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SAID BUSINESS SCHOOL
WWW.SBS.OXFORD.EDU
EDUCATING LEADERS FOR 800 YEARS
Getting knowledge into action.
Professor Sue Dopson
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Approaches to Change
1. Establish sense of urgency
2. Form guiding coalition
3. Create a vision
4. Communicate Vision
5. Empower people to act on vision
6. Create ‘short-term’ wins
7. Consolidate improvements to
produce further change
8. Institutionalise new approaches
Unfreeze
Movement
Refreeze
Lewin 1951; Kotter 19952 Prof Sue Dopson
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Focus of Studies:
ROGERS, E. (1995) “Diffusion of Innovations” 4th ed. New York, Free Press.
“we should increase our understanding of the motivations for adopting an innovation. Strangely, such ‘why’ questions about adopting an innovation have rarely been probed by diffusion researchers...” (p. 109)
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The data base for reflection on EBM
Seven studies have been brought together,
These comprise 49 separate case studies.
In total, more than 1400 interviews with clinical professionals and managers in health care in the U.K.
Across the acute & primary care sectors
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Findings on Evidence…..
• No such thing as ‘the evidence’, but competing bodies of evidence
• Credibility of evidence is based on source
• Hierarchies of evidence exist
• Different professional groups have different views on scientific evidence
• Limited data to show inter-professional sharing of evidence
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Findings on Evidence….
Social & cognitive professional boundaries :
• The source of differences between professional groups lies in education and socialisation into the profession;
• Cognitive boundaries have rarely been recognised;
• Many decisions about innovations and adoption are taken in uni-professional ‘communities of practice’
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The Influence of Context
History of prior relationships is critical
Diffusion is impeded when organizational structures are complex
ThereforeOnly context sensitive diffusion processes will be
effective;Sound ideas always need customizing to local context;
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Roles of Actors and Interactions
Opinion Leaders as Accelerators and Facilitators
of Change
similar pattern across contexts opinion leaders account for differential speed of adoption opinion leaders perform a range of roles e.g. technical
champion opinion leaders play a key role in translation to local level
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Case Study: The Genetic Knowledge Path Idea
“[The idea for GKPs] appeared very late in the drafting of the NHS plan, virtually just a sentence, just a throw away sentence that took everyone by surprise & when [the then Health Secretary] was questioned what it was, he said, ‘You tell me.’ We then had to develop some themes.”
Funded GKPs as a “reaction to lobbying”
Unclear specification of what GKPs should do
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OGKP (Conception: 2001)OGKP (Conception: 2001)
NHS Hospital
Old UniversityOld University
Dept of Dept of HealthHealth
NHS Science LabsNHS Science Labs
Genetics Prof
Epidemiology Prof
Social Science Institute
Ethics Prof
Medical Director
Genetics Prof
Pathology Prof
Lab Director
Cardiology Prof
Dept of Trade Dept of Trade & Industry& Industry
Genetics Prof
Research Institute
Genetics Prof
ScienceMedicineSocial scienceManagement / policy
Other GKPsOther GKPs
Lab Director
Civil servant
Health Secretary
Civil servant
Senior civil servant
Senior civil servant
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Community Affiliations
Community Institutional Affiliation Epistemic Affiliation
Medical Scientists University Medicine
NHS Medical Scientists NHS Hospital Medicine
Research Scientists University Biomedicine
NHS Scientists NHS Labs Biomedicine
Social Scientists University Social Science
Policy Community DH (& various) Policy (various)
Commissioning NHS PCT Management
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OGKP (end 2007)OGKP (end 2007)
NHS Hospital
NHS Hospital
Old University
DoHDoH
NHS Science LabsNHS Science Labs
Network Network DirectorDirector
Genetics Prof
Genetics Prof (PI WP2) Social Science
Institute
Prof Ethics
Medical Director
Genetics Prof
Pathology Prof
Lab DirectorLab Director
Cardiology Prof(PI WP1)
Genetics Prof (OGKP Chair)
Commissioners Commissioners (SHA)(SHA)
DTIDTI
AGGRAGGR
Research InstScientist (New PI WP3)
Scientist
Genetics Prof (Old PI WP3)
OtherOther UniversityUniversity
Consultant Geneticist
Economist
Business School
Commissioner
GIG - PatientsGIG - Patients
Innovation UnitInnovation UnitVCsVCs
Primary CarePrimary Care
Sociologist
Misunder-
standingOther GKPsOther GKPs
Other Other LabsLabs
Lawyer
ScienceMedicineSocial science Management / policy
Conflict
Conflict
Civil Servant
Executive Committee in boldGKP Supervisory Board underlined
Com
petitive
pressure
Consultant Consultant GeneticistGeneticist
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Epistemic Clash Science vs. Social Science
Economist able to communicate with scientists (shared quantitative epistemology) & helped to prove SCD test as cost-effective (producing further funding)
Sociologist’s work weird & of no benefit
“Our world is very black & white so when a sociologist talks to me about barriers in networks it does not mean much to me.” Research Scientist
“These weird sort of sociology people… we were just providing material for them to write interesting papers.” NHS Scientist
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Why is knowledge ‘Sticky’ ?
SPATIAL BOUNDARIES
ORGANIZATIONAL BOUNDARIES
INTER-ORGANIZATIONAL BOUNDARIES
PROFESSIONAL BOUNDARIES
BOUNDARIES BETWEEN ‘COMMUNITIES OF PRACTICE’ KNOWLEDGE TRANSPOSITION PROCESSES AND
KNOWLEDGE LEADERSHIP
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Processes for sharing across boundaries
SHARING WILL NOT ‘JUST HAPPEN’
ORGANIZATIONAL; INTER-ORGANIZATIONAL & PROFESSIONAL BOUNDARIES NEED PLANNED FACILITATION TO OVERCOME;
BRIDGING ROLES
RECOGNISE THE POWER DIFFERENCES
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The Challenge of Change
• Do different kind of challenges require different kind of change?
1. Critical Challenges: Commander
2. Tame Challenges: Management
3. Wicked Challenges: Leadership
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The challenge of ‘engagement’ and the role of leadership
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‘Technical Challenge’
Set goal and task
Tell why
Explain what and how
Give instruction
Motivate
Measure and monitor
‘Adaptive challenge’
Set the context
‘Get on the balcony’
Describe a view of the future
‘Give the work to the people’
Manage conflict
Encourage, coach, challenge
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Sir Geoffrey Vickers
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Background
(a) Victoria Cross, Classics at Oxford, City Solicitor, Director of Economic Intelligence, Board of National Coal Board (800,000 employees)
(b) Para-academic, prolific writer, Visiting Professor at Lancaster University, aged 85
Approach
‘I have spent my life in practising the law and helping to administer public and private affairs; and I have thus had opportunity to observe and take part in the making of policy. The more I have seen of this, the more insistent has been the challenge to understand it both as a mental activity and as a social process, for it seems strange and dangerous that something so familiar and apparently important should remain so obscure. My enquiry into it has led me further than I expected. I have had to question sciences in which I am not professionally qualified and sometimes to supply my own answers, when theirs seems so ambiguous, inconsistent or absent. I present the result with humility but without apology. Even the dogs may eat of the crumbs which fall from the rich man’s table; and in these days, when the rich in knowledge eat such specialized food at such separate tables, only the dogs have a chance of a balanced diet’.