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Intervention evaluations have not always accounted for long-term implementation of interventions. The purpose of this paper is to explore implementation of a primary care intervention during the lifespan of the trial and beyond.

Eight general practices participated in the trial (four control and four intervention). In-depth interviews (with nine GPs and four practices nurses who delivered the intervention) and observation methods were employed. Thematic analysis was utilized and Normalization Process Theory (NPT) constructs were compared with emergent themes.

Macro-level policy imperatives shaped practice priorities which resulted in the “whole system” new intervention not being perceived to be sustainable. Continued routinization of the intervention into usual care beyond the lifespan of the funded study was dependent on individualized monitoring and taking forward tacit knowledge.

The authors discuss the implications of these findings for sociological theories of implementation and understanding outcomes of research led complex interventions.

The study describes the complex interplay between macro processes and individual situated practices and contributes to understanding if, how, and why interventions are sustained beyond initial “research push”. The value of the study lies in describing the conditions and potential consequences of long-term implementation, which might be translated to other contexts.

The purpose of this paper is to argue for an improved conceptualisation of health service research, using Stengers' (2018) metaphor of “slow science” as a critical yardstick.

The paper is structured in three parts. It first reviews the field of health services research and the approaches that dominate it. It then considers the healthcare research approaches whose principles and methodologies are more aligned with “slow science” before presenting a description of a “slow science” project in which the authors are currently engaged.

Current approaches to health service research struggle to offer adequate resources for resolving frontline complexity, principally because they set more store by knowledge generalisation, disciplinary continuity and integrity and the consolidation of expertise, than by engaging with frontline complexity on its terms, negotiating issues with frontline staff and patients on their terms and framing findings and solutions in ways that key in to the in situ dynamics and complexities that define health service delivery.

There is a need to engage in a paradigm shift that engages health services as co-researchers, prioritising practical change and local involvement over knowledge production. Economics is a research field where the products are of natural appeal to powerful health service managers. A “slow science” approach adopted by the embedded Economist Program with its emphasis on pre-implementation, knowledge mobilisation and parallel site capacity development sets out how research can be flexibly produced to improve health services.

This paper aims to identify and evaluate resolutions to key learning and teaching challenges in very large courses that involve practical mathematics, such as foundational finance.

A design-based research approach is used across three semesters to iteratively identify practical problems within the course and then develop and evaluate resolutions to these problems. Data are collected from both students and teachers and analysed using a mixed-method approach.

The results indicate that key learning and teaching challenges in large foundational finance courses can be mitigated through appropriate consistency of learning materials; check-your-understanding interactive online content targeting foundational concepts in the early weeks; connection points between students and the coordinator to increase teacher presence; a sustained focus on supporting student achievement within assessments; and signposting relevance of content for the broader program and professional settings. Multiple design iterations using a co-design approach were beneficial to incrementally improve the course and consider multiple perspectives within the design process.

This paper develops a set of design principles to provide guidance to other practitioners who seek to improve their own courses.

The use of design-based research and mixed-method approaches that consider both student and teacher perspectives to examine the design of very large, foundational finance courses is novel.

Many countries have a renewed focus on health inequalities since COVID-19. In England, integrated care systems (ICSs), formed in 2022 to promote integration, are required to reduce health inequalities. Integration is supported by population health management (PHM) which links data across health and care organisations to inform service delivery. It is not well-understood how PHM can help ICSs reduce health inequalities. This paper describes development of a programme theory to advance this understanding.

This study was conducted as a mixed-methods process evaluation in a local ICS using PHM. The study used Framework to analyse interviews with health and care professionals about a PHM tool, the COVID-19 vaccination uptake Dashboard. Quantitative data on staff Dashboard usage were analysed descriptively. To develop a wider programme theory, local findings were discussed with national PHM stakeholders.

ICS staff used PHM in heterogeneous ways to influence programme delivery and reduce inequalities in vaccine uptake. PHM data was most influential where it highlighted action was needed for “targetable” populations. PHM is more likely to influence decisions on reducing inequalities where data are trusted and valued, data platforms are underpinned by positive inter-organisational relationships and where the health inequality is a shared priority.

The COVID-19 pandemic accelerated a shift toward use of digital health platforms and integrated working across ICSs. This paper used an evaluation of integrated data to reduce inequalities in COVID-19 vaccine delivery to propose a novel programme theory for how integrated data can support ICS staff to tackle health inequalities.

The purpose of this paper is to better understand how and why adoption and implementation of healthcare IT innovations occur. The authors examine two IT applications, computerised physician order entry (CPOE) and picture archiving and communication systems (PACS) at the meso and micro levels, within the context of the National Programme for IT in the English National Health Service (NHS).

To analyse these multi-level dynamics, the authors blend Rogers’ diffusion of innovations theory (DoIT) with Webster’s sociological critique of technological innovation in medicine and healthcare systems to illuminate a wider range of interacting factors. Qualitative data collected between 2004 and 2006 uses semi-structured, in-depth interviews with 72 stakeholders across four English NHS hospital trusts.

Overall, PACS was more successfully implemented (fully or partially in three out of four trusts) than CPOE (implemented in one trust only). Factors such as perceived benefit to users and attributes of the application – in particular speed, ease of use, reliability and flexibility and levels of readiness – were highly relevant but their influence was modulated through interaction with complex structural and relational issues.

