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      Analysing healthcare coordination using translational mobilization

      e-conceptual-paper

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Purpose

          The purpose of this paper is to introduce translational mobilization theory (TMT) and explore its application for healthcare quality improvement purposes.

          Design/methodology/approach

          TMT is a generic sociological theory that explains how projects of collective action are progressed in complex organizational contexts. This paper introduces TMT, outlines its ontological assumptions and core components, and explores its potential value for quality improvement using rescue trajectories as an illustrative case.

          Findings

          TMT has value for understanding coordination and collaboration in healthcare. Inviting a radical reconceptualization of healthcare organization, its potential applications include: mapping healthcare processes, understanding the role of artifacts in healthcare work, analyzing the relationship between content, context and implementation, program theory development and providing a comparative framework for supporting cross-sector learning.

          Originality/value

          Poor coordination and collaboration are well-recognized weaknesses in modern healthcare systems and represent important risks to quality and safety. While the organization and delivery of healthcare has been widely studied, and there is an extensive literature on team and inter-professional working, we lack readily accessible theoretical frameworks for analyzing collaborative work practices. TMT addresses this gap in understanding.

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          Most cited references77

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          Implementing, Embedding, and Integrating Practices: An Outline of Normalization Process Theory

          C. May, T Finch (2009)
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            Sharing Meaning Across Occupational Communities: The Transformation of Understanding on a Production Floor

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              Implementation, context and complexity

              Background Context is a problem in research on health behaviour change, knowledge translation, practice implementation and health improvement. This is because many intervention and evaluation designs seek to eliminate contextual confounders, when these represent the normal conditions into which interventions must be integrated if they are to be workable in practice. Discussion We present an ecological model of the ways that participants in implementation and health improvement processes interact with contexts. The paper addresses the problem of context as it affects processes of implementation, scaling up and diffusion of interventions. We extend our earlier work to develop Normalisation Process Theory and show how these processes involve interactions between mechanisms of resource mobilisation, collective action and negotiations with context. These mechanisms are adaptive. They contribute to self-organisation in complex adaptive systems. Conclusion Implementation includes the translational efforts that take healthcare interventions beyond the closed systems of evaluation studies into the open systems of ‘real world’ contexts. The outcome of these processes depends on interactions and negotiations between their participants and contexts. In these negotiations, the plasticity of intervention components, the degree of participants’ discretion over resource mobilisation and actors’ contributions, and the elasticity of contexts, all play important parts. Understanding these processes in terms of feedback loops, adaptive mechanisms and the practical compromises that stem from them enables us to see the mechanisms specified by NPT as core elements of self-organisation in complex systems.
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                Author and article information

                Contributors
                Journal
                JHOM
                10.1108/JHOM
                Journal of Health Organization and Management
                JHOM
                Emerald Publishing
                1477-7266
                08 May 2018
                17 May 2018
                : 32
                : 3
                : 358-373
                Affiliations
                [1]Department of Healthcare Sciences, Cardiff University , Cardiff, UK
                Author notes
                Davina Allen can be contacted at: allenda@cf.ac.uk
                Article
                608675 JHOM-05-2017-0116.pdf JHOM-05-2017-0116
                10.1108/JHOM-05-2017-0116
                29771202
                3c5c89b6-22f6-4437-8113-e427c92ae88c
                © Davina Allen

                Published by Emerald Publishing Limited. This article is published under the Creative Commons Attribution (CC BY 4.0) licence. Anyone may reproduce, distribute, translate and create derivative works of this article (for both commercial & non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this licence may be seen at http://creativecommons.org/licences/by/4.0/legalcode

                History
                : 26 May 2017
                : 15 January 2018
                : 16 January 2018
                Page count
                Figures: 0, Tables: 2, Equations: 0, References: 70, Pages: 16, Words: 6126
                Categories
                e-conceptual-paper, Conceptual paper
                cat-HSC, Health & social care
                cat-HMAN, Healthcare management
                Custom metadata
                yes
                yes
                JOURNAL
                excluded

                Health & Social care
                Translational mobilization theory,Organization-of-care,Coordination,Service quality,Improvement,Implementation

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