Increasing Capacity for Innovation in Bureaucratic Primary Care Organizations: A Whole System Participatory Action

PURPOSE 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 refl ect 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 fi nance 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 conclu-sions 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 refl ect and learn at all levels of the orga-nization, 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) inad-equate staff experience and supportive infrastructure, and (3) fi nancial defi cits. 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