change innovation case study

Ten Types of Innovation: 30 new case studies for 2019

If you’ve followed my work for a while, you’ll know that I’m a big fan of the Ten Types of Innovation, a framework developed by Doblin (now a part of Deloitte).

I previously listed it as the #2 innovation framework you should be using.

And with good reason. I have used it frequently with clients to get them to think beyond innovating their product , which becomes harder, more expensive and less differentiating over time.

However, what I have found in recent workshops is that since it was originally published in 2013, some of the case studies and examples in the book already come across as out of date. That’s how rapidly the world is changing.

So here, I present three new more recent case studies for each of the Ten Types of Innovation, along with an outline on what each of them represents. Try and see which of these examples you would also suggest touch on more than one of the Ten Types, and let me know in the comments below:

1) Profit Model: How you make money

Innovative profit models find a fresh way to convert a firm’s offerings and other sources of value into cash. Great ones reflect a deep understanding of what customers and users actually cherish and where new revenue or pricing opportunities might lie.

Innovative profit models often challenge an industry’s tired old assumptions about what to offer, what to charge, or how to collect revenues. This is a big part of their power: in most industries, the dominant profit model often goes unquestioned for decades.

Recent examples:

• Fortnite – Pay to customise: This Free-to-Play video game by Epic Game Studios is currently one of the most popular and profitable games in the world. Unlike other “freemium” games which incentivise people to spend money to speed up progression, Fortnite is completely free to progress and people only need pay if they want to unlock cosmetic items which don’t affect gameplay but act to personalise their characters.
• Deloitte – Value sharing: Professional Services firm Deloitte is the world’s largest Management Consulting firm and still growing. They noticed a desire from their clients for assurance that the advice they were being given and transformation projects which Deloitte was running would actually succeed. As a result, Deloitte has begun trialling projects where instead of their fee being based just on Time and Materials, they will also share in value delivery, where additional bonus payments are only activated if previously-agreed performance metrics are successfully met.
• Supreme – Limiting supply: While most companies want to get their products in to the hands of as many people as possible, Supreme has built a cult following through deliberately forcing scarcity of its products. The streetwear clothing retailer announces limited items which will only be available from a specific day when they “drop”, and once they are sold out, that’s it, unless you want to pay huge markups for a second-hand item on eBay. Their red box logo is now so collectible and desirable that the company is able to sell almost anything by putting the logo on it for a limited time only. Case in point: you can find official Supreme Bricks (yes, like the ones used to build houses) which are still selling on eBay for $500.

Supreme’s limited quantity releases often lead to people queuing overnight

2) Network: How you connect with others to create value

In today’s hyper-connected world, no company can or should do everything alone. Network innovations provide a way for firms to take advantage of other companies’ processes, technologies, offerings, channels, and brands—pretty much any and every component of a business.

These innovations mean a firm can capitalize on its own strengths while harnessing the capabilities and assets of others. Network innovations also help executives to share risk in developing new offers and ventures. These collaborations can be brief or enduring, and they can be formed between close allies or even staunch competitors.

Recent Examples:

• Ford & Volkswagen – Developing Self-driving cars: As two of the world’s largest car-makers, Ford and Volkswagen are competitors on the road. However, in 2019 they announced a partnership to work together to develop technology for self-driving cars and electric vehicles which would be used in both company’s fleets of the future. While Ford brings more advanced automated driving technology, Volkswagen was leading in electric vehicles. Through the combined venture called ARGO, both firms can spread their R&D spending across more cars, while both developing competing products.
• Microsoft – launching on competitors platforms: Since new Microsoft CEO Satya Nadella has taken over, he has changed the innovation ethos of the company. Whereas previously Microsoft was a product-first company who tried to eliminate competing products and customers should stay within the company’s ecosystem, Nadella has shifted the mindset to a service company where their products should be accessible to customers should be able to access the products in whichever way they prefer. As a result, products such as Office 365 are now available in any web browser, as well as on the mobile marketplaces of Google’s Android and Apple’s IOS, previously seen as competitors.
• Huawei – Leveraging celebrity endorsement: Until recently, “high-quality smartphone” made people think of companies like Apple (USA), Samsung and LG (South Korea). Brands from China were often seen as competing on price but suffering from lower build quality and a lack of innovation. So in order to raise their profile in Western markets, Huawei has invested heavily in celebrities to endorse their flagship phones, such as Scarlett Johanssen, Lionel Messi, Henry Cavill and Gal Gadot. This initial investment raised brand name recognition, to the stage where it is now focusing marketing more towards features and functionality.

Huawei has paid Lionel Messi millions to endorse their brand

3) Structure: How you organize and align your talent and assets

Structure innovations are focused on organizing company assets—hard, human, or intangible—in unique ways that create value. They can include everything from superior talent management systems to ingenious configurations of heavy capital equipment.

An enterprise’s fixed costs and corporate functions can also be improved through Structure innovations, including departments such as Human Resources, R&D, and IT. Ideally, such innovations also help attract talent to the organization by creating supremely productive working environments or fostering a level of performance that competitors can’t match.

• Perpetual Guardian – Four-day working week: This small financial advisory firm in New Zealand trialed moving to a four-day working week, giving their staff an additional free day each week as long as they got their outputs done. As a result, they found people adjusted their working rhythm to achieve the same outcomes in 20% less time , while also resulting in more satisfied employees.
• Netflix – Unlimited Vacations: In order to drive their breakneck growth, Netflix reviewed their formal HR policies to see what processes were getting in the way of people doing their best work. They discovered that most bureaucratic processes which slowed down high performing individuals were in place to only handle situations where a low-performance individual would do something wrong. As a result, they scrapped most formal HR policies to free people to work in their own ways to benefit the company, summarised in their “Freedom and Responsibility” culture document, including allowing staff to take as many vacation days as they felt they needed to produce their best work.
• WeWork – Leveraging other companies’ hard assets: WeWork’s business model revolves around providing affordable office rentals for entrepreneurs and companies, fitting a lot of tenants into the same space by offering co-working areas. In order to rapidly deploy new working spaces and attract customers, WeWork started using a system called rental arbitrage, where they would rent commercial space, create a ready-to-use coworking setup, and then rent this space to customers. By not having to spend CAPEX on purchasing the buildings themselves, they were able to rapidly expand with lower overhead.

Netflix allows staff to take unlimited vacation days

4) Process: How you use signature or superior methods to do your work

Process innovations involve the activities and operations that produce an enterprise’s primary offerings. Innovating here requires a dramatic change from “business as usual” that enables the company to use unique capabilities, function efficiently, adapt quickly, and build market–leading margins.

Process innovations often form the core competency of an enterprise, and may include patented or proprietary approaches that yield advantage for years or even decades. Ideally, they are the “special sauce” you use that competitors simply can’t replicate.

• Tesla – Vertically integrated supply chain: Tesla’s electric cars require huge packs of EV batteries, made of thousands of lithium-ion cells. Until recently, the lack of demand for electric vehicles meant that companies had not invested in battery technology development, resulting in prices remaining high and making the cost of cars prohibitively more expensive than their gasoline counterparts. Tesla invested in a massive gigafactory to produce the newest battery packs themselves, and the economies of scale, as well as not paying markups to manufacturers, are estimated to save them 30% of the cost of the batteries.
• Amazon Web Services – opening internal technology to third parties: When Amazon Web Services initially launched in 2006 , it effectively launched the cloud computing market, allowing external companies to not just host webpages but run code and calculations at a fraction of the cost of building their own server network. Since then, Amazon has continued to develop new technology it would use for its own services, such as artificial intelligence, image recognition, machine learning, and natural-language processing, and later make this technology available to their customers.
• AliExpress – Making everyone a Shop Owner: AliExpress is one of the world’s largest eCommerce sites, and serves as a commercial storefront for thousands of Chinese companies, allowing you to purchase everything to phone cases to forklifts. However, AliExpress also allows the platform to handle purchases as listed on external storefronts using a system called drop-shipping, where anyone can set up their own store, sell someone else’s products (but to customers it looks like they are coming from the seller) and then have those manufacturers send the product directly to the customer.

Tesla’s Gigafactory is the world’s largest building

5) Product Performance: How you develop distinguishing features and functionality

Product Performance innovations address the value, features, and quality of a company’s offering. This type of innovation involves both entirely new products as well as updates and line extensions that add substantial value. Too often, people mistake Product Performance for the sum of innovation. It’s certainly important, but it’s always worth remembering that it is only one of the Ten Types of Innovation, and it’s often the easiest for competitors to copy.

Think about any product or feature war you’ve witnessed—whether torque and toughness in trucks, toothbrushes that are easier to hold and use, even with baby strollers. Too quickly, it all devolves into an expensive mad dash to parity. Product Performance innovations that deliver long-term competitive advantage are the exception rather than the rule.

• Gorilla Glass – Changing chemistry to improve smartphone durability: Gorilla Glass by Corning was listed as one of the original Ten Types by becoming scratch resistant. I have included it again for how it has changed the properties of its glass based on customer feedback each year. In 2016, version 5 of the glass was designed to resist shattering when dropped from 5+ feet, dubbed “selfie height” drops. However, after discussing what properties their customers wanted, by 2018 version 6 was no longer trying to resist shattering when dropped from a height once, instead the chemistry and manufacturing process had been changed to make it resistant to cracking after 15 drops from a lower height (1 meter, or a “fumble drop from your pocket”). I love this example of innovation as the product performance doesn’t just try to become “ better ” by resisting one drop from a higher height than last year, instead figuring out what really matters to customers and delivering that.
• Raspberry Pi – full PC for $35: The original Rasperbby Pi was developed by a UK charity to make a simple yet expandable computer which was affordable enough for everyone. Their credit-card sized PC may look bare-bones (it comes without a case and is effectively an exposed circuit board), yet it contains everything which someone needs to run a Linux operating system, learn to program and even connect it with external sensors and peripherals to make all manner of machines. The latest version 4 is now powerful enough to serve as a dedicated PC, all for a price so low you can give it to a child to tinker with without fear of it being broken.
• Lush Cosmetics – Removing what people don’t want anymore: As people become more aware of their impact on the environment, customers are demanding that customers do more to reduce the amount of plastic packaging their products use which could end up in landfill or the ocean. Lush Cosmetics was an early pioneer in bringing packaging-free cosmetics to scale, offering some of their packaging-free products like shampoo bars and soaps in dedicated packaging-free stores .

Giving children a cheap PC like the Raspberry Pi to learn and experiment on

6) Product System: How you create complementary products and services

Product System innovations are rooted in how individual products and services connect or bundle together to create a robust and scalable system. This is fostered through interoperability, modularity, integration, and other ways of creating valuable connections between otherwise distinct and disparate offerings. Product System innovations help you build ecosystems that captivate and delight customers and defend against competitors.

• Ryobi – One battery to rule them all: While handheld tools have had rechargeable batteries for decades now, Ryobi’s innovation was designing the modular One+ battery which could be used with over 80 different tools. Not only was this convenient for customers who needed fewer batteries overall for multiple uses, it also encouraged someone to buy into the Ryobi tool ecosystem once they had previously purchased one tool and battery set.
• Zapier – making APIs easy: Many web-based applications nowadays have an Application Programming Interface (API) which allows them to share data with other services. However, this often requires complex coding from the developers, and repeated effort to integrate with multiple different APIs. Zapier acts as a middleman for data, providing ready-made actions and API integrations between popular web services, allowing customers to automate certain activities every time a specific event happens.
• Airbnb – Expanding into experiences: Airbnb built their business on allowing everyday people to sell accommodation in their homes to strangers. Now the company has begun offering complementary services to people visiting new places through Experiences . These experiences are also sold by local guides, and allow guests to try things they would otherwise not have known about in addition to staying somewhere new.

Ryobi One+ battery powers multiple different tools

7) Service: How you support and amplify the value of your offerings

Service innovations ensure and enhance the utility, performance, and apparent value of an offering. They make a product easier to try, use, and enjoy; they reveal features and functionality customers might otherwise overlook, and they fix problems and smooth rough patches in the customer journey. Done well, they elevate even bland and average products into compelling experiences that customers come back for again and again.

• Kroger – Smartphone grocery scanning: US retail giant Kroger has been trialing a new smartphone app which allows shoppers to scan items as they shop, and then skip checking out altogether. Using the Scan, Bag, Go app, a customer will scan each item as they pick them up and place them into whatever bag they want, and once they are done, they can simply pay using the app and leave. This prevents shoppers having to wait in checkout lines and gives them an overview of their running total as they go, and also allows the supermarket to entice shoppers by sending coupons and offers directly to them.
• PurpleBricks – bringing real estate online: Estate Agents have a poor reputation for treating both sellers and buyers, especially for the amount they charge relative to the service they provide. PurpleBricks was one of the first online-only estate agents , where they could charge a significantly lower fee if the seller chose to complete some of the service processes themselves, such as showing the home to potential buyers. The firm can provide additional services for additional charges.
• Meituan Dianping – providing one app for all the services you want: As Fast Company’s 2019 Most Innovative company , Meituan Dianping provides a platform for Chinese consumers to purchase a variety of services. Known as a transactional super-app, you can use the app to book and pay for food delivery, travel, movie tickets and more from over 5 million Chinese small and large merchants.

Scan your own groceries with the Scan-Bag-Go app

8) Channel: How you deliver your offerings to customers and users

Channel innovations encompass all the ways that you connect your company’s offerings with your customers and users. While e-commerce has emerged as a dominant force in recent years, traditional channels such as physical stores are still important — particularly when it comes to creating immersive experiences.

Skilled innovators in this type often find multiple but complementary ways to bring their products and services to customers. Their goal is to ensure that users can buy what they want, when and how they want it, with minimal friction and cost and maximum delight.

• Dollar Shave Club – Direct to your door: Razor Blades have always been high-margin products, and Gillette was one of the original innovators by giving away the razor handle to make money on the subsequent razor blade sales. Dollar Shave Club has taken a different approach, by reducing the cost of each set of blades, but having people join a subscription service where blades are delivered to them automatically. While the margin on each set of blades is lower than retail, the subscription model has provided steady, predictable revenue for the company, to the extend that subscription boxes can now be found for almost any consumable product.
• Zipline – Blood Delivery for remote areas: In hospital settings, getting fresh blood can a matter of life and death. Unfortunately, many Sub-Sharan African countries don’t have road infrastructure suitable for quickly delivering blood between hospitals or storage locations. This is why Zipline has developed a simple, reliable drone network where hospitals in Rwanda and Ghana can order fresh blood from a central processing area and receive it within an average of 15 minutes, rather than the hours or days it would take using conventional transportation.
• 3D Printers – produce whatever you need at home: Instead of a single company, the industry of 3D printers is slowly beginning to change the way in which consumers get simple tools and parts. By downloading schematics from the internet (or designing their own), people owning a 3D printer now no longer to go to a retail location or order the parts they need. In commercial settings, this is also speeding up how quickly companies are able to prototype new ideas and designs, waiting hours rather than days or weeks.

zipline blood drone innovation

9) Brand: How you represent your offerings and business

Brand innovations help to ensure that customers and users recognize, remember, and prefer your offerings to those of competitors or substitutes. Great ones distill a “promise” that attracts buyers and conveys a distinct identity.

They are typically the result of carefully crafted strategies that are implemented across many touchpoints between your company and your customers, including communications, advertising, service interactions, channel environments, and employee and business partner conduct. Brand innovations can transform commodities into prized products, and confer meaning, intent, and value to your offerings and your enterprise.

• Gillette / Nike – being willing to lose customers who don’t align with purpose: I have combined both Gillette and Nike into this example of brand innovation since they have both recently aligned their brands to a purpose (social and political), which has been positively welcomed by some people but has resulted in hatred from other groups. Nike began by making former NFL Quarterback Colin Kaepernick the face and voice of one of their advertising campaigns. Kaepernick rose in prominence when he refused to stand during the national anthem before his games, his way of protesting the police brutality and inequality towards his African American community. This led to some people claiming he was disrespecting the American Flag, and therefore what the flag stands for. When his advert launched, a vocal minority took to social media to upload videos of themselves saying that Nike no longer aligned with their values, and they burned their shoes, vowing to never buy Nike again. Similarily, Gillette came out with a commercial urging all men to be “The best a man can be”, by pushing aside previously ‘masculine’ traits like bullying, chauvinism or fighting, and showing children how a modern man should behave. As soon as the ad was released online, many media outlets praised its message, but it brought the wrath of angry men who claimed that the razor manufacturer shouldn’t tell them what to think or how to behave, how they would never buy the products again, and how the world was becoming too politically correct, with women and minorities getting preferential treatment over white men. The advert quickly became one of the most disliked videos on Youtube, and even my commentary about the innovative message (seen in the video below) had the comments section covered by hate-filled messages. What both Nike and Gillette realised was that if they wanted to align with positive, progressive messages and values (which align with their target demographic of the future), then they would risk upsetting and alienating the proportion of their current customer base who didn’t share those views. In both cases, these were decisions that would have been signed off by all levels in the company, through marketing, sales, legal and the board, and the brands will be stronger in the future because of it.
• Burberry – modernising a classic brand: Burberry had built its luxury fashion reputation by aligning itself with the British Aristocracy, and its famous chequer patterned fabric was iconic. However, when trying to modernise and make the brand “sexy” in the early 2000s, a misstep happened when the luxury house began to license the chequered fabric, resulting in it becoming a status symbol and desired motif for a different social group: the British “Chavs” (rough, lower class and sometimes aggressive). This poisoned the once iconic brand in the eyes of their intended luxury clientele. In order to survive, the company and brand embraced innovation , by becoming one of the first fashion houses to redesign their website to be mobile-optimised, aligning their store layout to mirror the website, highlighting young British talent and livestreaming content and fashion shows. Most importantly, they moved away from the iconic chequer pattern in their fashion designs, where it is now limited to less than 10% of products.

10) Customer Engagement: How you foster compelling interactions

Customer Engagement innovations are all about understanding the deep-seated aspirations of customers and users, and using those insights to develop meaningful connections between them and your company.

Great Customer Engagement innovations provide broad avenues for exploration and help people find ways to make parts of their lives more memorable, fulfilling, delightful — even magical.

• REI – closing their stores on the busiest shopping day: Outdoor equipment retailer REI had begun closing its doors on Black Friday , traditionally one of the busiest shopping days of the year. They claim they are doing this to Eddie their customers to actually get outdoors and use their equipment, rather than queuing for discounted material goods.
• Peloton – bringing the gym into the home: Many people benefit from going to joint gym classes because the sense of a group working toward is goals together with a coach is more powerful than trying to exercise by yourself. Peloton makes exercise equipment with built-in screens, powered by a subscription to live and on-demand classes. It’s like being part of a workout group with the benefits of being at home.
• NBA – bringing the fans into the action: The NBA had invested heavily in innovation to make their sport more immersive. From live analytics and player statistics, new ways to watch like VR video, and official video game players for each team, they are finding new ways to bring basketball to the next generation, while making it even more exciting for existing fans.

Peloton brings exercise classes into the home

There we go, a new set of 30 examples of the Ten Types of Innovation.

If you found some of these examples interesting, please share the article.

Can you think of any more good examples? Let me know in the comments below.

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great examples! I now feel inspired to innovate in my entrepreneurial project. Thank you ?

Greetings from Mexico

Excellent work!

They’s very interesting. Do you have the solutions of some of recent examples?

My university has taken pretty much everything from here, poorly rephrased a few things and have delivered it to us, the student, as an entire weeks worth of content. Maybe i should be paying my fees here…

Bachelor of business student Australia

Very interesting. Which course was it being used for?

