitions of trust at the point of service delivery and persuading organizational and institutional mindsets to consider the opportunities of locally-led innovation.
authors.affiliation: School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Qld, 4072, Australia. michele.foster@griffith.edu.au.|School of Human Services and Social Work, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Qld, 4131, Australia. michele.foster@griffith.edu.au.
authors.forename: Michele
authors.initials: M
authors.lastname: Foster
authors.affiliation: Discipline of General Practice, School of Medicine, The University of Queensland, Level 8, Health Sciences Building, Royal Brisbane & Women's Hospitals, Herston Road, Herston, Qld, 4006, Australia.
authors.forename: Letitia
authors.initials: L
authors.lastname: Burridge
authors.affiliation: Discipline of General Practice, School of Medicine, The University of Queensland, Level 8, Health Sciences Building, Royal Brisbane & Women's Hospitals, Herston Road, Herston, Qld, 4006, Australia.
authors.forename: Maria
authors.initials: M
authors.lastname: Donald
authors.affiliation: Discipline of General Practice, School of Medicine, The University of Queensland, Level 8, Health Sciences Building, Royal Brisbane & Women's Hospitals, Herston Road, Herston, Qld, 4006, Australia.
authors.forename: Jianzhen
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Discipline of General Practice, School of Medicine, The University of Queensland, Level 8, Health Sciences Building, Royal Brisbane & Women's Hospitals, Herston Road, Herston, Qld, 4006, Australia.
authors.forename: Claire
authors.initials: C
authors.lastname: Jackson
mesh_terms: D002908:Chronic Disease; D003299:Cooperative Behavior; D003695:Delivery of Health Care / Q000458:organization & administration; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D004059:Diffusion of Innovation; D005260:Female; D017144:Focus Groups; D058006:General Practice / Q000458:organization & administration*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D009936:Organizational Innovation; D011320:Primary Health Care / Q000458:organization & administration; D036301:Qualitative Research; D011793:Queensland