Dr. Maria Kapsali HaCIRIC Research Associate

Work: European Policy and Operational Change

Policy design and healthcare innovation projects:

the design of implementation policy instruments

Research theme 4. Policy problems and related

priorities for research

The research problem

. ,

• The first case (EARSS) shows that by

using an open systems approach a project

achieves most of its targets, attributed to:

1. The flexibility in decision making to

adjust plans and activities

2. Managing the internal and external

boundaries.

3. The alignment of policy goals with

project activities.

• The second case (eTEN) shows that under

a closed system approach a project:

1. Does not have the flexibility to manage

change due to the focus on controlling

the activities in the project process.

2. This leads to weak leadership and in-

group problems.

3. 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.

Literature says:

• 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

1. 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.

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

Question: WHY?

• 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)

WHY?

• Because the design of policy

implementation instruments presupposes

that process change can be tightly

controlled through bureaucratic

procedures and compliance to

bureaucratic rules

The theory

The findings

The method

• 12 healthcare technology deployment projects (adoption

and use of telemedicine) grouped into 2 embedded multiple

case studies: the EARSS case and the eTEN case.

• Each case was run under a different policy programme with

a different set of implementation instruments in place.

The results

• 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.

Unrealistic

expectations

Tension between

policy goals and

implementation

instruments

Implementation

instruments

confine

managerial action

and choice

Contact details:

Dr Maria Kapsali

m.kapsali@imperial.ac.uk

+44 (0)20 7594 6491

www.haciric.org

www.imperial.ac.uk/business-school

Causal connectedness between policy

implementation instruments and

project management practices was

the reason why projects failed..

Implementation instruments focused on

controlling-evaluating project activities

(not outcomes) in terms of time, cost and

quality, and interfered with project

management practices..

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..

Conclusions Priorities for future health policy research

1. 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.

2. Base the design of implementation instruments

(evaluation and participation rules) on these metrics