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Home » Change Management » Amazon: The Ultimate Change Management Case Study

Amazon: The Ultimate Change Management Case Study

Amazon’s innovations have helped it become extremely successful, making it an excellent change management case study.

Since it was formed, Amazon has innovated across countless areas and industries, including:

• Warehouse automation
• The web server industry
• Streaming video and on-demand media
• Electronic books

Considering that Amazon started as an online bookstore, these accomplishments are quite impressive.

Examining Amazon as a change management highlights a few important business lessons:

• Innovation fuels success, especially in today’s digital economy
• Speed is the ultimate weapon
• Those who resist organizational change can easily get left behind

Below, we’ll examine some of Amazon’s changes … and hopefully discover a few reasons why it has become so successful.

Let’s get started.

Below are 10 ways Amazon has changed its business, transforming itself far beyond a mere online bookseller.

In no particular order…

1. Amazon Web Services

When Amazon Web Services (AWS) started out, most developers didn’t take it seriously.

A decade later, it was the go-to cloud server company in the world.

In fact, Bezos has even said that AWS was the biggest part of the company.

Since it has more capacity than its nearest 14 competitors combined, this shouldn’t come as a surprise.

2. Whole Foods

After acquiring Whole Foods , Amazon began making changes to the grocery store chain.

A few of these include:

• Adding Amazon products to the shelves
• Integrating Whole Foods and Amazon Prime
• Internal restructuring

Other programs include food delivery from Whole Foods, rewards for customers using Amazon credit cards, and discounts for Prime members.

3. Delivery

Amazon has drastically innovated product delivery.

For instance, customers with Prime memberships can enjoy free two-day delivery.

In certain cities , Prime members can also get free same-day or one-day delivery.

And with its drone delivery program on the horizon, customers may be able to receive orders in 30 minutes or less .

4. Warehouse Automation

Amazon warehouses have undergone major technological transformations.

Currently, Amazon warehouses uses robots to collect and transport many of its products.

In coming years, though, even more of the company’s 200,000+ warehouse workers could be replaced by robots .

In 2016 alone, it increased robot workers by 50% .

5. TV and Prime Video

Another innovation of the former bookseller is its foray into TV, movies, and video.

Amazon began by selling videos and DVDs. Now it streams, rents, and sells digital copies of videos.

On top of that, the company has joined YouTube, Netflix, and other tech giants by producing its own movies and TV shows.

6. Amazon in Other Countries

Change managers would also be interested in how Amazon adapts itself to other countries’ economies.

In India, for instance, Amazon has been forced to adopt unique measures.

These include:

• Using mom-n-pop stores as delivery locations
• Hiring bicycle or motorcycle couriers for last-mile deliveries
• Creating mobile tea carts that serve tea and teach business owners about e-commerce

These types of innovations are necessary to succeed in other countries.

Failure to adapt to these changes often proves disastrous, which is a major reason why Google China failed .

7. Amazon Go

Amazon isn’t just an online retailer … it has now opened up physical grocery stores.

However, as with all of its business ventures, it aims to disrupt, transform, and dominate retail grocery stores.

In this case, Amazon wants to create grocery stores with zero clerks .

Amazon Go is a venture that promises no checkout lines, no hassle, and ultra-convenience.

8. Kindle and E-Books

Everyone knows that Kindle has been one of Amazon’s biggest innovations.

This product has single-handedly revolutionized the book publishing industry.

For better or for worse, Kindle has changed the way books are read, sold, and distributed.

Some estimates have placed Kindle e-book revenue at over half a billion dollars per year.

9. Affiliate Marketing

Early on in Amazon’s career, it opened its doors to online sales associates.

Members of Amazon Associates can earn revenue by sending web visitors to the sales giant.

According to Amazon, there are over 900,000 global members – all working to promote the company’s products and online presence.

10. Blue Origin

Technically speaking, Blue Origin is a different company from Amazon.

However, it’s worth noting that Amazon and Jeff Bezos can hardly be separated.

Without the famous founder’s extreme drive and vision, Amazon wouldn’t be what it is today.

And without his willingness to innovate, he never would have founded Blue Origin.

Like Elon Musk’s SpaceX, Blue Origin literally aims for the stars.

Its mission and goal – “millions of people living and working in space.”

Conclusion: Amazon Proves that Change Drives Success

It’s safe to say that Amazon’s defining trait has been its willingness to change.

What started as an online bookstore has become a multi-industry behemoth.

It has crushed companies that don’t innovate … it has revolutionized several industries … and it shows no signs of slowing.

The biggest lesson from this change management case study?

Innovation and change drive success .

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Short Case Study on Change Management

A short case study on change management can be very helpful in learning how to manage change effectively. In today’s business world, change is constantly happening and it can be very difficult to keep up.

Having a solid understanding of change management is essential for any manager or business owner.

A good case study will show you how one company successfully managed a major change and what lessons can be learned from their experience.

By studying short case study on change management, you will gain valuable insights into the importance of planning, communication, and employee involvement when managing change.

You will also learn about the different stages of change and how to overcome resistance to change.

These are all important topics that any manager or business owner should be familiar with. Learning about them through a short case study is an excellent way to gain a better understanding of these concepts.

Here are 05 short case studies on change management that offer you valuable insights on managing change.

1. Adobe- a transformation of HR functions to support strategic change

Many a times external factors lead to changes in organisational structures and culture. This truly happened at Adobe which has 11,000 employees worldwide with 4.5 billion $ yearly revenue.

Acrobat, Flash Player, and Photoshop are among the well-known products of Abode.

Due to new emerging technologies and challenges posed by small competitors Adobe had to stop selling its licensed goods in shrink-wrapped containers in 2011 and switched to offering digital services through the cloud. They gave their customers option of downloading the necessary software for free or subscribing to it every month rather than receiving a CD in a box.

The human resource (HR) function also took on a new role, which meant that employees had to adjust to new working practices. A standard administrative HR function was housed at Adobe’s offices. However, it was less suitable for the cloud-based strategy and performed well when Adobe was selling software items. 

HR changed its role and became more human centric and reduced its office based functions.

The HR personnel did “walk-ins,” to see what assistance they might offer, rather than waiting for calls. With a focus on innovation, change, and personal growth, Adobe employed a sizable percentage of millennials.

Instead of having an annual reviews, staff members can now use the new “check-in” method to assess and define their own growth goals whenever they find it necessary, with quick and continuous feedback. 

Managers might receive constructive criticism from HR through the workshops they conduct. The least number of employees have left since this changed approach of HR.

Why did Adobe’s HR department make this change? Since the company’s goals and culture have changed, HR discovered new ways to operate to support these changes.

2. Intuit – applying 7s framework of change management 

Steve Bennett, a vice president of GE Capital, was appointed CEO of Intuit in 2000. Intuit is a provider of financial software solutions with three products: Quicken, TurboTax, and QuickBooks, which have respective market shares of 73 percent, 81 percent, and 84 percent. 

Despite this market domination, many observers believed Intuit was not making as much money as it could.

Additionally, the business was known for making decisions slowly, which let rivals take advantage of numerous market opportunities. Bennett desired to change everything.

In his first few weeks, he spoke with each of the top 200 executives, visited the majority of Intuit’s offices, and addressed the majority of its 5,000 employees.

He concluded that although employees were enthusiastic about the company’s products, internal processes weren’t given any thought (based on Higgins, 2005).

He followed the famous Mckinsey 7S Model for Change Management to transform the organization. Let’s see what are those changes that he made:

By making acquisitions, he increased the products range for Intuit.

He established a flatter organizational structure and decentralized decision-making, which gave business units more authority and accountability throughout the whole product creation and distribution process.

To accomplish strategic goals, the rewards system was made more aligned to strategic goals.

He emphasized the necessity of a performance-oriented focus and offered a vision for change and also made every effort to sell that vision.

He acknowledged the commitment of staff to Intuit’s products and further strengthened process by emphasizing on quality and efficiency of his team.

Resources were allotted for learning and development, and certain selected managers were recruited from GE in particular skill categories, all to enhance staff capabilities concerning productivity and efficiency.

Superordinate goals:

Bennett’s strategy was “vision-driven” and he communicated that vision to his team regularly to meet the goals.

Bennett’s modifications led to a 40–50% rise in operating profits in 2002 and 2003.

8,000 people worked for Intuit in the United States, Canada, the United Kingdom, India, and other nations in 2014, and the company generated global revenues of nearly $5 billion.

3. Barclays Bank – a change in ways of doing business

The financial services industry suffered heavily during mortgage crisis in 2008. In addition to significant losses, the sector also had to deal with strict and aggressive regulations of their investing activities.

To expand its business, more employees were hired by Barclays Capital under the leadership of its former chief executive, Bob Diamond, who wanted to make it the largest investment bank in the world. 

But Barclays Capital staff was found manipulating the London Inter-Bank Offered Rate (LIBOR) and Barclays was fined £290 million and as a result of this the bank’s chairman, CEO, and COO had to resign.

In an internal review it was found that the mindset of “win at all costs” needed to be changed so a new strategy was necessary due to the reputational damage done by the LIBOR affair and new regulatory restrictions. 

In 2012, Antony Jenkins became new CEO. He made the following changes in 2014, which led to increase of 8% in share price.

Aspirations

The word “Capital” was removed from the firm name, which became just Barclays. To concentrate on the U.S. and UK markets, on Africa, and on a small number of Asian clients, the “world leader” goal was dropped.

Business model

Physical commodities and obscure “derivative” products would no longer be traded by Barclays. It was decided that rather than using its customers’ money, the business would invest its own.

Only thirty percent of the bank’s profits came from investment banking. Instead of concentrating on lending at high risk, the focus was on a smaller range of customers.

In place of an aggressive, short-term growth strategy that rewarded commercial drive and success and fostered a culture of fear of not meeting targets, “customer first,” clarity, and openness took precedence. Investment bankers’ remuneration was also reduced.

Beginning in 2014, branches were shut, and 19,000 jobs were lost over three years, including 7,000 investment banking employees, personnel at high-street firms, and many in New York and London headquarters. £1.7 billion in costs were reduced in 2014.

There was an increase in customers’ online or mobile banking, and increased automation of transactions to lower expenses.  To assist customers in using new computer systems, 30 fully automated branches were established by 2014, replacing the 6,500 cashiers that were lost to this change with “digital eagles” who used iPads.

These changes were made to build an organization that is stronger, more integrated, leaner, and more streamlined, leading to a higher return on equity and better returns for shareholders. This was also done to rebuild the bank’s credibility and win back the trust of its clients.

4. Kodak – a failure to embrace disruptive change

The first digital camera and the first-megapixel camera were both created by Kodak in 1975 and 1986 respectively.

Why then did Kodak declare bankruptcy in 2012? 

When this new technology first came out in 1975, it was expensive and had poor quality of images. Kodak anticipated that it would be at least additional ten years until digital technology started to pose a threat to their long-standing business of camera, film, chemical, and photo-printing paper industries.

Although that prediction came true, Kodak chose to increase the film’s quality through ongoing advances rather than embracing change and working on digital technology.

Kodak continued with old business model and captured market by 90% of the film and 85% of the cameras sold in America in 1976. With $16 billion in annual sales at its peak, Kodak’s profits in 1999 was around $2.5 billion. The brand’s confidence was boosted by this success but there was complete complacency in terms of embracing new technology.

Kodak started experiencing losses in 2011 as revenues dropped to $6.2 billion. 

Fuji, a competitor of Kodak, identified the same threat and decided to transition to digital while making the most money possible from film and creating new commercial ventures, such as cosmetics based on chemicals used in film processing.

Even though both businesses had the same information, they made different judgments, and Kodak was reluctant to respond. And when it started to switch towards digital technology, mobile phones with in-built digital camera had arrived to disrupt digital cameras.

Although Kodak developed the technology, they were unaware of how revolutionary digitalization would prove to be, rendering their long-standing industry obsolete.

You can read here in detail Kodak change management failure case study.

5. Heinz   – a 3G way to make changes

Warren Buffett’s Berkshire Hathaway and the Brazilian private equity business 3G Capital paid $29 billion in 2013 to acquire Heinz, the renowned food manufacturer with $11.6 billion in yearly sales.

The modifications were made right away by the new owners. Eleven of the top twelve executives were replaced, 600 employees were let go, corporate planes were sold, personal offices were eliminated, and executives were required to stay at Holiday Inn hotel rather than the Ritz-Carlton when traveling and substantially longer work hours were anticipated. 

Each employee was given a monthly copy restriction of 200 by micromanagement, and printer usage was recorded. Only 100 business cards were permitted each year for executives.

Numerous Heinz workers spoke of “an insular management style” where only a small inner circle knows what is truly going on.

On the other side, 3G had a youthful team of executives, largely from Brazil, who moved from company to company as instructed across nations and industries. They were loyal to 3G, not Heinz, and were motivated to perform well to earn bonuses or stock options. 

“The 3G way,” a theory that 3G has applied to bring about change in prior acquisitions like Burger King, was the driving reason behind these modifications. Everything was measured, efficiency was paramount, and “nonstrategic costs” were drastically reduced. 

From this vantage point, “lean and mean” prevails, and human capital was not regarded as a crucial element of business success. It was believed that rather than being driven by a feeling of purpose or mission, employees were motivated by the financial gains associated with holding company stock.

Because it had been well-received by the 3G partners, those who might be impacted by a deal frequently saw a “how to” guide published by consultant Bob Fifer as a “must read.”

However, many food industry experts felt that while some of 3G’s prior acquisitions would have been ideal candidates for a program of cost-cutting, Heinz was not the most appropriate choice to “hack and slash.” The company had already undergone several years of improved efficiency and it was already a well-established player in the market.

In summarizing the situation, business journalists Jennifer Reingold and Daniel Roberts predicted that “the experiment now underway will determine whether Heinz will become a newly invigorated embodiment of efficiency—or whether 3G will take the cult of cost-cutting so far that it chokes off Heinz’s ability to innovate and make the products that have made it a market leader for almost a century and a half.” 

Final Words

A short case study on change management can be a helpful tool in learning how to effectively manage change. These case studies will show you how one company successfully managed a major change and what lessons can be learned from their experience. By studying these case studies, you will gain valuable insights into the importance of planning, communication, and employee involvement when managing change. These are all vital elements that must be considered when implementing any type of change within an organization.

About The Author

Tahir Abbas

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Case study on Amazon’s approach to innovation and competition in the knowledge economy

Admin on 13/03/2020

Introduction

Amazon is generally regarded as one of the most innovative companies in the world (Reed, 2017). In considering how Amazon approaches innovation within the knowledge economy we’ll frame the analysis of new technologies by looking at McKinsey’s research on disruptive technologies that have potential for economic impact, how Amazon has approached innovation in each of these new technologies, and consider how innovation has impacted Amazon’s revenue growth.

Amazon’s approach to innovation

Since beginning in 1995 as an online bookstore Amazon has expanded into ecommerce marketplace, digital advertising, cloud computing, groceries and apparel, and artificial intelligence industries. Amazon’s investment strategy for innovation is to act like a growth investor, spreading it’s investments across a diverse range of sectors and industries. This is a markedly different strategy to other tech giants who choose to focus the majority of their innovation efforts within their core competencies e.g. Facebook with social networks and Apple with consumer electronic devices (Bowman, 2017).

Jeff Bezo, CEO of Amazon, explains, “Because of our emphasis on the long-term, we may make decisions and weigh tradeoffs differently than some companies… We will continue to make investment decisions in light of long-term market leadership considerations rather than short-term profitability considerations” (Bezos, 1997). It is through this approach to innovation that Amazon seeks to develop monopolies in all of the sectors that it enters.

McKinsey Global Institute’s report (Fig. 1) on disruptive technologies identifies “12 technologies that could drive truly massive economic transformations and disruptions in the coming years” (Manyika et al, 2013). Amazon is publicly investing in at least eight of the twelve technologies, through investing in companies that are working on new technologies, utilising the new technology to build organisational capacity and improve productivity, and through commercialising the new technologies in ways that enable Amazon’s business customers to implement within their companies.

Amazon is known for its secrecy around innovation, necessarily so in order to protect its trade secrets, but by looking at how Amazon approaches the six most impactful disruptive technologies we can gain an understanding of how Amazon approaches innovation.

Mobile Internet

“Increasingly inexpensive and capable mobile computing devices and Internet connectivity”

Amazon’s Kindle eReader, which launched in 2007, wasn’t the first eReader on the market but with it’s innovative WiFi hardware and Kindle Direct Publishing, the self-publishing platform, it enabled customers to have thousands of books available within seconds and authors to publish their writing without relying on the publishing industry (Fox Rubin, 2017). Whilst the design of the device was very similar to other eReaders, it was Amazon’s move to create its own ebook format and the Kindle Direct Publishing Network to allow ebooks to be published in its own format that fits with Amazon’s approach to innovation.

Whilst the majority of manufacturers were focused on developing eReader devices that could support .epub as the main format for ebooks, Amazon was instead establishing a core competency around its own format and publishing network. Developing the device was a complementary competency for Amazon, although one important enough for Amazon to ensure it controlled the device as part of the value chain for ebooks.

The digitization of books was a technological breakthrough which following Anderson and Tuishman’s evolutionary model of technological change, resulted in lots of technical variation in the formats available. Over the first decade the variations in formats reduced until the current situation of having two formats, epub and Amazon KIndle format, available. The ebook market hasn’t yet arrived at a single dominant design (Anderson & Tushman, 1990. Suárez & Utterback, 1995) however as Amazon currently dominates the eReader market with 60% of worldwide device sales in 2017 (Fox Rubin, 2017), only time will tell if the Amazon format for ebooks becomes the dominant design.

Automation of knowledge work

“Intelligent software systems that can perform knowledge-work tasks”

In 2018 Amazon “reorganised around Artificial Intelligence” (Morgan, 2018). This reorganisation focused other teams and departments at Amazon to utilise AI in their products and services, including warehouse management, recommendations on Amazon Music, Prime Video and on the ecommerce marketplace, Alexa and the Amazon Go store (Levy, 2018). This demonstrates Amazon’s approach to automating knowledge work. AI isn’t considered a single product that remains within a single team, it is a technology and capability that Amazon clearly regards as a core competency that should be utilised in as many ways as possible in order to give Amazon a competitive advantage in all of the sectors it operates in.

This is an example of what Tushman and Anderson explain when they say, “Technological innovation affects not only a given population, but also those populations within technologically interdependent communities” (Tushman & Anderson, 1986). Amazon leveraged the technological innovation of AI to gain benefits across all areas of its business, however it remains unclear whether this new technology was a competence-destroying because it required completely different skills and knowledge to operate or competence-enhancing because it built “on existing know how yet did not render skills obsolete” (Tushman and Anderson 1986).

Having realised the benefits Amazon went on to commercialise it’s AI by creating AutoGluon, a service that enables developers to build applications involving machine learning on top of AWS (Hepburn, 2020). “Commercial AI has enjoyed what we at Amazon call the flywheel effect: customer interactions with AI systems generate data; with more data, machine learning algorithms perform better, which leads to better customer experiences; better customer experiences drive more usage and engagement, which in turn generate more data.” (Sarikaya, 2019).

