Addressing complex healthcare problems in diverse settings: insights from activity theory

Gail Greig, Vikki A. Entwistle, Nic Beech

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

In the UK, approaches to policy implementation, service improvement and quality assurance treat policy, management and clinical care as separate, hierarchical domains. They are often based on the central knowledge transfer (KT) theory idea that best practice solutions to complex problems can be identified and 'rolled out' across organisations. When the designated 'best practice' is not implemented, this is interpreted as local - particularly management - failure. Remedial actions include reiterating policy aims and tightening performance management of solution implementation, frequently to no avail.We propose activity theory (AT) as an alternative approach to identifying and understanding the challenges of addressing complex healthcare problems across diverse settings. AT challenges the KT conceptual separations between levels of policy, management and clinical care. It does not regard knowledge and practice as separable, and does not understand them in the commodified way that has typified some versions of KT theory. Instead, AT focuses on " objects of activity" which can be contested. It sees new practice as emerging from contradiction and understands knowledge and practice as fundamentally entwined, not separate. From an AT perspective, there can be no single best practice.The contributions of AT are that it enables us to understand the dynamics of knowledge-practice in activities rather than between levels. It shows how efforts to reduce variation from best practice may paradoxically remove a key source of practice improvement. After explaining the principles of AT we illustrate its explanatory potential through an ethnographic study of primary healthcare teams responding to a policy aim of reducing inappropriate hospital admissions of older people by the 'best practice' of rapid response teams.
Original languageEnglish
Pages (from-to)305-312
Number of pages8
JournalSocial Science & Medicine
Volume74
Issue number3
Early online date1 Mar 2011
DOIs
Publication statusPublished - Feb 2012

Fingerprint

Practice Guidelines
Delivery of Health Care
best practice
knowledge transfer
management
Patient Care Team
Quality Improvement
Primary Health Care
Activity Theory
Healthcare
Organizations
policy implementation
quality assurance
Best Practice
Knowledge Transfer
performance

Keywords

  • Scotland
  • activity theory
  • management practice
  • primary healthcare
  • hospital admissions
  • policy
  • UK

Cite this

Addressing complex healthcare problems in diverse settings : insights from activity theory. / Greig, Gail; Entwistle, Vikki A.; Beech, Nic.

In: Social Science & Medicine, Vol. 74, No. 3, 02.2012, p. 305-312.

Research output: Contribution to journalArticle

Greig, Gail ; Entwistle, Vikki A. ; Beech, Nic. / Addressing complex healthcare problems in diverse settings : insights from activity theory. In: Social Science & Medicine. 2012 ; Vol. 74, No. 3. pp. 305-312.
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