Results reveal that combining contextual system level theories with DoIT increases understanding of real-life processes underpinning implementation of IT innovations within healthcare. They also highlight important drivers affecting success of implementation, including socio-political factors, the social body of practice and degree of “co-construction” between designers and end-users.

The originality of the study partly rests on its methodological innovativeness and its value on critical insights afforded into understanding complex IT implementation programmes.

A major part of knowledge management for knowledge-intensive firms such as professional service firms is the increasing focus on thought leadership. Despite being a well-known term, it is poorly defined and analysed in the academic and practitioner literature. The aim of this article is to answer three questions. First, what is thought leadership? Second, what tensions exist when seeking to create thought leadership in knowledge-based organisations? Third, what further research is needed about thought leadership? The authors call for cross-disciplinary and academic–practitioner approaches to understanding the field of thought leadership.

The authors review the academic and practitioner literature on thought leadership to provide a rich oversight of how it is defined and can be understood by separating inputs, creation processes and outcomes. The authors also draw on qualitative data from 12 in-depth interviews with senior leaders of professional service firms.

Through analysing and building on previous understandings of the concept, the authors redefine thought leadership as follows: “Knowledge from a trusted, eminent and authoritative source that is actionable and provides valuable solutions for stakeholders”. The authors find and explore nine tensions that developing thought leadership creates and propose a framework for understanding how to engage with thought leadership at the industry/macro, organisational/meso and individual/micro levels. The authors propose a research agenda based on testing propositions derived from new theories to explain thought leadership, including leadership, reducing risk, signalling quality and managing social networks, as well as examining the suggested ways to resolve different tensions.

To the best of the authors’ knowledge, they are the first to separate out thought leadership from its inputs, creation processes and outcomes. The authors show new organisational paradoxes within thought leadership and show how they can play out at different levels of analysis when implementing a thought leadership strategy. This work on thought leadership is set in a relatively under-explored context for knowledge management researchers, namely, knowledge-intensive professional service firms.

The purpose of this paper is to explore what happens when changes to clinical practice are proposed and introduced in healthcare organisations. The authors use the implementation of Treatment Escalation Plans to explore the dynamics shaping the translational journey of a complex intervention from research into the everyday context of real-world healthcare settings.

A qualitative instrumental collective case study design was used. Data were gathered using qualitative interviews (n = 36) and observations (n = 46) in three English acute hospital trusts. Normalisation process theory provided the theoretical lens and informed data collection and analysis.

While each organisation faced the same translational problem, there was variation between settings regarding adoption and implementation. Successful change was dependent on participants' ability to manage and shape contexts and the work this involved was reliant on individual capacity to create a new, receptive context for change. Managing contexts to facilitate the move from research into clinical practice was a complex interactive and iterative process.

The paper advocates a move away from contextual factors influencing change and adoption, to contextual patterns and processes that accommodate different elements of whole systems and the work required to manage and shape them.

The paper addresses important and timely issues of change in healthcare, particularly for new regulatory and service-oriented processes and practices. Insights and explanations of variations in implementation are revealed which could contribute to conceptual generalisation of context and implementation.

Diabetes is regarded as a global epidemic with 382 million people globally suffering from diabetes. It also has major implications on patients’ quality of life. There are also high cost of treatment associated with diabetes for both patient and healthcare provider. Telemonitoring represents an excellent technology opportunity to redefine health care delivery. Using technology for home-based care promises the ability to deliver more cost effective care whilst also enhancing quality of care and patient satisfaction. The paper aims to discuss these issues.

The current research aims to contribute to the methodological design of action research projects in their use to implementation health technologies such as telemonitoring. In particular, it seeks create a model which can be used to demonstrate the efficacy of the use of the action research method as a viable alternative to the traditional randomised control trials methodology currently employed in healthcare.

The paper contributes towards the methodological design to investigate the area of practice making use of the telemonitoring programme within a Victorian Health Services Network using action research.

It intends to address the research problem of the low utilisation of telemonitoring within Monash Health as a whole, and more specifically within the diabetes unit. In this context the research intends to utilise the benefits of telemonitoring to improve clinical outcomes of patients by increasing insulin stabilisation. It is also intended the research organisation benefits by increased efficiency by decreasing clinical workforce time spent on managing patient insulin data.

The purpose of this paper is to investigate the prevalence of household food insecurity among immigrant women connected to perinatal programs offered through a community-based organization in Edmonton, and to explore their experiences in coping with food insecurity.

This study utilized a mixed methods research design. A community-based participatory research approach was used to engage health workers who were connected to immigrant women and families through the Multicultural Health Brokers Cooperative in Edmonton. Through the health workers a sample of 213 immigrant women connected to their perinatal programs completed the Household Food Security Survey. Following the survey, 17 women completed semi-structured interviews which were analyzed using content analysis.

The vast majority of women (94 percent (n=199)) lived in food insecure households, and 53 percent (n=112) in severely food insecure. In semi-structured interviews, women specifically described not having enough money to buy vegetables, fruit and meat, and perceiving a lack of control over foods they ate and offered to their families.

This study highlights the need for support to be provided to immigrant families for acquiring healthy food in Canada.

The mixed methods design with a decent sample of often underrepresented research participants highlights an area in need of further research and greater support.