Internet of Things

“Networks of low-cost sensors and actuators for data collection, monitoring, decision making, and process optimisation”

The Amazon Dash, an internet-enabled button for making repeat purchases, was Amazon’s move into Internet of Things devices. On sale for less than four years the device fell foul of consumer protection laws in Germany, Amazon’s second biggest market at the time, where a court ruled that Amazon Dash didn’t provide customers with enough information to make informed purchases (Jagannathan, 2019). Although a regulatory and revenue-generating failure, the device may have been more of a success in establishing Amazon’s first-mover advantage into the market of consumer IoT devices and in collecting data on buying behaviour (Newman, 2016) to inform the next generation of devices.

Echo and Dot, the home speakers with the Alexa voice technology, soon replaced the Dash as a means of making purchases easier for consumers and as a means of collecting data on buying behaviour, data which could also be used to train the machine learning algorithms that powered Alexa. Voice-powered machine learning algorithms are intangible assets that require investment but have different economic characteristics to tangible assets (Haskell & Westlake, 2017):

• Sunk costs – represent an investment that is unlikely to deliver a return in the way a tangible asset would if resold as intangible assets are difficult to sell as they are often bespoke to the company developing them, as in the case of Alexa algorithms.
• Spillovers – are benefits competitors may gain from appropriating intangible assets such as the design of a device which is easy to reverse engineer. Amazon’s defense is to focus more on things that are difficult to copy such as bespoke algorithms.
• Scalability – a characteristic of an intangible asset that can be leveraged in ways that tangible assets cannot without increased investment, such as the Alexa algorithm which works on all Alexa powered devices, but also the ‘brand’ of Alexa as a likeable, humanised, ‘part of the family’ voice assistant in comparison to Google choice to call its voice assistant Google.
• Synergies – occur when intangible assets become more valuable together than in isolation. Alexa has more value because it connects to Amazon’s ecommerce systems and allows customers to make purchases, and because Amazon allows developers to build other services on top of the Amazon ecosystem that enables customers to control the heating and lighting in their homes.

Amazon’s approach to investing more in its intangible assets, such as algorithms, than in the physical devices seems to suggest that they recognise the competitive advantage intangible assets can give them a over other companies, but also that they recognise the risks Haskell and Westlake point out can be associated with this kind of investment (Haskell & Westlake, 2017). The economic value of intangible assets in the case of Alexa comes from strategic choices about how they are leveraged to drive purchasing behaviour in customers.

“Use of computer hardware and software resources to deliver services of the Internet ”

Amazon Web Services is a leading (Gartner, 2018) infrastructure-as-a-service provider. Gartner calls out AWS’ “prioritisation of being first to market” along with being the “most mature enterprise-ready provider, with the strongest track record of customer success” as key aspects of being a leading cloud provider (Bala, et al, 2018). AWS started from the needs of Amazon’s ecommerce business, which required reliable, scalable technology to power its growth in the early 2000’s. By 2003, providing infrastructure services and reliable, scalable data-centers was considered a core competency by Bezos and Amazon senior executives. When Amazon launched AWS in 2006 they were “first to market with a modern cloud infrastructure” (Miller, 2016). AWS holds 40% of the market share in cloud computing (Carey, 2019), a position it gained by building on core competencies it owned in other areas of its business and being years ahead of competitors (Miller, 2016).

Teece talks about the ‘perplexing’ problem of how many companies who are first to market with an innovation are not the ones to commercialise and profit from it. With AWS, Amazon demonstrated that it’s approach to innovation can deliver on significant commercial success. Teece’s framework for determining which company will win from introducing innovation involves understanding the appropriability; the environmental factors that affect the ability to capture profits from an innovation, the design phase; whether a dominant design has emerged, and the competencies necessary for the commercialisation of the innovation.

In the early 2000s, cloud infrastructure services had what Teece describes as a “tight appropriability regime” (Teece, 1986). The environments in which the technology for providing infrastructure services over the internet existed was easy to protect simply because competitors were not yet building their core competencies in cloud. Having a “tight appropriability regime” for cloud services gave AWS the time it needed to launch its products and services before the regime weakened and other entrants could imitate the technology.

At the time of launching AWS, cloud infrastructure services were pre-paradigmatic, the majority of infrastructure providers weren’t even considering cloud, so there was no dominant design. Teece says that, “when imitation is possible and occurs coupled with design modification before the emergence of a dominant design, followers have a good chance of having their modified product anointed as the industry standard, often to the great disadvantage of the innovator.” (Teece, 1986), but this did not happen to Amazon.

Amazon already owned the complementary assets required to commercialise AWS successfully (procurement, marketing, sales, etc.) which removed any bargaining power issues that may have arisen from contracting assets, and put AWS in a good position to quickly establish the dominant design for cloud infrastructure services and so leverage its position as a first-to-market pre-paradigmatic innovator and as a paradigmatic market leader.

Advanced robotics

“Increasingly capable robots with enhanced sensors, dexterity, and intelligence; used to automate many tasks”

In 2012, Amazon acquired Kiva Systems, a small robotics company for $775 million providing Amazon with mobile robots and the technical expertise to begin automating its warehouses and sorting facilities. (Del Rey, 2019). This automation of the work of pickers and packers enabled Amazon to increase efficiency in its warehouse operations by reducing the time taken to pick items for delivery to its customers (Simon, 2019), and so driving the success of its ecommerce business. In 2019 Amazon introduced machines to automate putting customer orders into boxes ready for delivery, a job that was previously performed by thousands of workers. It “would amount to more than 1,300 cuts across 55 U.S. fulfillment centers for standard-sized inventory. Amazon would expect to recover the costs in under two years, at $1 million per machine plus operational expenses.”, reported Reuters (Dastin, 2019). Amazon currently has more than 200,000 mobile robots working inside its warehouse network, alongside hundreds of thousands of human workers.

Amazon, as a low margin business, seeks to organise its supply chain more effectively than its competitors to maximise profits (Teece, 1986). Automation increasingly allows for this in Amazon’s fulfilment business as it replaces the routine work (Autor, Levy & Murnane, 2003) of pickers and packers. In making capital investments in technologies to replace workers with robots Amazon could be said to be taking a skills-biased approach; that is, that it favours more highly skilled workers such as programmers, engineers and mechanics at the cost of lower skilled workers and assumes thats increased productivity for the company comes from fewer highly skilled workers over more lower skilled workers. Ordinarily we would expect that companies would make decisions about how much to invest in automation technologies by considering economic factors such as the cost of labour in a particular geographic market however, from what we’ve seen of Amazon’s investment strategy in innovation it seems more likely that Amazon is playing the long game with automation and betting on machines being capable of performing non-routine cognitive and manual tasks in the future (Frey & Osborne 2013) and so replacing lower skilled workers completely.

The adoption of automation in warehouses and fulfilment centres has been congruent with Amazon’s approach to innovation involving massive investment in technology that provides increased internal capabilities enabling Amazon to become a market leader and then selling that capability to businesses to deliver long term revenue gains. The question of whether robots will replace workers, at least in Amazon warehouses, seems to have an inevitable answer.

Autonomous or near-autonomous vehicles

“Vehicles that can navigate and operate autonomously or semi autonomously in many situations”

Amazon has invested $700 million in Rivian, the electric vehicle manufacturer and $530 million in Aurora, an autonomous driving startup. “For Amazon, this small investment is a good way to enlarge their bet on the E.V. [electric vehicle] market without having to tool up a plant to find out if it will fly. Over time, the Rivian investment could give Amazon a starting point to own and operate an in-house package delivery business.” (Mitchell, 2019).

Amazon has been developing delivery drones “that can fly up to 15 miles and deliver packages under five pounds to customers in less than 30 minutes.” (Vincent, 2019). Developing delivery drones and getting FAA approval might be considered a big enough innovation for most companies, but Amazon goes a huge step further by developing its own Air Traffic Control System for drones. “The system also gives aviation authorities, like the FAA, the ability to track the drones in the airspace to ensure safety and create “no fly zones” in times of emergency. The traffic management system is easy to use for various operators in the same airspace because it will connect via the internet” (Amazon, 2019). In a similar strategic play to the Kindle, Amazon realises that controlling the platform that controls the devices creates considerable more competitive advantage than simply developing the best drones.

Developing drones and autonomous electric vehicles will reduce Amazon’s reliance on third-party delivery partners and own the supply chain (Prosser, 2019), and conceivably it could commercialise the service to compete with FedEx, UPS, etc., and thus drive increased revenue for the company, but in order to do so it needs to protect the design of the drones and vehicles from competitors. Archibugi & Pianta explain that, “technological change impinges on codified and tacit knowledge… innovations can either be embodied in capital goods and products or disembodied, i.e. the know-how included in patents” (Archibugi & Pianta, 1996). As it is almost impossible to protect designs for publicly available machines like drones through trade secrets in the way Amazon does for its software and algorithms, Amazon needs to file patents to protect its disembodied codified knowledge in order to continue to be innovative.

In 2019 Amazon filed over two thousand patents (Capriel, 2019) many for drones and autonomous vehicles, and since 2010 Amazon has grown its patent portfolio from less than 1,000 active patents in 2010 to nearly 10,000 in 2019 (Columbus, 2019), a ten-fold increase in less than a decade (Fig. 2).

Patents can be used strategically by companies in a number of ways; to protect inventions with the intention of commercialising them, or simply to prevent competitors from entering the space. This makes the number of patents filed a poor indicator of innovation, and so it seems that the number of patents Amazon has filed has increased over time because they have become involved in more sectors and industries rather than because they have become more innovative.

Amazon’s sources of competitive advantage

These six examples demonstrate Amazon’s superior ability over its competitors and how they employ the same approach towards innovation; not constrained to sectors or industries that they have previously operated in, investing huge amounts to own the sector they move into, building core competencies in their value chain to protect their own competitiveness, and making new technologies available outside their own ecosystem to allow their customers to leverage the technology in ways that support and scale Amazon’s business model, in many cases the customer becoming reliant on Amazon in their value chain, for example Netflix using AWS (Uenlue, 2018).

Amazon’s economic growth from innovation

Amazon’s approach to innovating across multiple sectors and industries has given them significant competitive advantage and commercial success, growing from $6.92 billion in 2004 to $280.52 bn in 2019 (Clement, 2020), an almost 4000% increase.

The breakdown of Amazon’s commercial performance by it’s main areas of business in 2018 shows it’s longstanding ecommerce business as the main revenue producing business (Day & Gu, 2019):

• Ecommerce: $234.61 bn sales
• Cloud computing: $25.6 bn in revenue
• Groceries: $25.4 bn in sales
• Online apparel: $24.61 bn in sales
• Consumables: $23.6 bn in sales
• Digital advertising: $7.4 bn in revenue

Of the six disruptive innovations discussed above, only cloud computing, where Amazon is the market leader, generates significant income. This reflects Amazon’s approach to innovation involving long-term investment to establish commercial success.

Amazon has earned its reputation as one of the most innovative companies in the world. Amazon’s approach innovation can be broadly summed up in three parts:

• Large investments and acquisitions in software and hardware startups spread across multiple sectors and industries. This puts Amazon in control of the value chain and reduces the risk of suppliers holding strong bargaining positions.
• Use the technology that is produced to develop efficiency and productivity gains in products and services in a diverse range of sectors and ensure competitive advantage over the long term.
• Commercialise those products and services, allowing other companies to leverage them, generating revenue and creating lock-in network effects (Katz & Shapiro, 1994) for those companies and Amazon’s customers.

This approach to innovation has enabled Amazon to develop significantly successful businesses in ecommerce, cloud computing, digital advertising and retail, and is likely to contribute to Amazon’s continued success into the future.

Reed, N. 2017. Why Amazon Is The World’s Most Innovative Company Of 2017. Fast Company.

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Suárez, F. F. and Utterback, J. M.. 1995. Dominant Designs and the Survival of Firms. Strategic Management Journal, Vol. 16, No. 6 (Sep., 1995), pp. 415-430. Wiley

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Levy, S. 1990. Inside Amazon’s Artificial Intelligence Flywheel. Wired.com .

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Dastin, J. 2019. Amazon rolls out machines that pack orders and replace jobs. Reuters.

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Frey, C. B. & Michael A. Osborne, M. A. 2013. The Future Of Employment: How Susceptible Are Jobs To Computerisation? Oxford Martin School, University of Oxford, Oxford.

Mitchell, O. 2019. Amazon keeps on truckin’ with autonomous vehicle investments. The Robot Report.

Vincent, J. 2019. Here’s Amazon’s new transforming Prime Air delivery drone. The Verge.

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Capriel, J. 2019. The most interesting Amazon patents of 2019: From drones that follow you home to virtual reality noses. Washington Business Journal.

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Clement, J. 2020. Annual net sales of Amazon 2004-2019. Statista.

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Case study on adoption of new technology for innovation: Perspective of institutional and corporate entrepreneurship

Asia Pacific Journal of Innovation and Entrepreneurship

ISSN : 2398-7812

Article publication date: 7 August 2017

This paper aims at investigating the role of institutional entrepreneurship and corporate entrepreneurship to cope with firm’ impasses by adoption of the new technology ahead of other firms. Also, this paper elucidates the importance of own specific institutional and corporate entrepreneurship created from firm’s norm.

Design/methodology/approach

The utilized research frame is as follows: first, perspective of studies on institutional and corporate entrepreneurship are performed using prior literature and preliminary references; second, analytical research frame was proposed; finally, phase-based cases are conducted so as to identify research objective.

Kumho Tire was the first tire manufacturer in the world to exploit the utilization of radio-frequency identification for passenger carâ’s tire. Kumho Tire takes great satisfaction in lots of failures to develop the cutting edge technology using advanced information and communication technology cultivated by heterogeneous institution and corporate entrepreneurship.

Originality/value

The firm concentrated its resources into building the organization’s communication process and enhancing the quality of its human resources from the early stages of their birth so as to create distinguishable corporate entrepreneurship.

• Corporate entrepreneurship
• Institutional entrepreneurship

Han, J. and Park, C.-m. (2017), "Case study on adoption of new technology for innovation: Perspective of institutional and corporate entrepreneurship", Asia Pacific Journal of Innovation and Entrepreneurship , Vol. 11 No. 2, pp. 144-158. https://doi.org/10.1108/APJIE-08-2017-031

Emerald Publishing Limited

Copyright © 2017, Junghee Han and Chang-min Park.

Published in the Asia Pacific Journal of Innovation and Entrepreneurship . Published by Emerald Publishing Limited. This article is published under the Creative Commons Attribution (CC BY 4.0) licence. Anyone may reproduce, distribute, translate and create derivative works of this article (for both commercial & non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this licence may be seen at http://creativecommons.org/licenses/by/4.0/legalcode

1. Introduction

Without the entrepreneur, invention and new knowledge possibly have lain dormant in the memory of persons or in the pages of literature. There is a Korean saying, “Even if the beads are too much, they become treasure after sewn”. This implies importance of entrepreneurship. In general, innovativeness and risk-taking are associated with entrepreneurial activity and, more importantly, are considered to be important attributes that impact the implementation of new knowledge pursuing.

Implementation of cutting edge technology ahead of other firms is an important mechanism for firms to achieve competitive advantage ( Capon et al. , 1990 ; D’Aveni, 1994 ). Certainly, new product innovation continues to play a vital role in competitive business environment and is considered to be a key driver of firm performance, especially as a significant form of corporate entrepreneurship ( Srivastava and Lee, 2005 ). Corporate entrepreneurship is critical success factor for a firm’s survival, profitability and growth ( Phan et al. , 2009 ).

The first-mover has identified innovativeness and risk-taking as important attributes of first movers. Lumpkin and Dess (1996) argued that proactiveness is a key entrepreneurial characteristic related to new technology adoption and product. This study aims to investigate the importance of corporate and institutional entrepreneurship through analyzing the K Tire’s first adaptation of Radio-frequency identification (RFID) among the world tire manufactures. Also, this paper can contribute to start ups’ readiness for cultivating of corporate and institutional entrepreneurship from initial stage to grow and survive.

K Tire is the Korean company that, for the first time in the world, applied RFID to manufacturing passenger vehicle tires in 2013. Through such efforts, the company has built an innovation model that utilizes ICTs. The adoption of the technology distinguishes K Tire from other competitors, which usually rely on bar codes. None of the global tire manufacturers have applied the RFID technology to passenger vehicle tires. K Tire’s decision to apply RFID to passenger vehicle tires for the first time in the global tire industry, despite the uncertainties associated with the adoption of innovative technologies, is being lauded as a successful case of innovation. In the global tire market, K Tire belongs to the second tier, rather than the leader group consisting of manufacturers with large market shares. Then, what led K Tire to apply RFID technology to the innovation of its manufacturing process? A company that adopts innovative technologies ahead of others, even if the company is a latecomer, demonstrates its distinguishing characteristics in terms of innovation. As such, this study was motivated by the following questions. With regard to the factors that facilitate innovation, first, what kind of the corporate and institutional situations that make a company more pursue innovation? Second, what are the technological situations? Third, how do the environmental situations affect innovation? A case study offers the benefit of a closer insight into the entrepreneurship frame of a specific company. This study has its frame work rooted in corporate entrepreneurship ( Guth and Ginsberg, 1990 ; Shane and Venkataraman, 2000 ) and institutional entrepreneurship ( Battilana, 2006 ; Fligstein, 1997 ; Rojas, 2010 ). As mentioned, we utilized qualitative research method ( Yin, 2008 ). This paper is structured as follows. Section two presents the literature review, and section three present the methodology and a research case. Four and five presents discussion and conclusions and implications, respectively.

2. Theoretical review and analysis model

RFID technology is to be considered as not high technology; however, it is an entirely cutting edged skills when combined with automotive tire manufacturing. To examine why and how the firm behaves like the first movers, taking incomparable high risks to achieve aims unlike others, we review three kinds of prior literature. As firms move from stage to stage, they have to revamp innovative capabilities to survive and ceaseless stimulate growth.

2.1 Nature of corporate entrepreneurship

Before reviewing the corporate entrepreneurship, it is needed to understand what entrepreneurship is. To more understand the role that entrepreneurship plays in modern economy, one need refer to insights given by Schumpeter (1942) or Kirzner (1997) . Schumpeter suggests that entrepreneurship is an engine of economic growth by utilization of new technologies. He also insists potential for serving to discipline firms in their struggle to survive gale of creative destruction. While Schumper argued principle of entrepreneurship, Kirzner explains the importance of opportunities. The disruptions generated by creative destruction are exploited by individuals who are alert enough to exploit the opportunities that arise ( Kirzner, 1997 ; Shane and Venkataraman, 2000 ).

Commonly all these perspectives on entrepreneurship is an appreciation that the emergence of novelty is not an easy or predictable process. Based on literature review, we note that entrepreneurship is heterogeneous interests and seek “something new” associated with novel outcomes. Considering the literature review, we can observe that entrepreneurship is the belief in individual autonomy and discretion, and a mindset that locates agency in individuals for creating new activities ( Meyer et al. ,1994 ; Jepperson and Meyer, 2001 ).

the firm’s commitment to innovation (including creation and introduction of products, emphasis on R&D investments and commitment to patenting);

the firm’s venturing activities, such as entry into new business fields by sponsoring new ventures and creating new businesses; and

strategic renewal efforts aimed at revitalizing the firm’s ability to compete.

developing innovation an organizational tool;

allowing the employees to propose ideas; and

encouraging and nurturing the new knowledge ( Hisrich, 1986 ; Kuratko, 2007 ).

Consistent with the above stream of research, our paper focuses on a firm’s new adaptation of RFID as a significant form of corporate entrepreneurial activity. Thus, CE refers to the activities a firm undertakes to stimulate innovation and encourage calculated risk taking throughout its operations. Considering prior literature reviews, we propose that corporate entrepreneurship is the process by which individuals inside the organization pursuing opportunities without regards to the resources they control.

