Dr. Maria Kapsali HaCIRIC Research Associate Work: European Policy and Operational Change Research theme 4. Policy problems and related priorities for research The research problem Policy design and healthcare innovation projects: the design of implementation policy instruments The method The theory The results Problem:
The evaluation of healthcare innovation projects is difficult to achieve accurately
A lot of resource is going to unsuccessful projects that do not achieve their target outcomes
Policy implementation instruments, such as evaluation procedures and metrics and participation rules, are not suitable for managing healthcare innovation projects (as they were initially made to control processes in engineering / construction projects)
Because the design of policy implementation instruments presupposes that process change can be tightly controlled through bureaucratic procedures and compliance to bureaucratic rules
CLOSED systems control complexity in and out of the system – project through procedures to monitor process compliance
OPEN systems adjust to complexity with internal management mechanisms and boundary management
Policy design of instruments and project management practices mostly follow a closed systems approach 2. The application of open systems thinking in empirical studies is inhibited by the lack of constructs-metrics that are easily operationalisable and measurable. 3. Different perspectives on the theories of implementation of innovation policy have not generated a common generalizable theory and suffer from lack of consensus on measures, factors of success and research analysis units.
12 healthcare technology deployment projects (adoption and use of telemedicine) grouped into 2 embedded multiple case studies: the EARSS case and the eTENcase.
Each case was run under a different policy programme with a different set of implementation instruments in place.
Causal connectedness between policy implementation instruments and project management practices was the reason why projects failed.. The successful projects established the minimum critical outcomes in each phase in terms of time, cost and quality (not the outputs of workpackages) and allowed flexibility in changing formal plans through managerial autonomy.. The findings
3 projects (EARSS case) were successful and 9 (eTEN case) were not.
Successful projects were managed and evaluated through critical minimum specifications based on outcomes – the others were managed through traditional top down review procedures
. , Open systems thinking was practiced in project management through minimum critical specifications and boundary management. Implementation instruments confine managerial action and choice
The first case (EARSS) shows that by using an open systems approach a project achieves most of its targets, attributed to:
Theflexibilityin decision making to adjust plans and activities Managing the internal and external boundaries. Thealignmentof policy goals with project activities.
The second case (eTEN) shows that under a closed system approach a project:
Does not have the flexibility to manage change due to the focus on controlling the activities in the project process. This leads to weak leadership and in-group problems. Because of buffering the system and standardizing boundary management, the project managers could not deal with operational complexity. An open systems approach is more useful for projects of high complexity and unpredictability like innovation projects. Conclusions Priorities for future health policy research Implementation instruments focused on controlling-evaluating project activities (not outcomes) in terms of time, cost and quality, and interfered with project management practices.. Unrealistic expectations Tension between policy goals and implementation instruments Develop metrics that link managerial / project metrics (time, cost and quality) to minimum critical outcomes and boundary management (rather than the project process) and embed flexibility in them. Base the design of implementation instruments (evaluation and participation rules) on these metrics Contact details: Dr Maria Kapsali firstname.lastname@example.org +44 (0)20 7594 6491 www.haciric.org www.imperial.ac.uk/business-school