Handbook of Innovation in Public Services
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Handbook of Innovation in Public Services

Edited by Stephen P. Osborne and Louise Brown

Leading researchers from across the globe review the state of the art in research on innovation in public services, providing an overview of key issues from a multi-disciplinary perspective. Topics explored include: context for innovation in public services and public service reform; managerial change challenges; ICT and e-government; and collaboration and networks. The theory is underpinned by seven wide-ranging case studies of innovation in practice.
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Chapter 36: Exploring the diffusion and sustainability of service innovation in healthcare

Trisha Greenhalgh, Cathy Barton-Sweeney and Fraser Macfarlane


As James Barlow has described in Chapter 35, the UK National Health Service (NHS) is much exercised with the challenge of innovation. To summarise his message, healthcare is a complex field of practice; innovations which promise to lengthen life or improve its quality are alluring and (often) expensive; and for various reasons many promising innovations have limited uptake and use. The main focus of Barlow’s chapter is on drugs, medical devices and technologies for diagnosing or monitoring disease. This chapter considers a somewhat more abstract form of innovation: new service models – that is, new ways of organising and delivering health services which aim to improve such things as the accessibility of care, the experience of patients and staff, and the efficiency (and hence costs) of services. Back in 2003, the NHS Service Delivery and Organisation Programme funded our team to undertake a systematic literature review on ‘Diffusion, spread and sustainability of service innovations’. The impetus for the research call was what Adler et al. had called the ‘Six West problem’ – that is, that a bright idea for improving service delivery on ward Six West often did not even get as far as ward Five East in the same hospital, let alone spread to other hospitals locally or nationally (Adler, Kwon and Singer 2003).

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