If a firm has corporate entrepreneurship, innovation (i.e. transformation of the existing firm, the birth of new business organization and innovation) happens. In sum, corporate entrepreneurship plays a role to pursue to be a first mover from a latecomer by encompassing the three phenomena.

2.2 Institution and institutional entrepreneurship

Most literature regarding entrepreneurship deals with the attribute of individual behavior. More recently, scholars have attended to the wider ecosystem that serves to reinforce risk-taking behavior. Institution and institutional entrepreneurship is one way to look at ecosystem that how individuals and groups attempt to try to become entrepreneurial activities and innovation.

Each organization has original norm and intangible rules. According to the suggestion by Scott (1995) , institutions constrain behavior as a result of processes associated with institutional pillars. The question how actors within the organizations become motivated and enabled to transform the taken-for-granted structures has attracted substantial attention for institutionalist. To understand why some firms are more likely to seek innovation activities despite numerous difficulties and obstacles, we should take look at the institutional entrepreneurship.

the regulative, which induces worker’s action through coercion and formal sanction;

the normative, which induces worker’s action through norms of acceptability and ethics; and

the cognitive, which induces worker’s action through categories and frames by which actors know and interpret their world.

North (1990) defines institutions as the humanly devised constraints that structure human action. Actors within some organization with sufficient resources have intend to look at them an opportunity to realize interests that they value highly ( DiMaggio, 1988 ).

It opened institutional arguments to ideas from the co-evolving entrepreneurship literature ( Aldrich and Fiol, 1994 ; Aldrich and Martinez, 2001 ). The core argument of the institutional entrepreneurship is mechanisms enabling force to motivate for actors to act difficult task based on norm, culture and shared value. The innovation, adopting RFID, a technology not verified in terms of its effectiveness for tires, can be influenced by the institution of the society.

A firm is the organizations. An organization is situated within an institution that has social and economic norms. Opportunity is important for entrepreneurship. The concept of institutional entrepreneurship refer to the activities of worker or actor who have new opportunity to realize interest that they values highly ( DiMaggio, 1988 ). DiMaggio (1988) argues that opportunity for institutional entrepreneurship will be “seen” and “exploited” by within workers and not others depending on their resources and interests respectively.

Despite that ambiguity for success was given, opportunity and motivation for entrepreneurs to act strategically, shape emerging institutional arrangements or standards to their interests ( Fligstein and Mara-Drita, 1996 ; Garud et al. , 2002 ; Hargadon and Douglas, 2001 ; Maguire et al. , 2004 ).

Resource related to opportunity within institutional entrepreneurship include formal or informal authority and power ( Battilana, 2006 ; Rojas, 2010 ). Maguire et al. (2004) suggest legitimacy as an important ingredient related to opportunity for institutional entrepreneurship. Some scholars suggest opportunity resources for institutional entrepreneurship as various aspects. For instance, Marquire and Hardy (2009) show that knowledge and expertise is more crucial resources. Social capital, including market leadership and social network, is importance resource related to opportunity ( Garud et al. , 2002 ; Lawrence et al. , 2005 ; Townley, 2002 ). From a sociological perspective, change associated with entrepreneurship implies deviations from some norm ( Garud and Karnøe, 2003 ).

Institutional entrepreneurship is therefore a concept that reintroduces agency, interests and power into institutional analyses of organizations. Based on the previous discussion, this study defines institution as three processes of network activity; coercion and formal sanction, normative and cognitive, to acquire the external knowledge from adopting common goals and rules inside an organization. It would be an interesting approach to look into a specific company to see whether it is proactive towards adopting ICTs (e.g. RFID) and innovation on the basis of such theoretical background.

2.3. Theoretical analysis frame

Companies innovate themselves in response to the challenges of the ever-changing markets and technologies, so as to ensure their survival and growth ( Tushman and Anderson, 1986 ; Tidd and Bessant, 2009 ; Teece, 2014 ). As illustrated above, to achieve the purpose of this study, the researcher provides the following frames of analyses based on the theoretical background discussed above ( Figure 1 ).

3. Case study

3.1 methodology.

It is a highly complicated and tough task to analyze the long process of innovation at a company. In this paper, we used analytical approach rather than the problem-oriented method because the case is examined to find and understand what has happened and why. It is not necessary to identify problems or suggest solutions. Namely, this paper analyzes that “why K Tire becomes a first mover from a late comer through first adoption of RFID technology for automotive tire manufacture with regards to process and production innovations”.

To study the organizational characteristics such as corporate entrepreneurship, institutional entrepreneurship, innovation process of companies, the qualitative case study is the suitable method. This is because a case study is a useful method when verifying or expanding well-known theories or challenging a specific theory ( Yin, 2008 ). This study seeks to state the frame of analysis established, based on previously established theories through a single case. K Tire was selected as the sample because it is the first global tire manufacturer, first mover to achieve innovation by developing and applying RFID.

The data for the case study were collected as follows. First, this study was conducted from April 2015 to the end of December 2015. Additional expanded data also were collected from September 12 to November 22, 2016, to pursue the goal of this paper. Coauthor worked for K Tire for more than 30 year, and currently serves as the CEO of an affiliate company. As such, we had the most hands-on knowledge and directed data in the process of adoption RFID. This makes this case study a form of participant observation ( Yin, 2008 ). To secure data on institutional entrepreneurship, in-depth interviews were conducted with the vice president of K Tire. The required data were secured using e-mail, and the researchers accepted the interviewees’ demand to keep certain sensitive matters confidential. The interviewees agreed to record the interview sessions. In this way, a 20-min interview data were secured for each interviewee. In addition, apart from the internal data of the subject company, other objective data were obtained by investigating various literatures published through the press.

3.2 Company overview

In September 1960, K Tire was established in South Korea as the name of Samyang Tire. In that time, the domestic automobile industry in Korea was at a primitive stage, as were auto motive parts industries like the tire industry. K Tire products 20 tires a day, depending on manual labor because of our backward technology and shortage of facilities.

The growth of K Tire was astonishment. Despite the 1974 oil shock and difficulties in procuring raw materials, K Tire managed to achieve remarkable growth. In 1976, K Tire became the leader in the tire sector and was listed on the Korea Stock Exchange. Songjung plant II was added in 1977. Receiving the grand prize of the Korea Quality Control Award in 1979, K Tire sharpened its corporate image with the public. The turmoil of political instability and feverish democratization in the 1980s worsened the business environment. K Tire also underwent labor-management struggles but succeeded in straightening out one issue after another. In the meantime, the company chalked up a total output of 50 million tires, broke ground for its Koksung plant and completed its proving ground in preparation for a new takeoff.

In the 1990s, K Tire expanded its research capability and founded technical research centers in the USA and the United Kingdom to establish a global R&D network. It also concentrated its capabilities in securing the foundation as a global brand, by building world-class R&D capabilities and production systems. Even in the 2000s, the company maintained its growth as a global company through continued R&D efforts by securing its production and quality capabilities, supplying tires for new models to Mercedes, Benz, Volkswagen and other global auto manufacturers.

3.3 Implementation of radio-frequency identification technology

RFID is radio-frequency identification technology to recognize stored information by using a magnetic carrier wave. RFID tags can be either passive, active or battery-assisted passive (BAP). An active tag has an on-board battery and periodically transmits its ID signal. A BAP has a small battery on board and is activated when in the presence of an RFID reader. A passive tag is cheaper and smaller because it has no battery; instead, the tag uses the radio energy transmitted by the reader. However, to operate a passive tag, it must be illuminated with a power level roughly a thousand times stronger than for signal transmission. That makes a difference in interference and in exposure to radiation.

an integrated circuit for storing and processing information, modulating and demodulating a radio frequency signal, collecting DC power from the incident reader signal, and other specialized functions; and

an antenna for receiving and transmitting the signal.

capable of recognizing information without contact;

capable of recognizing information regardless of the direction;

capable of reading and saving a large amount of data;

requires less time to recognize information;

can be designed or manufactured in accordance with the system or environmental requirements;

capable of recognizing data unaffected by contamination or the environment;

not easily damaged and cheaper to maintain, compared with the bar code system; and

tags are reusable.

3.3.1 Phase 1. Background of exploitation of radio-frequency identification (2005-2010).

Despite rapid growth of K Tire since 1960, K Tire ranked at the 13th place in the global market (around 2 per cent of the global market share) as of 2012. To enlarge global market share is desperate homework. K Tire was indispensable to develop the discriminated technologies. When bar code system commonly used by the competitors, and the industry leaders, K Tire had a decision for adoption of RFID technology instead of bar code system for tires as a first mover strategy instead of a late comer with regard to manufacture tires for personal vehicle. In fact, K Tire met two kinds of hardship. Among the top 20, the second-tier companies with market shares of 1-2 per cent are immersed in fiercer competitions to advance their ranks. The fierceness of the competition is reflected in the fact that of the companies ranked between the 11th and 20th place, only two maintained their rank from 2013.

With the demand for stricter product quality control and manufacture history tracking expanding among the auto manufacturers, tire manufacturers have come to face the need to change their way of production and logistics management. Furthermore, a tire manufacturer cannot survive if it does not properly respond to the ever stricter and exacting demand for safe passenger vehicle tires of higher quality from customers and auto manufacturers. As mentioned above, K Tire became one of the top 10 companies in the global markets, recording fast growth until the early 2000. During this period, K Tire drew the attention of the global markets with a series of new technologies and innovative technologies through active R&D efforts. Of those new products, innovative products – such as ultra-high-performance tires – led the global markets and spurred the company’s growth. However, into the 2010s, the propriety of the UHP tire technology was gradually lost, and the effect of the innovation grew weaker as the global leading companies stepped forward to take the reign in the markets. Subsequently, K Tire suffered from difficulties across its businesses, owing to the failure to develop follow-up innovative products or market-leading products, as well as the aggressive activities by the company’s hardline labor union. Such difficulties pushed K Tire down to the 13th position in 2014, which sparked the dire need to bring about innovative changes within the company.

3.3.2 Phase 2. Ceaseless endeavor and its failure (2011-2012).

It needs to be lightweight : An RFID tag attached inside a vehicle may adversely affect the weight balance of the tires. A heavier tag has greater adverse impact on the tire performance. Therefore, a tag needs to be as light as possible.

It needs to be durable : Passenger vehicle tires are exposed to extensive bending and stretching, as well as high levels of momentum, which may damage a tag, particularly causing damage to or even loss of the antenna section.

It needs to maintain adhesiveness : Tags are attached on the inner surface, which increase the possibility of the tags falling off from the surface while the vehicle is in motion.

It needs to be resistant to high temperature and high pressure : While going through the tire manufacture process, a tag is exposed to a high temperature of around 200°C and high pressure of around 30 bars. Therefore, a tag should maintain its physical integrity and function at such high pressure and temperature.

It needs to be less costly : A passenger vehicle tire is smaller, and therefore cheaper than truck/bus tires. As a result, an RFID tag places are greater burden on the production cost.

Uncountable tag prototypes, were applied to around 200 test tires in South Korea for actual driving tests. Around 150 prototypes were sent to extremely hot regions overseas for actual driving tests. However, the driving tests revealed damage to the antenna sections of the tags embedded in tires, as the tires reached the end of their wear life. Also, there was separation of the embedded tags from the rubber layers. This confirmed the risk of tire separation, resulting in the failure of the tag development attempt.

3.3.3 Phase 3. Success of adoption RFID (2013-2014).

Despite the numerous difficulties and failures in the course of development, the company ultimately emerged successful, owing to its institutional entrepreneurship and corporate entrepreneurship the government’s support. Owing to the government-led support project, K Tire resumed its RFID development efforts in 2011. This time, the company discarded the idea of the embedded-type tag, which was attempted during the first development. Instead, the company turned to attached-type tag. The initial stages were marked with numerous failures: the size of a tag was large at 20 × 70 mm, which had adverse impact on the rotation balance of the tires, and the attached area was too large, causing the attached sections to fall off as the tire stretched and bent. That was when all personnel from the technical, manufacturing, and logistics department participated in creating ideas to resolve the tag size and adhesiveness issues. Through cooperation across the different departments and repeated tests, K Tire successfully developed its RFID tag by coming up with new methods to minimize the tag size to its current size (9 × 45 mm), maintain adhesiveness and lower the tag price. Finally, K Tire was success the adoption RFID.

3.3.4 Phase 4. Establishment of the manufacture, logistics and marketing tracking system.

Whenever subtle and problematic innovation difficulties arise, every worker and board member moves forward through networking and knowledge sharing within intra and external.

While a bar code is only capable of storing the information on the nationality, manufacturer and category of a product, an RFID tag is capable of storing a far wider scope of information: nationality, manufacturer, category, manufacturing date, machines used, lot number, size, color, quantity, date and place of delivery and recipient. In addition, while the data stored in a bar code cannot be revised or expanded once the code is generated, an RFID tag allows for revisions, additions and removal of data. As for the recognition capability, a bar code recognizes 95per cent of the data at the maximum temperature of 70°C. An RFID tag, on the other hand, recognizes 99.9 per cent of the data at 120°C.

The manufacture and transportation information during the semi-finished product process before the shaping process is stored in the RFID tags, which is attached to the delivery equipment to be provided to the MLMTS;

Logistics Products released from the manufacture process are stored in the warehouses, to be released and transported again to logistics centers inside and outside of South Korea. The RFID tags record the warehousing information, as the products are stored into the warehouses, as well as the release information as the products are released. The information is instantly delivered to the MLMTS;

As a marketing, the RFID tags record the warehousing information of the products supplied and received by sales branches from the logistics centers, as well as the sales information of the products sold to consumers. The information is instantly delivered to the MLMTS; and

As a role of integrative Server, MLM Integrative Server manages the overall information transmitted from the infrastructures for each section (production information, inventory status and release information, product position and inventory information, consumer sales information, etc.).

The MLMTS provides the company with various systemic functions to integrate and manage such information: foolproof against manufacture process errors, manufacture history and quality tracking for each individual product, warehousing/releasing and inventory status control for each process, product position control between processes, real-time warehouse monitoring, release control and history information tracking across products of different sizes, as well as link/control of sales and customer information. To consumers, the system provides convenience services by providing production and quality information of the products, provision of the product history through full tracking in the case of a claim, as well as a tire pressure monitoring system:

“South korea’s K Tire Co. Inc. has begun applying radio-frequency identification (RFID) system tags on: half-finished” tire since June 16. We are now using an IoT based production and distribution integrated management system to apply RFID system on our “half-finished products” the tire maker said, claiming this is a world-first in the industry. The technology will enable K Tire to manage products more efficiently than its competitors, according to the company. RFID allows access to information about a product’s location, storage and release history, as well as its inventory management (London, 22, 2015 Tire Business).

4. Discussions

Originally, aims of RFID adoption for passenger car “half-finished product” is to chase the front runners, Hankook Tire in Korea including global leading companies like Bridgestone, Michaelin and Goodyear. In particular, Hankook Tire, established in 1941 has dominated domestic passenger tire market by using the first mover’s advantage. As a late comer, K Tire needs distinguishable innovation strategy which is RFID adoption for passenger car’s tire, “half-finished product” to overcome shortage of number of distribution channels. Adoption of RFID technology for passenger car’s tire has been known as infeasible methodologies according to explanation by Changmin Park, vice-CTO (chief technology officer) until K Tire’s success.

We lensed success factors as three perspectives; institutional entrepreneurship, corporate entrepreneurship and innovation. First, as a corporate entrepreneurship perspective, adopting innovative technologies having uncertainties accompanies by a certain risk of failure. Corporate entrepreneurship refers to firm’s effort that inculcate and promote innovation and risk taking throughout its operations ( Burgelman, 1983 ; Guth and Ginsberg, 1990 ). K Tire’s success was made possible by overcome the uncountable difficulties based on shared value and norms (e.g. Fligstein and Mara-Drita, 1996 ; Garud et al. , 2002 ; Hargadon and Douglas, 2001 ; Maguire et al. , 2004 ).

An unsuccessful attempt at developing innovative technologies causes direct loss, as well as loss of the opportunity costs. This is why many companies try to avoid risks by adopting or following the leading companies’ technologies or the dominant technologies. Stimulating corporate entrepreneurship requires firms to acquire and use new knowledge to exploit emerging opportunities. This knowledge could be obtained by joining alliances, selectively hiring key personnel, changing the composition or decision-making processes of a company’s board of directors or investing in R&D activities. When the firm uses multiple sources of knowledge ( Branzei and Vertinsky, 2006 ; Thornhill, 2006 ), some of these sources may complement one another, while others may substitute each other ( Zahra and George, 2002 ). Boards also provide managers with appropriate incentives that better align their interests with those of the firm. Given the findings, K Tire seeks new knowledge from external organizations through its discriminative corporate entrepreneurship.

When adopting the RFID system for its passenger vehicle tires, K Tire also had to develop new RFID tags suitable for the specific type of tire. The company’s capabilities were limited by the surrounding conditions, which prevented the application of existing tire RFID tag technologies, such as certain issues with the tire manufacturing process, the characteristic of its tires and the price of RFID tags per tire. Taking risks and confronting challenges are made from board member’s accountability. From the findings, we find that entrepreneurship leadership can be encouraged in case of within the accountability frame work.

Despite its status as a second-tier company, K Tire attempted to adopt the RFID system to its passenger vehicle tires, a feat not achieved even by the leading companies. Thus, the company ultimately built and settled the system through numerous trials and errors. Such success was made possible by the entrepreneurship of K Tire’s management, who took the risk of failure inherent in adopting innovative technologies and confronting challenges head on.

Second, institutional entrepreneurship not only involves the “capacity to imagine alternative possibilities”, it also requires the ability “to contextualize past habits and future projects within the contingencies of the moment” if existing institutions are to be transformed ( Emirbayer and Mische, 1998 ). New technologies, the technical infrastructure, network activities to acquire the new knowledge, learning capabilities, creating a new organization such as Pioneer Lab and new rules to create new technologies are the features. To qualify as institutional entrepreneurs, individuals must break with existing rules and practices associated with the dominant institutional logic(s) and institutionalize the alternative rules, practices or logics they are championing ( Garud and Karnøe, 2003 ; Battilana, 2006 ). K Tire established new organization, “Special lab” to obtain the know technology and information as CEO’s direct sub-committees. Institutional entrepreneurship arise when actors, through their filed position, recognize the opportunity circumstance so called “norms” ( Battilana et al. , 2009 ). To make up the deficit of technologies for RFID, knowledge stream among workers is more needed. Destruction of hierarch ranking system is proxy of the institutional entrepreneurship. Also, K Tire has peculiar norms. Namely, if one requires the further study such as degree course or non-degree course education services, grant systems operated via short screen process. Third, as innovation perspectives, before adopting the RFID system, the majority of K Tire’s researchers insisted that the company use the bar code technology, which had been widely used by the competitors. Such decision was predicated on the prediction that RFID technology would see wider use in the future, as well as the expected effect coming from taking the leading position, with regard to the technology.

Finally, K Tire’s adoption of the RFID technology cannot be understood without government support. The South Korean government has been implementing the “Verification and Dissemination Project for New u-IT Technologies” since 2008. Owing to policy support, K Tire can provide worker with educational service including oversea universities.

5. Conclusions and implications

To cope with various technological impasses, K Tire demonstrated the importance of institutional and corporate entrepreneurship. What a firm pursues more positive act for innovation is a research question.

Unlike firms, K Tire has strongly emphasized IT technology since establishment in 1960. To be promotion, every worker should get certification of IT sectors after recruiting. This has become the firm’s norm. This norm was spontaneously embedded for firm’s culture. K Tire has sought new ICT technology become a first mover. This norm can galvanize to take risk to catch up the first movers in view of institutional entrepreneurship.

That can be cultivated both by corporate entrepreneurship, referred to the activities a firm undertakes to stimulate innovation and encourage calculated risk taking throughout its operations within accountabilities and institutional entrepreneurship, referred to create its own peculiar norm. Contribution of our paper shows both importance of board members of directors in cultivating corporate entrepreneurship and importance of norm and rules in inducing institutional entrepreneurship.

In conclusion, many of them were skeptical about adopting RFID for its passenger vehicle tires at a time when even the global market and technology leaders were not risking such innovation, citing reasons such as risk of failure and development costs. However, enthusiasm and entrepreneurship across the organization towards technical innovation was achieved through the experience of developing leading technologies, as well as the resolve of the company’s management and its institutional entrepreneurship, which resulted in the company’s decision to adopt the RFID technology for small tires, a technology with unverified effects that had not been widely used in the markets. Introduction of new organization which “Special lab” is compelling example of institutional entrepreneurship. Also, to pursue RFID technology, board members unanimously agree to make new organization in the middle of failing and unpredictable success. This decision was possible since K Tire’s cultivated norm which was to boost ICT technologies. In addition, at that time, board of director’s behavior can be explained by corporate entrepreneurship.

From the findings, this paper also suggests importance of firms’ visions or culture from startup stage because they can become a peculiar norm and become firm’s institutional entrepreneurship. In much contemporary research, professionals and experts are identified as key institutional entrepreneurs, who rely on their legitimated claim to authoritative knowledge or particular issue domains. This case study shows that authoritative knowledge by using their peculiar norm, and culture as well as corporate entrepreneurship.

This paper has some limitations. Despite the fact that paper shows various fruitful findings, this study is not free from that our findings are limited to a single exploratory case study. Overcoming such limitation requires securing more samples, including the group of companies that attempt unprecedented innovations across various industries. In this paper, we can’t release all findings through in-depth interview and face-to-face meetings because of promise for preventing the secret tissues.

Nevertheless, the contribution of this study lies in that it shows the importance of corporate entrepreneurship and institutional entrepreneurship for firm’s innovative capabilities to grow ceaselessly.

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Further reading

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Acknowledgements

 This work was supported by 2017 Hongik University Research Fund.

Corresponding author

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Kessler I, Spilsbury K, Heron P. Developing a high-performance support workforce in acute care: innovation, evaluation and engagement. Southampton (UK): NIHR Journals Library; 2014 Aug. (Health Services and Delivery Research, No. 2.25.)

Developing a high-performance support workforce in acute care: innovation, evaluation and engagement.

Chapter 3 innovation: case studies.

• Focus and methods

The primary aim of the IC studies was to develop an understanding of the development of a new role or practice in a given trust, examining the details of how and why it emerged and evolved within a specific organisational context. If the scoping and survey phases were designed to map the form taken by, and the distribution of, innovation, the case study phase sought to explain innovative management and the use of nurse support workers in particular trusts. More specifically, why were some trusts able to innovate in these respects, while others, providing similar health-care services, were not?

Table 10 sets out the six IC studies. The cases were purposefully selected to fall within three dimensions of innovation. Two cases focused on new approaches to management: values-based recruitment and the introduction of a HCA development nurse. Three cases examined new roles: a C-SW; a surgical assistant practitioner; and a band 4 educator role with responsibility for training CSWs. Finally, one case study looked at new ways of working: APs in specialist clinical areas. In all cases, the role or practice was new to the trust, although not necessarily unique to the NHS. The six trusts explicitly agreed to attach their names to the presentation of the material in this report. The cases were, after all, examples of ‘good practice’, and in general the trusts were proud of their achievement in ‘successfully’ introducing them.

Innovation case study interviews

Carried out between the winter of 2011 and the early summer of 2013, the cases were mainly based upon interviews with a vertical slice of trust actors who had a stake in the innovation under consideration. Table 10 sets out those interviewed in the respective cases. In total, there were 79 interviews carried out. These interviews were typically supplemented by relevant documentary material, for example trust policies, job descriptions and training programmes.

In general, the interviewees were asked fairly open questions about:

• the context for the innovation, including trust structure, culture and history
• the nature and aims of the innovation
• the design and implementation of the innovation
• the impact of the innovation on various stakeholders and outcomes
• the broader lessons.

All interviews were recorded and transcribed. The transcriptions were read through on a number of occasions with a view to establishing whether or not there was an agreed narrative from the stakeholders on the development of the innovation, its aims, design features and consequences, and, if not, where differences of view lay. A draft case report was fed back to the respective trusts, providing the opportunity for inaccuracies and misinterpretation to be picked up.

This section presents an overview of the findings from the respective cases. A final section provides a summary and discussion. To protect the identity of those we interviewed, and to provide consistency between the case study reports, the quotes within the text use the identifier IC plus attributions related to three broad job areas: trust manager , which may include senior and executive managers, personnel within HR, the education and learning teams and external managers; service manager, which can include matrons, divisional managers and senior nurses not working on wards; and ward staff, which can include ward or clinic managers, medical staff, nurses, HCAs and APs. Where an interviewee could be easily identified owing to their specific role, they were contacted to give their approval prior to the case study report being made public. Approval was given in all instances.

• Values-based recruitment

This case study deals with a new values-based approach to the recruitment and retention of HCAs introduced by York Teaching Hospital NHS Foundation Trust in 2010. The innovative character of this initiative was reflected in the fact that it had won the 2011 HPMA award for innovation in HR and a similar Health Service Journal (HSJ) award in 2012. The trust’s interest in such an approach was underpinned by two broad considerations. The first related to a high turnover among its 500-or-so HCAs, particularly in the first 6 months of employment, which the trust found to be associated with recruits not being fully aware of the nature of the HCA job:

So many people just came and didn’t have a clue really what they were going to be doing . . . They come and think, ‘oh I thought I was only making tea’. And you think, ‘gosh no, there’s a whole host of things, and tea isn’t one of them’. IC1_ward staff_1

The second consideration was values based, and reflected York’s interest in aligning its values, revolving around ‘caring and ‘compassion’, with those of new HCAs:

We wanted to be able create the opportunity for the individual to demonstrate their caring disposition. IC1_trust manager_1

The new recruitment model

York’s new approach to HCA recruitment comprised a number of elements:

• A new band 2 HCA job description placed emphasis on personal disposition rather than formal qualification. The person specification was modified to reduce the need for ‘relevant work experience’ and the need for a NVQ level 2 qualification. There was a sharper focus on an understanding of the HCA role and an ability to demonstrate a caring orientation.
• A new application process sought to address the high turnover of HCAs, stemming from the failure of candidates to fully appreciate the HCA role. The centrepiece of the change was a mandatory open day: ‘On the open day, they come and talk to other healthcare assistants, and they get a view of what the job actually entails. They can look around at the stands, and it’s a really good push into what the role is’ (IC1_trust manager_2). Only those attending were provided with a unique identification number which allowed them access to the application form. As a means of providing more detailed information about the role, the trust also produced a 10-minute film made available on DVD and online, involving HCAs talking about their role.
• A new selection process sought to ensure a better fit between applicant and clinical area, with shortlisted candidates having the opportunity to list their order of preferred wards. Moreover, the old standard list of interview questions was replaced by an open, scenarios approach, better able to assess whether or not candidates had a caring disposition.
• A new 2-week HCA induction programme was introduced, with new recruits only taking up their post on the ward on its completion. Replacing an often deferred corporate induction of a couple of days, the new programme ensured that HCAs were better prepared for their role, and so more able to deliver compassionate care and become more appreciative of what the role involved before ‘hitting the ward’.

Key processes and actors

The emergence of York’s new recruitment model rested on a number of processes and actors.

Identifying health-care assistant recruitment as a legitimate issue of concern

Informally, HCA turnover had been a concern for some time, particularly among the trust’s matrons:

We were a very sort of tight knit group of matrons and the problem with retention in terms of health-care assistants was not something strange that had escaped our attention. IC1_service manager_1

However, defining high HCA turnover as an issue worthy of further action had to be sanctioned by senior trust managers:

The assistant chief nurse and [recruitment manager] along with their line managers, the chief nurse and HR director had initial meetings to say we’re getting feedback from matrons and ward sisters that the health-care assistants . . . don’t understand what the role’s about. IC1_trust manager_2

Devising the means to address concerns about health-care assistant recruitment

The trust’s attempts to deal with the recruitment of HCAs rested on close working relationships between different trust functions, particularly the nursing directorate and the HR directorate. The latter was crucial in presenting substantive ideas; thus, the notion of values-based recruitment came from HR. However, the former was essential in carrying these forward and ensuring ‘buy-in’ from nurses and ward sisters to any changes in recruitment procedures.

A third partner in the design process was the trust’s applied learning and research directorate. This was a standalone directorate at York, rather than more typically a part of the HR function, and it acted as a useful resource in designing and delivering a new, credible induction programme.

In the initial stages, there was some informal working between these partners, especially the assistant chief nurse and the recruitment manager, testing ideas and establishing a ‘direction of travel’. These relations were, however, formalised and extended by the establishment of a small working group comprising matrons and ward sisters, which allowed ideas to be sharpened.

Implementation

The implementation of the new recruitment model was an iterative process, with trust managers regularly seeking the views of nursing staff, and ‘tweaking’ in response to staff views:

We had focus groups, we went to matron meetings to get their feedback. We tried to pull from a whole kind of range of nursing staff, so we didn’t just talk to the health-care assistants, we spoke to some of the staff nurses that dealt with them, we spoke to ward sisters, we spoke to matrons . . . And the feedback we got was really beneficial in terms of how we shaped the process. IC1_trust manager_3

Equally crucial was formal sanctioning and buy-in from the trust’s senior management, which lent legitimacy and credibility to the initiative, and, more prosaically, helped to address certain obstacles:

We needed that board level sign up because there was an issue when we needed the freedom to really change things, not just tweak things . . . I think it was helpful because you know that you did have the ability to change things and actually just to have, if you’re wanting to do it quickly you need that kind of senior sign up. IC1_trust manager_3

There was strong ongoing support from the chief nurse for the initiative:

It is important that you’ve got the support of your chief nurse and your director of HR who can help overcome some of those obstacles . . . because there are resource implications. IC1_trust manager_3

There were some organisational concerns raised about the introduction of values-based recruitment at York. For example, it was suggested that setting up the model was time consuming:

. . . probably just the time to set it up. Because there was a lot of work in, you know, producing the DVD, getting people to come and feel confident enough as a HCA to stand up and talk to a room of what can be a 100 people. IC1_trust manager_4

More generally, however, responses to the new model were positive, with a number of benefits being highlighted.

In providing applicants with a fuller appreciation of the HCA role, the new process walked a fine line between realism and deterrence: more information about the HCA role might as easily have discouraged as encouraged applicants. However, the trust produced data that revealed the effectiveness of open days in attracting those interested in the HCA role: between May 2010 and April 2011, the average attendance was around 100. The average number submitting a formal application had fallen from some 100 to 67, suggesting some ‘deselection’ among those attending the open days. The enthusiasm of those who did apply was reflected in the fact that the numbers of those not attending interviews when called fell by over two-thirds.

Preparation

The new induction was seen to better prepare HCAs for their role, particularly in terms of competence. As well as contributing to high-quality care, better preparation was viewed as lowering HCA turnover by reducing initial difficulties and stress. The value of the new induction programme was certainly not uncontested. There was, for example, a 2-week lag between the appointment of a HCA and their taking-up of the role on the ward, which caused some ward manager concern. In general, however, HCAs were seen as more equipped for their role following the new extended induction:

They seem to fit in the team quickly, they pick things up much faster, they have an understanding of what is expected of them, their documentation is pretty quick really, they know what they should be doing and what they shouldn’t be doing. IC1_ward staff_2

The new recruitment process, with its open day and extended induction, also signalled the greater support or value placed by the trust on the HCA:

It’s nice that they’re actually thinking about us [HCAs] now; that they’re thinking, ‘oh yes well they’re doing this role so we need to put some training in’. IC1_ward staff_1

There was circumstantial evidence to suggest that HCA retention had improved under values-based recruitment. The trust’s need for fewer rounds of HCA recruitment suggested that HCAs were more inclined to stay. Figures backed this up: turnover reduced from 17% to 12% in the immediate aftermath of the changes and this lower figure has been sustained for 3 years. Indeed, given the costs invested in HCAs who had previously left, this high HCA retention rate was seen to render the initiative highly cost-efficient.

There was similarly anecdotal evidence to suggest that the new interview process was effectively seeking to probe the dispositions of prospective HCAs. As a HCA who had been through the process noted:

They were definitely trying to find out sort of about your personality as well rather than what you are on paper . . . There was quite a lot of that and there was lots of kind of smiling and laughing and it did feel quite relaxed and I did feel that I could bring my personality across and I wasn’t just kind of reciting the notes in my head and answering sort of regimented questions. IC1_ward staff_3

Figure 2 provides an overview of York’s new approach to HCA recruitment. It can be seen that the initiative was embedded in two closely related but analytically distinct streams of development based on retention and on values, which fed into the design of the new recruitment model in various ways.

Tracking the initiative.

• Developing assistant practitioners as a flexible resource

This case study explored the development of the AP role at South Devon Healthcare NHS Foundation Trust (henceforth referred to as Torbay). The AP role was first introduced at Torbay in 2006 and, with the foundation degree (FD) taking 2 years to complete, the first cohort of APs qualified in 2008. Two further cohorts have since completed their training. With three cohorts active, in the summer of 2012 there were around 30 APs in the trust, with another 14 trainees in either the first or the second year of their FD. The emergence of the AP role at Torbay some 7 or 8 years ago placed the trust at the vanguard of developments in the south-west.

This leading position was indicative of an organisational culture, which, in a more general sense, displayed a capacity to innovate. Torbay had won the HSJ Acute Healthcare Organisation of the Year Award in November 2011, with the judges commenting that ‘the trust works as a team in an integrated way to deliver best outcomes and innovations in care with high levels of clinical engagement’.

Inevitably, questions arise as to how Torbay was able to develop such an innovative culture, with suggestions that the trust’s structure played a part. As a medium-sized district general hospital, with its acute services located on a single site, Torbay was a relatively compact organisation. The workforce was relatively stable, with low turnover. These characteristics fostered an open and friendly organisational culture, encouraging the kind of direct personal interaction needed to raise, share and develop new ideas.

The culture and working environment provided the backdrop to, and fostered, Torbay’s lead role in developing APs. Initially, this lead role assumed a somewhat opportunistic form. There was money available from the Strategic Health Authority (SHA) for a pilot to develop an educational programme to support band 4 APs. In 2006, Torbay worked with a trust in Cornwall on such a programme, with an initial intake of around 20 trainee APs covering community and mental health as well as acute health care. The opportunistic nature of this involvement was further reflected in the absence of clearly articulated objectives underpinning Torbay’s development of the AP role:

It was a gamble. But we made it work and that was the impetus to do more. There were pound signs and, ‘oh we’ve got some money coming in, let’s take it, let’s see if we can do something that would actually benefit the patients’, without really understanding what the [AP] role would be. IC2_trust manager_1

However, this initial opportunism was quickly transformed into a more strategic approach to the AP role, characterised by a number of features, each discussed below.

Clarifying the assistant practitioner role

The trust felt that the AP role needed to be sensitive to the particular needs of the clinical areas:

The trust didn’t use a one model fits all. So like if every ward needs a band 4, I don’t think they’ve ever seen it that way, but they also recognised that there are some things that band 4s will never do and you need a registration for. IC2_trust manager_2

Narrow and deep

The trust acknowledged that the AP role was most likely to become established where a ‘critical mass’ of post-holders could develop within a given clinical area. This would allow APs to support one another and to become a ‘fixture’ within the ward team:

We needed to go deep rather than wide . . . and it really did work, because it was sort of safety in numbers because there was at least two in, or two wards, they would work closely together, would have one on each ward, so there was a presence being seen. IC2_trust manager_1

An emergent approach

Torbay’s approach was based on learning through practice. By taking the lead in the region, the trust was often the first to confront the difficult issues, such as clarifying the contribution to be made by APs and the design and management of a viable FD programme, and, in so doing, learned from the experience and sharpened their approach going forward:

Torbay has done this with their band 4s over the past five years and they’ve had really a lot of quite I suppose difficult discussions and challenging problems in order for them to do that. IC2_trust manager_2

A variety of aims came to inform Torbay’s interests in the AP role, some formally stated by senior management and others more informally articulated in the organisation.

Career opportunities

Senior managers at Torbay viewed the AP role as a means of developing career opportunities for HCAs at bands 2 and 3, particularly as pathways into registered nursing became limited and problematic. Nurse training represented a significant leap for HCAs, with progression to a band 4 AP role seen as more manageable. The use of the AP role to develop such career opportunities for bands 2 and 3 HCAs was not, however, an end in itself. It was viewed as a means of retaining and making the most of the unregistered part of the workforce, which had considerable skill, experience and potential:

What we said is it’s not a stepping-stone to become a nurse; it’s a different type of role and it’s valued and it’s better paid, and it gives you opportunities to think about a different future career if you want to, but at the same time you know you could stay there as well. IC2_trust manager_3

Flexibility: crossing boundaries

The AP role was seen as much more flexible than the RN role, with scope to develop ‘bolt-on’ competencies to undertake particular tasks. One manager described this flexibility as ‘The ability to have a modular content backed up by the academic theory, [with] assessment in clinical practice to do “strange jobs” that really nobody thought of doing before’ (IC2_trust manager_1).

Specialisation

Torbay saw the potential for the AP role to fill service gaps, and, in so doing, establishing a new area of expertise within the nursing workforce:

If you’re just going to use them like a member of the workforce, that for me is well why bother to even train people at band 4; band 2s and 3s are doing that. If you’ve got somewhere, for example, the stroke clinic where you’ve got a band 4 that does some occupational therapy, physiotherapy and some nursing care as well, that person is valuable in terms of care plans, patient journey, discharge planning liaison, a whole slew of things that are very specific around stroke care. IC2_trust manager_2

Nurse shortages

The AP role was seen to address future shortages of RNs:

We know that we’re going to see less RNs coming through and I think we have to proactively try and work with the [AP] role to make it a role that we want and it works for us. IC2_service manager_1

Cost reductions

Among staff within clinical areas, cost control was seen as informing the trust’s use and development of the AP role, particularly at ward level:

I feel it’s [the use of APs] a cheaper option. We run on four trained at the moment, and then they’re saying we can have three trained plus an AP and I think that’s the way it is. I think they’re saving money, truthfully. IC2_ward staff_1

Nurse relief

The AP was viewed as a means of taking away certain tasks from a nurse, and so allowing them to concentrate on ‘more pressing’ activities:

[The development of the AP] was taking out some of the more basic standard levels of perhaps dressings and chaperoning to allow us to use our specialist, clinical nurse skills. IC2_ward staff_2

Torbay’s AP initiative had the following design features:

• trainee assistant practitioners (TAPs) recruited from HCAs within the trust
• a 2-year FD delivered by South Devon College (SDC), but with significant input from Torbay’s education department (ED) and other staff members
• TAPs mainly employed as band 3s
• two study days, although one of these was taken from their own time
• band 4 on qualification
• a preceptorship programme, also involving RNs.

The design of this initiative was based on a ‘virtuous triangle’, set out in Figure 3 .

A virtuous triangle at Torbay.

This ‘triangle’ rests on two key relationships. The first was between the trust’s ED and SDC as the provider of the FD taken by the TAPs. This relationship was strengthened by idiosyncratic features, particularly the fact that the key point of contact at SDC had formerly worked at Torbay, and indeed had been involved in the initial AP pilot.

The quality of the Torbay–SDC relationship ensured that the delivered FD was sensitive to the needs of discrete clinical areas:

Working with SDC was a revelation really because they were hungry for doing something that actually would link them in to us, but also it was actually sort of saying we’ve got enough people locally, we’ve got a local workforce, we need to tap in to it. IC2_trust manager_5

This relationship also allowed Torbay to develop a cross-subsidising funding model. SDC had agreed to expand its AP programme to include self-funders, alongside those on the programme employed by and supported by the trust. These funders needed placements and, in providing them, Torbay generated an income stream which supported its internal candidates.

The second key relationship was between the trust’s ED and clinical areas interested in introducing an AP role. The most important aspect of this relationship was establishing a clear role for the AP. This was ‘hammered out’ in intense discussions between ward managers and the ED. The clinical areas brought to these discussions a full appreciation of clinical requirements, work routines and what a distinctive AP role might be able to bring to care delivery. The ED brought a capacity to clarify issues and sort out any ‘blockages’. For example, with a need to amend trust policy and develop protocols, allowing APs to undertake certain clinical procedures, the ED engaged the pharmacist in the development the AP role:

Over the years pharmacy started to teach on the AP programme, so they’re setting learning standards with me as to what they’re teaching. So they’re knowing the education they’ve given and feeling more comfortable because they know the standard of teaching. IC2_trust manager_1

The impact of the AP role at Torbay can be considered from the perspective of different stakeholders, each discussed below.

Assistant practitioner post-holders

While some APs saw the role as a stepping-stone into nursing, many regarded it as an end in its own right, allowing considerable scope for personal development:

I really enjoyed my job as a HCA but I wanted to progress a little bit further, I wanted some promotion, I also kind of felt I deserved some promotion; that I’d been in the trust a long time and had given a long service to the trust. But having children at home and a husband that worked away, I didn’t want to go and do my training, I didn’t want the responsibility of having to take three years out unpaid, as it would have been if I’d gone on to do my nurse training. IC2_ward staff_3

A few concerns were raised about the impact of the AP role on post-holders. For example, it was suggested that, having taken up an extended role, APs might be somewhat frustrated at not being able to push the boundaries further:

They’re [APs] getting frustrated with their job descriptions and they want to do more, and I’m having to say to them ‘look, I’m really sorry but you aren’t registered and you can’t do more’. IC2_trust manager_4

For some nurses, the AP represented a general challenge to the nurse status and role:

Some trained nurses do feel threatened because they’ve got this cheaper nurse coming up who they definitely are replacing trained nurses. IC2_ward staff_1

More specifically, APs with more specialist or practiced skills were sometimes seen to erode nurse capability:

They’re [APs] actually better cannulators than a lot of the RNs. So they’ll end up putting canullas in here, there and everywhere around the ward for patients, for their treatment . . . because they’re handing it over to the APs to do, they’re losing that skill. IC2_ward staff_4

At the same time, nurses often viewed APs as relieving them of certain tasks, allowing them to concentrate on core activities, with positive consequences for patient care:

That shows very well in breast care, that they [APs] will do stuff that’s seen as mundane but they’ll love it because they’ll give more time to the patient in clinics with sort of smaller breast operations, which relieves the RNs to do psychosexual counselling, the more advanced dressings. IC2_trust manager_1

Interviewees suggested that the APs contributed to patient care by taking on technical tasks and not, therefore, having to seek the RNs to carry out certain clinical procedures. This often improved the capacity of a service or clinic, speeding up the flow of patients, reducing service pressures and allowing patients to be dealt with in a more timely manner.

• The colorectal support worker

This case study focuses on the development of a role designed to provide support for the delivery of stoma care at Hillingdon NHS Foundation Trust (henceforth referred to as Hillingdon). Developed under the job title ‘colorectal support worker’, the role was based within a team of specialist coloproctology nurses. This specialist nursing team had four members: a colorectal nurse and a senior colorectal nurse, working alongside the one C-SW, and headed by a nurse consultant. Most of the patients undergoing colorectal surgery at Hillingdon were located on a single ward, although the team were responsible for patients needing stoma care help throughout the hospital.

The specialist nursing team was involved in three broad areas of activity:

• consultant- and nurse-led clinics
• on-ward work, immediately prior to and following the surgery
• community, typically post-operative, outreach work, involving home visits.

Within this set-up, the C-SW was seen as an innovative role, not only within the trust but also across the NHS:

We think it is the only one in the UK, because I haven’t come across any more. IC3_service manager_1

The C-SW role was designed principally to engage in on-ward work dealing with those patients in need of stoma care. The number of stoma patients in the trust at any given time varied. During the research fieldwork, there were 13 patients in need of stoma care at Hillingdon. Over the year, it was estimated the trust would deal with between 80 and 100 stomas, with the C-SW likely to be involved in most of these cases.

The role had emerged 3 years ago but then developed organically, rather than in response to any clear-cut strategic initiative. More specifically, the role was a response to the confluence of two broad sets of factors: institutional and personal.

Institutional

At an institutional level, various developments had impacted on ways of working within the specialist nursing team, creating the space for a new support role:

• General pressure. Partly in response to public health campaigns, awareness of cancer and the number of cases picked up had increased.
• More acute patients. The increasing scale of care needs had been accompanied by the growing acuity of patients treated in a hospital setting. The requirement for more intense care from RNs had, in turn, generated a need for more support, whether in providing such care or in undertaking more routine tasks.
• New models of care. The trust’s enhanced recovery programme (ERP) had placed new demands on specialist nurses, for example in running enhanced recovery clinics. It also generated a specific need for patients more quickly to become comfortable with, and capable of, dealing with their stomas.
• Staffing. These developments placed pressure on the specialist team’s staffing capacity: ‘It’s very easy for the stoma care nurses to get pulled in to other areas with their consultants and things like that at MDT [multidisciplinary team] meetings and all of the sort of upper echelons of patient care’ (IC3_trust manager_1).

The institutional factors combined with the availability of a worker already present within colorectal surgery particularly well suited to take up a specialist support role. As a consequence, the development of the role became inextricably linked to the personal circumstances of this individual. A number of characteristics of the post-holder are worth noting:

• Experience in care work prior to joining the trust, combined with a personal disposition displaying enthusiasm for taking on an expanded and specialist technical role: ‘Initially she [the post-holder] was quite despondent about what healthcare assistants could do. She is quite an assertive person and kind of felt that she wanted more, she wanted to be a bit more autonomous, whereas on the wards it was kind of quite limited’ (IC3_trust manager 2).
• Experience of working in the trust. The post-holder had worked at Hillingdon for 8 years in a HCA post, before taking on the new specialist support role.
• Experience as a HCA working with colorectal patients on the ward before moving into the specialist nursing team. This was reinforced by a 6-month period working on a temporary basis with the specialist colorectal nursing team, which then became a permanent post.

Design and implementation

This confluence of institutional need, and the availability of a person with the background and skills to meet it, was appreciated by the nurse consultant leading the team of specialist colorectal nurses, and taken forward by her, with the support of others, through various processes.

Shaping the role

The C-SW role was initially formalised with the development of a job description by the HR department. Initially, the role was graded at band 2, although at the time of the fieldwork, the C-SW had moved onto pay band 3 and it was envisaged that she would move onto band 4 on completing the FD. The job description listed no fewer than 26 main duties. Exactly half of these were patient-centred, including teaching patients to look after their stomas and ensuring that patients were given appropriate food and nutritional information.

The C-SW role, along with the two specialist colorectal specialist nurses, was funded by a firm producing stoma care products. Given the scale of stoma care at Hillingdon, it was unlikely that the trust would attract sponsorship for a third specialist nurse. However, a C-SW role (particularly one working 25 hours per week) represented a viable, lower-cost sponsorship option.

The post-holder had already achieved a NVQ level 3 in her capacity as a HCA. As a C-SW, this was supplemented by a 1-week dedicated training course on stoma care. Less formally, the post-holder had, over the years, acquired relevant tacit skills and knowledge:

Working on the colorectal ward, you had to have a certain amount of knowledge and training anyway. IC3_ward staff_1

The acquisition of experience, knowledge and skills allowed the post-holder gradually to push the role’s boundaries, affecting how others viewed and engaged with it. As nursing and clinical staff became more aware of and confident in the post-holder, increasingly they drew upon her:

Over the last year or so things have evolved and the job itself has matured in a way that she’s taken on more and more responsibility as she’s got on . . . Overall she has been fairly well supervised and trained to fulfil this role and she’s not just been let go on her own, but she’s sort of coming to a stage where she could do it independently or with advice. IC3_ward staff_2

In terms of general functioning, the C-SW role largely involved on-ward pre- and post-operative patient-centred work. The nature of the C-SW engagement with patients was intense and sustained, reflected in the following description of her role by the post-holder:

I always see them first day post-op. I like to see them before they have their surgery, just to introduce myself so that they know a familiar face when I see them on the first day post-op and basically review the stoma and everything because at that time they don’t want to do anything. Then they gradually get a little bit better and a little bit more mobile, and I start educating them about it; start teaching them about their diet and giving tips. Then I discharge them as well back into the community. IC3_ward staff_3

More specifically, the C-SW’s impact assumed a number of forms, each discussed below.

Patient teacher

The core of the C-SW role revolved around preparing and providing support for patients in the future management of their stoma:

The nurses are always busy; there is always something to do, but when the girls are in clinic or doing ERP clinics she will be on the ward; if there’s teaching for the stomas to be done, she will do the teaching of the stomas. IC3_service manager_2

Emotion manager

This sustained and close contact with the patient allowed the C-SW to manage patient emotions in invariably difficult circumstances:

[Patients] come in confused and worried and depressed, and the stoma care nurse can only give them five or 10 minutes a day and they might see them twice and that’s it. The [C-SW] will see them nearly every day on the ward; she becomes a constant to them and so is much more supportive to their actual needs. She is the most important psychological support for that patient and their subsequent recovery, because the aim is to get them back and living a normal life and doing everything they ever did before. IC3_trust manager_1

Another ‘pair of eyes’

The C-SW came to represent another ‘pair of eyes’ with the capacity to feed insights on the patient into broader clinical deliberation and decision-making. For example, discharge decisions were often informed by the C-SW’s perception of the patient’s readiness to leave hospital based on whether or not they could manage their stoma care.

In acting as another ‘pair of eyes’, the C-SW was often able to connect to, and articulate, the patient’s perspective, a capacity drawn upon by other carers. As a consultant noted:

If I’ve got a patient with a stoma, I usually take [the C-SW] along with me on the ward round, and I find it very useful to get her side of the story. She always has a different angle on how the patient should be managed. She’s been trained over the years as a HCA on the ward, so she has a more holistic view rather than the stoma nurses who will be looking at stomas and the technical problems with it. IC3_ward staff_2

The C-SW role was designed to relieve specialist colorectal and ward nurses of the main responsibilities for stoma care, allowing them to concentrate on other tasks. The C-SW appeared to be fulfilling this relief role:

So it takes the workload off them as well for them to do other things like clinics and work in the community and all that. So in that sense it does help. IC3_ward staff_2

Expert and mentor

Dedicated to specialist tasks, the C-SW had clearly become an expert in stoma care:

[The C-SW role] is a useful resource because the stoma nurses obviously have got other things on their plate. They’re working at the clinic, which [the C-SW] doesn’t, and so she’s purely dedicated to the ward as such. And, you know, the first port of call would be her if there was any problem on the ward in terms of primary management of stomas. IC3_ward staff_2

This expertise allowed the C-SW to act as a mentor to others, including registered ward nurses, specialist colorectal nurses, HCAs and student nurses. Each is illustrated by a quote below.

When we have newly qualified nurses joining the team, [the C-SW] is there to teach them, to help them. IC3_service manager_3

[The C-SW] is able to tell [name of colorectal nurse] quite a lot of things. [The latter] has not got a lot of back knowledge, whereas [the C-SW] has built up her knowledge over time from first of all being on the ward, enjoying looking at stoma patients, which not many people do, and then doing the temporary post and then moving into it as a full-time job. IC3_service manager_1

As the time’s gone on she’s [the C-SW] very much more been a link to the other health-care assistants on the ward in terms of getting them more involved in learning stoma care and engaging them in teaching patients as well. IC3_ward staff_4

Most of the students that we have on placement will work with [the C-SW] who will show them about the stoma care. IC3_service manager_1

The C-SW role had a largely positive impact on a range of stakeholders. However, a few qualifications are worth noting. First, the C-SW’s capacity to impact in these ways was closely tied to the personal characteristics of the post-holder, someone known and trusted by these various actors. It was, therefore, not a contribution easily replicated by another taking on this role.

Second, there was some resistance to the C-SW role. As an expert, the C-SW might challenge the registered and higher-graded professional:

Registered practitioners maybe feel a bit intimidated because she’s [the C-SW] doing teaching on the ward and obviously teaching patients and seeing patients on her own without that direct supervision and that has caused a bit of a problem. IC3_trust manager_2

Third, the specialist nature of the C-SW role might encourage ward staff to ‘dump on’ her all those tasks associated with the stoma care, with detrimental consequences for the quality of the C-SW’s working life and perhaps for patient care more widely:

Most ward staff, because there’s a stoma care nurse, it’s not their job to change bags, so some would be happy to leave a patient with a leaking bag until they found a stoma care nurse to come and do it. IC3_service manager_1

Figure 4 summarises the C-SW’s various contributions.

The C-SW’s contribution to stoma care.

• The health-care assistant development nurse

This case study explores the introduction of a dedicated corporate role, the HCA development nurse (HCA-DN), to support the management of HCAs at UCLH. One of the first trusts to acquire foundation status in 2004, UCLH is a large organisation comprising seven hospitals, some specialist and some general, located on different sites in central London and employing around 7000 staff in total.

The emergence of the HCA-DN role reflected an increasing focus on the unregistered component of the trust’s nursing workforce in the delivery of patient care:

The heads of nursing, corporate nursing and the trust itself has a commitment to training and development and to healthcare assistants and to that support. Otherwise we wouldn’t have I suppose the [HCA-DN] post we have. IC4_trust manager_1

Driven by financial pressures, this focus was integral to an attempt to review the trust’s traditionally rich skill mix. Indeed, there was a growing interest not only in the balance between unregistered and registered staff, but in the distribution between HCAs at band 2 and band 3 in the trust. UCLH had a relatively high proportion of its HCA workforce at band 3: the trust’s 428 HCAs were spilt roughly half and half between band 2s and band 3s.

From a financial perspective they [HCAs] save the trust money and if we can bolster them as much as possible, then it’s fantastic not just for their self-esteem and their educational purposes but also from the trust’s financial perspective, and I think you’re foolish if you don’t utilise them to their fullest potential. IC4_ward staff_1

The trust’s greater interest in the nurse support workforce was also influenced by perceived challenges to the future supply of RNs with implications for the nature of the nurse role:

We looked at the demographics of the nursing workforce . . . and thought that first of all we might be limited in the numbers of registered nurses and it was thought that the assistant practitioner would be assistants to some of the day to day delivery of care, the sort of routine stuff that didn’t need a more advanced assessment of the patient’s needs. IC4_trust manager_2

The health-care assistant development nurse role

The HCA-DN post was initially supported by SHA funding. It was filled on secondment by a clinical practice facilitator (CPF) from within the trust (initially for 3 months), who had since remained in the role. In a large and complex organisation, these background characteristics were not without significance: the post-holder understood the trust’s systems and routines and had credibility in the role.

In terms of purpose and focus, the HCA-DN role was principally seen by senior nurse managers as a way of developing training standards on entry to the trust, and supporting the establishment of clearer career pathways for HCAs:

What was very frightening to us when we were first expanding the numbers was that for band 2s these are people who could be working in Woolies one day and here tomorrow. There’s not a lot of training in between and what we wanted to try and do is make sure that at least there were very clear induction standards, very clear development programmes associated with these roles, and hence the development of [the HCA-DN] role. IC4_trust manager_2

In practice, the role’s remit was broader, covering nurse support workers at bands 2 to 4, and concentrating on a number of aspects of HCA training and development:

• assessing the capabilities (numeracy and literacy) of candidates for HCA posts
• developing and delivering corporate HCA induction
• developing and delivering in-house HCA training
• managing accredited training/education programmes, including the apprenticeships and the FD
• supporting HCA career development
• liaising with and supporting wards in the development of their more bespoke training.

Working with wards to address their particular HCA training and development needs involved the HCA-DN connecting to another key role within the trust, the CPF. Graded at band 6, typically performed by a RN and found in many of the trust’s wards, the CPF’s main purpose, according to the job description, was ‘. . . to support and develop band 5 and band 6 nursing staff and healthcare assistants through facilitation in clinical practice and promotion/implementation of relevant education and development pathways’ [emphasis added]. 50

The training and development of health-care assistants

The HCA-DN role had been responsible for developing a number of initiatives related to HCA training and development. These are set out in Figure 5 .

Training and development initiatives.

Health-care assistant induction

The HCA-DN was heavily involved with HCAs as they entered the trust. This involvement was reflected in some work around recruitment practices, such as establishing whether or not applicants had basic numeracy and literacy skills. It was also aimed at establishing whether or not HCA applicants had appropriate values and capabilities:

One of the things that the [HCA-DN’s] been trying is scenario-based assessment so that we understand the values around individuals that we appoint, but we’ve got much more clarity around, you know, basic life skills like numeracy, literacy and communication. IC4_trust manager_2

At the outset, the HCA-DN role was seen to be particularly concerned with establishing an acceptable level of basic competence in newly recruited HCAs:

The priority was getting the induction programme right, getting the right competencies. IC4_trust manager_3

Consulting with a range of staff, the HCA-DN developed, piloted and implemented a new induction programme. The corporate element of the new induction (including infection control, moving and handling) was held before HCAs began on the ward. The HCA training element was usually held within 5 to 6 weeks of their being in post. This part of the induction covered 4 days of HCA skills, including communication and washing. Each recruit was given a competency pack for their first 6 months that formed their probationary period and had to be achieved to attain a permanent contract.

A more recent initiative, designed to underpin the induction process, was the development by the HCA-DN of an e-learning package to support competencies and development online. This e-learning focused on mandatory training and the development of certain basics, such as vital signs, and, given the scattered nature of the trust across central London, provided an efficient means of dealing with such training.

Still a work in progress, this e-resource, in a more general sense, enabled the HCA-DN to track that HCAs were getting the support they needed:

I’ll be able to monitor who logs on, when they log on, if they complete a whole module or whether they do the whole package in one go, and if they haven’t passed, do they go back and log on again, how many times they’ve actually completed a module, how many tries they’ve had and not completed. IC4_trust manager_3

Domino training

A more specific initiative centred on a half-day study day preparing HCAs to recognise the signs of deteriorating patients. This programme, run monthly under the title ‘Domino’, extended the delivery of a programme from medical and registered nursing staff to HCAs. Domino was based on the critical care Patient Emergency Response Team training given to nurses and junior doctors. Domino was piloted for HCAs in 2009 and ‘went live’ in 2010.

Pressure ulcer workshop

The HCA-DN instituted additional study days on other topics of relevance to HCAs. In identifying such topics, the HCA-DN was again sensitive to the views of others, with pressure ulcers emerging as an issue worthy of a study day:

We’re sort of having very preliminary discussions about having a mandatory study day to cover some of the things that maybe are required . . . so around pressure ulcers, for example, maybe patient falls. IC4_trust manager_3

Accredited programmes

The HCA-DN was responsible for various aspects of accredited programmes available to nurse support workers: their design, publicising and recruiting to them and dealing with the HEIs. In the case of band 2 and 3 HCAs at UCLH, the main available programme was the apprenticeship. The trust’s apprenticeship programme began in 2010 and focused on existing staff. At the time of the research fieldwork, a proposal was pending on a new approach to recruitment, with all future recruitment to the HCA role via a 1-year apprenticeship contract at band 2 level, supported by all new job descriptions, and promotion to the band 3 level restricted to internal candidates only.

In the case of APs, the main programme was the FD. In 2010, UCLH had its first large cohort of APs passing through the London South Bank University FD. Originally, the cohort was for 10 trainee clinical APs at band 3 level but this was extended to 20. The original 10 were guaranteed a band 4 role on completion. There was a forum for APs held quarterly by the HCA-DN to facilitate networking and support. Each session had an external speaker. A band 4 booklet of competencies and expectations was being piloted at the time.

Road show and website

The HCA-DN communicated with HCAs on various types of issues, with two main systems developed to support this activity. Established by the HCA-DN in 2009, the HCA road show was a monthly event open to nurse support workers from across the trust and held on a rotating basis between the different UCLH sites. The road show had evolved to serve a number of purposes: connecting with HCAs and other staff groups from across the trust for the HCA-DN to find out about their concerns and issues; an opportunity for HCAs to raise queries, not least in relation to their current training; and an information and learning space for HCAs, with speakers coming along to make formal presentations.

The second communication initiative was the establishment of a dedicated HCA website. This website played an important role in informing HCAs about the availability of different study days and programmes, along with details about how courses might be accessed:

[The HCA-DN] has written loads of stuff online which are all around processes of applying, when they have workshops, you know, what’s entailed. IC4_trust manager_1

The role in practice

As a single post-holder working in a large and multi-site organisation, the HCA-DN needed considerable skill in taking these initiatives forward and in establishing wider commitment to them across the trust. A consideration of process issues suggests the importance of three organisational characteristics ( Figure 6 ): institutions, actors and systems.

Elements of process in developing HCA initiatives. N&M, Nursing and Midwifery.

Institutions

There were a number of formal institutions or bodies within UCLH that played an important part in both discussing and formally signing off a HCA-DN initiative. At the peak of the trust was the Nursing and Midwifery Advisory Board , comprising the chief and assistant chief nurses and the heads of nursing. This board introduced trust-wide initiatives with significant implications for the nursing workforce. The HCA-DN had sought sign-off from this board on the development of HCA competencies and on the design of a new approach to HCA recruitment based on the use of numeracy and literacy tests.

At the next level, divisional meetings involving the relevant head of nursing and her matrons were used as a means of developing or fine-tuning a proposal. For example, the HCA-DN used these meetings to develop specialist modules on certain HCA programmes, particularly the FD.

There were also a couple of bodies, specifically concerned with training and education, which played a role in the development of HCA initiatives. The education forum, convened by the assistant chief nurse, brought HEI providers to the trust for discussions on an accredited training programme. More important in this context was the CPF forum, a monthly meeting for CPFs across the trust. The extension of the Domino programme to HCAs, for example, was signed off at this forum.

At UCLH, a number of actors were crucial to the functioning of the HCA-DN role. The support of the chief nurse was important in setting the broad direction for the development of the trust’s unregistered workforce:

[The HCA-DN] needs the chief nurse’s support as well. It would be true to say that the chief nurse is essential; they’re going to drive the direction that this goes in. IC4_trust manager_2

If the chief nurse set the direction, the assistant chief nurse leading on education and research was needed to ‘make things happen’: pushing decisions to action and ensuring that the necessary resourcing was in place. The assistant chief was particularly accessible to the HCA-DN.

The HCA-DN’s line manager and, in particular, the corporate team of nurse educators and facilitators played an important part in actually delivering aspects of the HCA-DN’s programme. For example, the teaching on the study days would often come from this team.

Two systems were particularly important in allowing the HCA-DN to take forward initiatives in such a large and complex organisation. The first was the emphasis placed by the trust on guidance to divisions and clinical areas. Guidance was less prescriptive and more flexible than rules, and, in a large, complex and diverse organisation such as UCLH, played a role in giving effect to some of the HCA developments. The second was the HCA-DN’s use of networking to test, consult and build alliances in support of various initiatives:

[The HCA-DN] has done a lot of work around sort of networking with the ward sisters and trying to understand what it is that we want in terms of development. So therefore she’s got quite a lot of our buy-in for that. IC4_ward staff_2

The HCA-DN’s impact on the training and development of nurse support workers was seen as significant and beneficial. Views on the positive contribution made by the HCA-DN were often provided in an unprompted way, and suggested that the HCA-DN had made a tangible difference to improving these aspects of the HCAs’ working lives and changing the trust’s capacity in these respects:

The trust has put a lot of funds and effort into it recently, certainly the recruitment of [name of HCA-DN] . . . Giving someone of [name of HCA-DN’s] level and experience a whole-time equivalent job to spend putting together training for them, and to be fair pretty much every course that we run for qualified staff, [the HCA-DN] has adapted. So the work [HCA-DN’s name] done has been fantastic. So asking me the question now, I do think we have great learning and development opportunities for unqualified staff. IC4_ward staff_2

For some, the HCA-DN role had provided trust focus and direction on HCA training and development:

What [HCA-DN’s name] has done is given it a bit more focus. Everybody knows [HCA-DN’s name], she’s done a lot of good work for lots of other projects within the trust and I think that now she’s sort of taken this on-board, it’s got a bit more direction. IC4_ward staff_1

In the HCA focus group, the name of the HCA-DN was mentioned on no fewer than 18 separate occasions, providing some insight into how HCAs viewed and used the role. Thus, HCAs perceived the role and engaged with it as a channel for raising concerns, accessing opportunities and sorting out problems. Each of these areas is illustrated with a quote below.

[HCA-DN’s name] was one of the persons I said, ‘sorry, I’m not here just to do domestics, I’m here because I want to become a nurse; I give up my degree in biomedical because I want to be a nurse, I don’t want to be a domestic’. IC4_HCA_focus group

So you have, so you have regular e-mails from [HCA-DN’s name] letting you know about things. There’s the website to check things on. And so there’s the availability of study days, courses that you can do. IC4_HCA_focus group

I didn’t know what to do because I finished my nursing from [name of country], came here, was not able to work as a nurse because of the English exam. So then I approached [HCA-DN’s name] what to do, then she told me if you’re going to go back to nursing, do this course and then go. IC4_HCA_focus group

Data on the scale and coverage of many of the in-house initiatives developed by the HCA-DN are presented in Table 11 . Some noteworthy achievements stand out from these figures. Most striking, perhaps, is the significant number of HCAs completing the Domino and pressure care programmes. The number of HCAs who had been through the new induction programme, close to 100 over the last 2 years, was also striking.

Nursing assistant in-house training numbers

• Consultant-driven innovation: the surgical assistant practitioner role

This case study focuses on a band 4 AP role developed in the dermatology department of OUH NHS Trust. Introduced in 2011 and to date held by one post-holder, the role was labelled surgical assistant practitioner (SAP). In examining the nature and consequences of this role, four actors were interviewed in March 2013: the post-holder herself, a consultant dermatologist, a specialist nurse and the trust’s AP lead. During the fieldwork, the SAP was observed working alongside a consultant during a procedure.

The SAP role generates interest within the context of this project as an innovative development both within the trust and more generally across the NHS. Pushing role or practice boundaries perhaps further than any other innovative development considered in the project, this unregistered support role was designed to perform relatively complex clinical tasks, including minor surgical procedures.

The development of the SAP role took various turns, emerging in an iterative rather than in a fully formed way. Asked if the nature of the AP role was clear from the outset, the post-holder noted:

No, it’s just evolved really. IC5_SAP_1

Indeed, despite clinical consultant interest in it, the role initially emerged through discussion between the AP lead in the ED and a specialist nurse in the dermatology department, within the broader context of the trust’s second cohort of APs around 2008–9. These discussions, which also involved the potential AP post-holder, considered service gaps in dermatology that might be filled by an AP role. This encouraged an initial focus on how such a role might contribute to service flows in the outpatient clinic, with the aim of relieving nurses of aspects of work in this area and allowing them to concentrate more on their specialist tasks. All patients were seen in the dermatology department on an outpatient basis, with any surgery being performed as day surgery.

Against the backdrop of these discussions, a person had been selected for the AP support role in dermatology and had begun the FD. However, around 1 year into the degree, the specialist nurse who had originally sponsored the role as a support for the department’s clinics left the trust. At around the same time, the value of a role supporting the department’s day surgery work became apparent, particularly to one of the department’s consultant dermatologists, resulting in a shift in the role’s focus from the general clinics to the operating theatres.

The emergence of a support role centred on the dermatology department’s surgical activities was related to the confluence of two sets of factors: institutional need and personal circumstance. Institutionally , the need for such a role to contribute to surgical work was linked to the nature of the service provided by the dermatology department, and by the performance management regime underpinning it. Physically, and indeed clinically, the department was divided into two main parts. The upstairs section, comprising consultant-led general clinics, dealt with the full range of conditions: ‘. . . leg ulcers, anything to do with your skin, so eczema, psoriasis’ (IC5_specialist nurse_1).

A tumour clinic was also run upstairs, a ‘one-stop’ service which provided those in need of skin surgery with a same-day service. This same-day surgery was provided downstairs in the department’s operating theatres, along with elective surgery. These operating theatres were staffed by a number of clinical consultants – the department had a team of four consultants working on tumours along with two band 6 specialist nurses and the band 4 SAP.

Within the context of this set-up, a SAP role, able to undertake a wide range of tasks, many overlapping with those performed by the specialist nurses, was seen as a means of addressing service capacity and workload pressure. Such a role could undertake and finish off work, freeing up consultants and specialist nurses to see more patients:

With the one-stop service we try and do as much as we can on the same day, and we have so many referrals it’s really hard to keep on top of all the skin cancers that we need to perform surgery on. So having that supportive role, somebody to stitch up a hole while you’re doing the paperwork, it means that we can get through everything so much faster. IC5_specialist nurse_1

More specifically, such a role provided a greater a range of options in terms of staff deployment, particularly important given variation in and uncertainty about the availability of staff on any given shift:

The way we’ve done that is that we have clinics which are designed to see, screen and recommend treatment for patients at the same time as the theatre is open downstairs, so that they can be seen and treated at a one-stop. The difficulty with that is staffing it really, and so the way we’ve staffed it is by having a consultant downstairs and a consultant upstairs and if one of the consultants is away on holiday, the other consultant comes up and then covers the clinic, and then supervises the nurses and junior doctors downstairs; which is why it’s essential that we have the flexibility we’ve got from the girls [the nursing staff in the operating theatres]. IC5_consultant_1

The personal circumstances contributing to the development of the SAP role were apparent in a potential post-holder with a profile particularly well suited to the role. In part, this profile was characterised by a work history which provided the post-holder with a firm platform to develop in an extended unregistered role. Prior to joining the trust, the post-holder had been involved in nursing work in the military. More significantly, the post-holder had some experience of the trust and the department prior to taking up the SAP role:

I worked with them beforehand anyway and they know that if I was never happy I’d always come and find them, and there is a massive amount of trust involved in this and I think that’s one thing that needs to be stressed, you know, that they have to trust me. IC5_SAP_1

In fact, the post-holder had taken up a band 2 HCA post around 7 years before commencing the FD. This allowed her to develop an appreciation of the department’s systems, team members and ways of working. Equally significantly, it provided an opportunity for the department’s clinical and nursing staff to get to know her and to build trust in her personality and skills.

The disposition to take on more complex tasks was the final feature of the personal profile underpinning the emergence of the SAP role:

I’ve known [post-holder’s name] for I don’t know, seven or eight years now, it was very obvious early on that she had the competence to do this. IC5_consultant_1

This approach to identifying development potential in an individual and then building upon it encouraged the view that an evolutionary, ‘grow-your-own’ process was the ‘best’ way to develop an extended support role within the department:

The problem is identifying those HCAs that will have the competence and confidence to be able to do those, it’s much more of a sort of an evolutionary ad hoc thing, it’s very difficult to find the individual right for the job, you know, we have to grow our own almost. IC5_consultant_1

The development of the role

If institutional need and personal circumstance provided the basis for the role, these drivers still needed to be converted into a process that provided for the development and emergence of the SAP role. As played out in the dermatology department of OUH, a number of features of this process are worth highlighting. The first was the emphasis placed on competence as a means of cutting through formalities and any apparent barriers to change. It was a view summed up by the consultant in noting the range of complex tasks undertaken by the unregistered band 4 SAP:

As long as the competencies are in place to demonstrate ability and safety, then to be honest that’s far more important than a name or a label. IC5_consultant_1

The second feature of the process was a willingness to push boundaries. Without in any way compromising patient safety, the role was developed to undertake the complex clinical tasks associated with skin surgery, and systems were found to facilitate this extension.

The third feature was the importance of the consultant’s authority and support in giving effect to the changes needed to establish the SAP role:

So long as they know that they’ve got the support of the consultant, then it gives them the confidence to proceed. IC5_consultant_1

The importance of the consultant’s support was particularly apparent in his engagement with the post-holder; indeed, this consultant–post-holder relationship was pivotal to the development of the role. The relationship provided the basis for a shaping of the role, and more tangibly drawing out the requisite competencies. It was also a supportive relationship, with the consultant acting not only as a mentor but more actively as a trainer, facilitating on-the-job learning for the post-holder:

I do like the surgical side, and because I’ve worked down here with him very closely, he said I’d like to develop you into doing anaesthetics. And because I’d given injections and done a little bit of minor surgery in the RAF [Royal Air Force], he said let’s have a go and see where you develop. So I started off doing a little bit of suturing, then some minor procedures, and then it’s just developed and snowballed from there really. IC5_SAP_1

The significance of the consultant–post-holder relationship should not, however, detract from the importance of other relationships to the development of the role, in particular that between the trust’s AP lead and the post-holder. The AP lead was another key support for the post-holder, particularly during the FD. More specifically, the AP lead was able to give effect to the consultant’s aspirations for the role by developing appropriate specialist competencies to be built into the second year of the FD. The development of the role also required an education provider able and willing to provide bespoke programmes sensitive to the needs of the trust and the role it was seeking to develop.

Issues of clinical governance needed to be addressed. They were dealt with by putting in place thorough systems, demonstrably ensuring that the post-holder had acquired the requisite competencies without any risk to patient safety. Certainly, staff trust in the post-holder’s sensitivity to these safety issues underpinned this approach. There was a confidence in the SAP’s awareness of her limits and boundaries.

However, formal and comprehensive guarantees of competence were in place, for example reflected in the number of times a procedure had to be practiced and witnessed before the competence was signed off:

We ensured that her competencies were such that they were kind of unassailable, they were better than had been done for the junior doctors, better than I’d had as a trainee. IC5_consultant_1

There were specific clinical governance issues to be addressed, in particular related to prescribing and the administration of local anaesthetic. These took time to sort out. Indeed, it was suggested that ‘. . . we worked around it rather than work through it. And then did it properly afterwards’ (IC5_consultant_1).

The final aspect of the process relates to the involvement of the nursing directorate or nurse management in the development of the role. This involvement was limited. As a consultant-driven initiative, the role had a particular credibility and legitimacy, with responsibility at the end of the day presented as lying with the consultant:

As long as they know that they’ve got the support of the consultant, then it gives them the confidence to proceed. I would always ultimately be responsible for what goes on surgically and if there are issues with the nurses. IC5_consultant_1

The post-holder formally took up the SAP role on the completion of the 2-year FD. During the period of the FD, the post-holder was working at band 3, with 2 days per week off for study (one of these in her own time). On completion, she moved on to pay band 4. The role developed during the period of the FD, with the support of the AP lead, the consultant and other colleagues. On completion of the FD, the SAP role was striking in terms both of the range and complexity of the tasks performed.

Unable to secure patient consent for a surgical procedure, the SAP was not in a position to run lists, and therefore concentrated on providing assistance to the specialist nurses and the consultants with their lists. However, with the exception of the issue of acquiring patient consent, there was very little to distinguish the SAP role from that of the specialist nurse. Thus, the SAP tasks included administering local anaesthetic; conducting shave and puncture biopsies; removing moles; undertaking suturing; applying dressing; and dealing with after-care.

The consequences of the SAP role can mainly be seen in terms of positive service outcomes. At the outset, it was suggested that, given staffing and workload pressures, particularly associated with a same-day surgical service, an extended support role contributed to departmental capacity and flexibility:

From an efficiency perspective, it just means that we can ride the peaks and troughs of a busy clinical service, you know, more or less able to deal with whatever comes at us. So it means that we’re pretty rock solid. IC5_consultant_1

A more detailed consideration of the role highlights how it contributed to these ends and, arguably, also to improvements in service quality. Thus, the impact of the role can be seen to lie in a number of areas, each discussed below.

Sequential working

The SAP worked sequentially with the consultant in two senses. First, she prepared patients, allowing the consultant to come in and begin his work with speed and confidence. As indicated, this preparation involved not only clinical tasks, such as the administration of the local anaesthetic, but the ‘softer’ tasks of relaxing and putting the patient at ease:

He [the consultant] knows that my local [anaesthetic] will have been done properly, that the patient’s completely nice and numb, comfortable, warm, reassured. I’ve been with that patient all the time, whereas he’ll have to go in and out to see other rooms, so I’ve very often escorted the patient all the way down and I’m there right until the very end, which he won’t be. IC5_SAP_1

Second, the SAP worked in sequence with the consultant by finishing off a surgical procedure and associated activities, allowing the consultant to move on to deal with another patient.

Partnership working

As well as working alone and in sequence, the SAP acted alongside the consultant and the specialist nurse, again allowing a patient to be dealt with in a timely and speedier fashion. A specialist nurse provided an example:

So we work together most days, so if I have a surgical list I might go in and consent the patient, while I’m doing that, she’s drawing up the local anaesthetic. And then she’ll numb the patient. I might remove the lesion and leave her to stitch up while I do the paperwork. So potentially that patient’s time on the bed is halved, the paperwork takes up, you know, as long as the surgery, so while I’m doing the paperwork she can be finishing off and stitching up. IC5_specialist nurse_1

As implied, the SAP appeared to have more time to engage with patients, relaxing them, dealing with anxieties and putting them at ease:

So once you’ve reduced somebody’s blood pressure by being relaxed with the anaesthetic, then usually the operation is a doddle. IC5_SAP_1

Accessibility

Accessibility to the SAP also contributed to a positive patient experience. To the patient, the SAP was far less intimidating than the consultant or indeed the nurse:

I’ve been able to chat to them and explain to them what’s going to happen in more detail, in layman’s terms. I’m not as intimidating as a doctor, who’s quite loud and I can relax them and say, ‘well this is what’s going to happen’. IC5_SAP_1

In focusing on the performance of particular support tasks, the SAP became expert in their performance: a degree of specialisation bred increased proficiency. This was seen to be the case in relation to the administration of local anaesthetic:

I’ve done so many [local anaesthetics] now, so on the sites that are very painful or if people have a needle phobia, I get given those patients because it doesn’t bother me. IC5_SAP_1

In a slightly less positive vein, the consequences of the SAP might also be seen in terms of certain tensions. These were apparent in how others in the department viewed the role. Pushing the boundaries of the nurse support role meant that there had been some resistance from RNs in the department:

There are some other nurses in the department who haven’t been so accepting and have made comments, but they’re in the minority, and actually there’s only one that I can really think of who’s really made a fuss of it. IC5_specialist nurse_1

A summary of the features and issues associated with the development of the SAP role is presented in Figure 7 .

The development of the SAP role.

• The role of the clinical support worker trainer at band 4

This case study explores the development of a new educator role at OUH, specifically designed to help CSWs at pay bands 2 and 3 undertake training, particularly those on the Qualification and Credit Framework (QCF) diplomas and apprenticeships. The trust viewed the role as a means of strengthening its capacity to train CSWs, increasing both the scale of such training and the speed of completion. The fieldwork was undertaken in two phases. The first comprised interviews with key members of the trust’s CSW training team and with the CSW trainer herself, conducted at the end of 2012, soon after role had been introduced. The second phase involved repeat interviews with these actors, plus interviews with three CSWs engaging with the CSW trainer. These interviews were carried out in May 2013, some 6 months after the role had been introduced and been given time to ‘bed down’. The second-phase CSW interviewees were employed in different clinical areas: maternity, neuroscience and orthopaedics. In total, 11 interviews were completed.

Context and objectives

The CSW trainer was designed as a corporate role, working in a small team positioned in the nursing directorate and responsible for the training and development of the trust’s CSWs at bands 1 to 4. The emergence of the CSW trainer role was related to two sets of factors. The first was strategically driven, being tied to a broader initiative on the management and development of CSWs at the trust. OUH had decided to set up what it labelled as a CSW academy, with the CSW trainer role long envisaged as an integral part of it.

The rationale for the CSW trainer role within the CSW academy was associated with a perceived need to improve the trust’s approach to the training of CSWs, particularly at bands 2 and 3. Much of this training had been centred on the acquisition of NVQs (levels 2 and 3), although at the time the CSW trainer post took effect, the national training regime was underpinned by the QCF providing level 1 and 2 diplomas, and, when linked to functional skills, an apprenticeship. The trust was seen as ‘lagging’ in the number of CSWs seeking such accredited qualifications and in the pace and scale of completion.

The problem was seen to lie in the limited support available to CSWs undertaking this programme. In large part, this limited support derived from a lack of assessors in the trust. Indeed, it was the need for a dedicated corporate assessor for trainee CSWs across the trust that underpinned the introduction of the CSW role. The job description for the post noted one of the overall objectives: ‘[t]o effectively assess NVQ/QCF learners’ performance, knowledge and understanding against the national occupational standards’. 51

In more general terms, the CSW trainer role was a means of providing support to trainees during diploma and apprenticeship programmes. Formal training for CSWs was a far from straightforward process: not only had many trainees been away from formal learning for some time, but typically the requisite training involved juggling ongoing work and domestic responsibilities. In this context, support from a dedicated CSW trainer role was seen as assuming different forms. In part, it was related to ongoing advice, particularly on time management. Indeed, the CSW trainer’s contribution in this respect was reflected in another job description objective: ‘[t]o support a cohort of learners to achieve key performance targets relating to achievement and timely success rates’. 51

In addition, such support had a more personal dimension, with the CSW trainer available to deal with the stresses and strains likely to emerge during the training period. As the job description notes, the trainer role seeks ‘to provide pastoral support’ for trainees.

A significant dimension of this support was accessibility: the CSW trainer needed to be someone CSWs could relate to and readily approach in seeking support. The job description explicitly presented the CSW trainer’s post as a ‘role model’, and suggested the need to appoint an individual with a personal and professional background compatible with such a requirement. 51

The second set of factors driving the introduction of the trainer role was more opportunistic, reflecting immediate needs and pressures. Other initiatives associated with the CSW academy, particularly a new recruitment system and induction programme, were generating unexpected demands on other team members. The academy team was small, comprising only three other staff members, with the intensity of work exacerbated by the lack of replacement cover while the academy lead took 1 year’s sabbatical leave. In such circumstances, the CSW trainer role was perceived as crucial in relieving other team members of certain duties in relation to supporting CSW trainees, freeing the team up to concentrate on these other initiatives and activities:

[We] weren’t doing a good enough job really in supporting, there was just too much to do in terms of launching the academy, trying to support that initiative and also trying to run apprenticeships and trying to make them effective, trying to meet targets from [college name] who have the overall managerial responsibility for the apprenticeships. So really we felt that we needed someone dedicated to [QCF] assessment and to support apprenticeships. IC6_trust manager_1

Implementation and operation

The CSW trainer took up her post in September 2012. Graded at pay band 4, the post was internally funded and due to last until May 2013. This period of employment was subsequently extended until the end of 2013. The appointee came from outside the trust but had experience as a qualified nurse. As a new role to the trust, issues arose as to how it would establish itself and operate in practice. These processes unfolded iteratively: ‘I don’t think any of us really knew what was going to happen’ (IC6_CSW trainer_1).

In the event, the role developed along three activity tracks: assessor, champion and team. Each of these is discussed below.

An assessor track

The assessor track revolved around the range of tasks associated with managing a group of CSW trainees. At the outset, the post-holder took on six trainees but this rapidly increased to a steady-state number of 19, broken down into seven taking the apprenticeship and 12 taking the standalone QCF diploma. This aspect of the role centred on a one-to-one CSW trainer–trainee relationship. The trainer quickly established a routine of face-to-face meetings with each trainee every 2 weeks.

Such meetings were supplemented by the CSW trainer’s engagement with relevant actors at ward level. This included witnessing and assessing the performance of competencies, as well as dealing with ward managers in facilitating the CSW’s training and development: ‘I always liaise with the managers and try and get them onside’ (IC6_CSW trainer_1).

Closely related, the assessor role involved various activities related to the local accrediting college. For example, the post-holder was involved with the college in carrying through a diagnostic process, which evaluated the capabilities of potential trainees. This determined the appropriate level of training and, where necessary, connected the trainee to a bridging programme allowing them to build up capabilities.

Clinical support worker champion track

Working across a large and dispersed trust, as well as ‘starting from scratch’, championing the CSW role was a challenging aspect of the job. It was initially taken forward by the post-holder developing regular ‘drop-in sessions’ on the various trust sites. At the outset, these sessions introduced interested parties to and informed them about the presence of the new CSW trainer role. As an appreciation of the role developed, these sessions provided advice and information to CSWs on available training and dealt directly with CSW queries and problems associated with ongoing training.

This champion track had other dimensions. For instance, the CSW trainer made an effort to make the trust’s libraries more accessible to CSWs, not least by ensuring that the libraries acquired publications and other sources of use and relevance to CSW trainees. Moreover, the CSW role was increasingly contacted by ward managers seeking to develop competencies for their CSWs, as a means of explaining and encouraging the process: ‘She’s now sort of helping go round, as I was saying we’re doing competency workshops’ (IC6_trust manager_1).

The final track involved the CSW trainer in tasks somewhat beyond the training needs of established CSWs and more supportive of the broader activities of the CSW academy. Most striking in this respect was the work undertaken by the post-holder in helping the team to deliver the trust’s CSW induction. In part, this support was organisational and administrative: ensuring that speakers were available, rooms were booked and the appropriate paperwork was available. More substantively, the CSW was also contributing some of the teaching on the induction, for instance on the communication sessions.

Responses to the CSW trainer role from various stakeholders were extremely positive. In general, the role was seen as having taken on more than envisaged:

She’s taken on a lot more than we’d first anticipated, she’s sort of taken on organising key skill sessions and booking rooms for that and liaising with the key skills tutor and liaising with the students, even [when] they’re not her students. IC6_trust manager_1

At corporate level and in terms of impact on the trust’s CSW academy, the consequences of the role included:

‘[It’s] freed them up to do other things. I’m always willing to put my hand to whatever’s happening if I can help’ (IC6_CSW trainer_1).

‘With our capacity we couldn’t have considered taking on another cohort of apprentices or people just wanting to do standalone QCF awards, but her [the CSW trainer] coming in that September time for when they started, she helped with their recruitment and the interviewing and taking them on, with their induction taking them through their programme’ (IC6_trust manager_1).

‘There was certainly a gap in the market: they all knew about NVQs, and they all wanted to do them, but up till now there’d never been any way of them accessing it, they didn’t know who to go to or where to go’ (IC6_CSW trainer_1).

At an interpersonal level, the role impacted by providing various forms of support to trainees, again with meaningful corporate consequences such as improved and quicker completion rates. The CSW trainer noted that 18 of her 19 trainees were on schedule with their training. Asked to reflect on the various ways in which the CSW trainer had impacted on their learning and helped to keep them on schedule, CSWs noted:

I see her as a mentor that helps me with . . . [as] a lot of stuff is written in such a way that you don’t understand it. She helps you break it down. IC6_CSW_1

If I’ve got some question I can always phone to her or e-mail to her that I’ve got problem, ‘can we just meet?’ And it’s not a problem at all. IC6_CSW_2

More generally, the CSW interviewees highlighted the trainer’s role in:

• problem solving
• clarifying.

The capacity of the CSW trainer to contribute in these different ways can be related to the structure of the role and to three associated factors: personality, background and skills. In terms of role structure, the post was designed as a dedicated trainer role with a core focus on the direct relationship with the CSWs, and as a consequence the post-holder had more time to devote to the CSWs:

I can give all my time to it now really, whereas they’re [other members of the CSW academy] constantly having to deal with the AP course, that takes a lot of time up. IC6_CSW trainer_1

It will also be recalled that, as a band 4 role, the post was designed to be more accessible to CSWs than the other, higher-graded members of the CSW academy. There were signs of such accessibility:

I suppose they just feel a bit more comfortable; sometimes I think they’re aware [that other members of the CSW academy] are quite high up nurses and, you know, a little bit wary of them. Whereas with me they’re, especially after they’ve known me for a few weeks, because we do have a little bit of a laugh and coffee together and so it’s quite informal. IC6_CSW trainer_1

Most of the CSWs were unaware of the CSW trainer’s work background, and placed greater weight on her personality and style:

She’s [the CSW trainer] just got really positive body language; she’s not in your face; she’s quite calm; she never raises her voice and if I was struggling to get words out like on a piece of paper, she’s like, ‘I can see like you’re struggling, let’s just look at it a different way’. Like she’s just more relaxed about it and I never walk out thinking that made no entire sense. IC6_CSW_1

In terms of skills, it was clear that the post-holder was extremely well organised: she was juggling a range of tasks, including meeting all 19 trainees at least every other week. For one CSW, the regular meetings provided a structure and regularity of contact which had been absent in her previous assessor relationship. Indeed, this CSW asserted that without the CSW trainer she would have given up her training:

[Without the CSW trainer] I’d probably be looking at stopping it, to be honest; because [before] I wasn’t doing much with it at all . . . The structure wasn’t there and I know she’s very busy, I wasn’t seeing her that often, to be honest, I’d have probably looked at giving up if, if I’m honest. IC6_CSW_1

Figure 8 summarises the form assumed, and objectives achieved, by the CSW trainer role.

Summarising the CSW trainer role.

• Overview: discussion and lessons

The purpose of the innovation studies was to examine how and why trusts were able to introduce new nurse support roles and new management or working practices. These innovative interventions were defined as being new to the trust rather than unique to the NHS. There was an interest in why some trusts were able to take such steps while others were not, and what circumstances and organisational architectures permitted and supported them. In exploring various types of innovation, the cases have highlighted important differences in the conditions, processes and outcomes underpinning the introduction of new management practices, new support roles and new ways of working. These differences have included the following:

• New management practices are likely to be less threatening to other groups of staff than new work roles and ways of working, which might well challenge job boundaries and status.
• New work roles and ways of working represent more of a challenge to ward routines than new management practices, and therefore are more difficult to establish and sustain.
• New management practices are less likely to generate clinical governance issues which draw in a distinctive range of actors and often involve more complex and extended procedures.
• There is often a stronger training dimension associated with a new support role or way of working than with a new management practice.

Equally striking, however, are the similar lessons to be drawn from innovating in these various ways. These lessons relate to context, systems and actors:

• Trusts seeking to innovate in the management and use of nurse support workers are often innovative in other aspects of care delivery.
• Such innovative trust cultures are found within compact rather than large, sprawling trusts, with the personal interaction and networks needed to generate, share and develop ideas more likely in the former than in the latter.
• Innovation associated with nurse support workers is often initially opportunistic, rather than planned or strategic. The rationale and objectives underpinning such innovation might well emerge and be sharpened once the initiative has been implemented and ‘bedded down’.
• New nurse support roles and practices develop iteratively, as confidence, trust and understanding grow. Indeed, in doing so, innovation sometimes evolves in unexpected ways: for example, a new role might take on more than originally envisaged.
• Innovations need to be resourced; various sources are available and can be used to ‘pump-prime’ an initiative.
• Innovation in the use and management of nurse support roles needs to be seen as legitimate by key trust stakeholders: it has to address a ‘real’ issue or concern and be seen as an effective way of dealing with it.
• Innovation rests upon effective communication with those involved in, and affected by, the innovation. Such communication serves various purposes: testing ideas, getting feedback and informing.
• While formal structures might facilitate such communication, more informal contact and interaction often facilitates effective communication.
• The bottom-up rather than top-down introduction of an innovation, sensitive to ward-based needs and circumstance, is often more likely to be accepted, particularly by those at ward level.
• Actors from a range of functional areas within a trust – nursing, HR, education – often need to work in partnership in taking forward an innovation; they bring complementary capacities and insights to the process.
• Access to, and the support of, senior management, particularly senior nurse management, is often crucial to those taking forward an innovation. Senior management commitment legitimises innovation, while also helping to identify and remove barriers to it.
• Key individuals within the trust, ‘institutional entrepreneurs’, are often important in driving through and sustaining an innovation, becoming a hub for processing issues and maintaining essential relationships.
• A powerful internal sponsor, for example a clinical consultant, is likely to add weight to calls for the introduction of an innovation related to nurse support workers.
• Trust insiders – those with some knowledge and experience of a trust – are more likely to achieve traction in performing a new role and developing a new practice. They will be better known and trusted by others, and have a deeper understanding of trust routines and systems.
• Actors external to the trust can be crucial players in innovation, suggesting the need to develop constructive relationships with them. This is particularly the case where accredited training is involved, requiring outside education providers.

Included under terms of UK Non-commercial Government License .

• Cite this Page Kessler I, Spilsbury K, Heron P. Developing a high-performance support workforce in acute care: innovation, evaluation and engagement. Southampton (UK): NIHR Journals Library; 2014 Aug. (Health Services and Delivery Research, No. 2.25.) Chapter 3, Innovation: case studies.
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Management of Change and Innovation - Case Study of Coastline Electrics, Uk

Introduction The changes endured by Coastline occurred in the very specific context of privatisation. In this perspective, clashes of paradigms are common, in particular in the way knowledge is viewed and exercised as well as between the past and present goals of companies engaged in such process. As described by Grey and Mitev (quoted in Wilson, 1995, p.59): "If ‘post-industrial society ' does offer the possibility of decentralization of work and industrial structures, as well as an increase in the quantity of information and/or knowledge, it is important to remember that these changes have emerged in particular circumstances, that is, the countervailing tendencies towards (re)centralization of overall control; an increasing …show more content…

Threatened in their autonomy both as experts and managers, the marginalization of engineers results in the deprofessionalisation of the organisation as a whole. The question remains whether on the long-term this should lead to an improvement or a deterioration of the company 's performance. Knowledge distribution as a vector of normalisation One of the most striking measure implemented by the new management is the process labelled as "job Redesign" by which the checking of the work by engineers is replaced by an auto-check of the staff 's work, using a step-by-step guide. To achieve this important step, rules of the guide have been written by the engineers, therefore transforming what is known as a tacit knowledge into a explicit knowledge easily transferable. Although White and Jacques (1995) argue that post-industrialism often emphasises the importance of ‘changes in the knowledge requirements of workers (from an emphasis on technical knowledge to an emphasis on scientific or theoretical knowledge) ', one can also see the Job Redesign process as a "taylorisation of knowledge", as Wilson (1995) describes by "systematically gathering together ‘all of the great mass of traditional knowledge, which in the past has been in the heads of the

Assignment 3 Understanding Innovation And Change In An Organisation

I work for Abertawe Bro Morgannwg University Health Board. ABMU Health Board was formed on 1st October 2009 as a result of a reorganisation within the NHS in Wales and consists of the former Local Health Boards for Swansea, Neath Port Talbot and Bridgend. The Health Board covers a

Evaluating the Theories of Innovation and Change from a Leadership Perspective

Transformational leaders have the ability to take diverse talents and viewpoints in any organization and meld them together into a cohesive, focused and highly effective force to accomplish challenging goals and objectives. The intent of this analysis is to evaluate theories of innovation and change from a leadership perspective in the first section, followed by an analysis of experiences, and finally a self-assessment of leadership skills.

Matthew B. Crawford's The Case For Working With Your Hands

At the beginning of the article, Crawford outlined the increased of demand for technical jobs, "making the manual trades- plumbing, electrical work, car repair- more attractive as careers” (n.p). Although it is idealized as "the salt of the earth", in reality, workers are prevented from joining this field by family members (n.p). Believed to be no-brain work, the author argued that trades turn out to require a lot of effort and “metacognition” in order to “eliminate variables…The gap between theory and practice stretches

Constitutional Law Australia - Interpretations Essay

Through the progression of history the need for the principles articulated in Engineers’ Case was both necessary and appropriate. Callinan J in Workchoices’ Case made

Dgl International

When DGL International, a manufacturer of refinery equipment, brought in John Terrill to manage its Sales Engineering division, company executives informed him of the urgent situation. Sale Engineering, with 20 engineers, was the highest-paid, best-educated, and least-productive division in the company. The instruction to Terrill: Turn it around. Terrill called a meeting of engineers. He showed great concern for their personal welfare and asked point blank: “What’s the problem? Why can’t we produce? Why does this division have such turnover?

Leading Innovation & Change

The environment of an individual including culture of the company, management style, level of stress at work, etc…are also very important factors.

The Great Management Theorists : F. W. Taylor, Max Weber, And Douglas Mcgregor

Let’s begin by analyzing F. W. Taylor. Taylor’s scientific method can be summed up as a systematic study of relationships between people and tasks to increase efficiency (Jones and George 2015). There are four principles involved in this method: (1) Study the way workers perform their tasks, gather all the informal job knowledge that workers possess, and experiment with ways of improving the ways that tasks are performed. This step has the similar attributes of the organizing and controlling tasks discussed earlier in that the controlling task also involves evaluating the division of labor. (2) Codify the new methods of performing tasks into written rules and standard operating procedures. This step is very much about the organizing task. Although there are written rules, this aspect diverges from the leading

Compare Frederick Taylor's Mass Production and Eric Trists Socio-Technical Team Based Production Approaches to the Design of Work Systems

The fundamental theory behind scientific management is breaking down each part of a job to its science (Taylor). In the Principles of Scientific Management, Taylor talks about pig iron handlers, shoveling and bricklaying as a few examples in which he implemented scientific management. He proposed four important elements that are essential to scientific management. In this example Taylor discusses the science of bricklaying. First management must develop the science of bricklaying with standard rules of each task. Every task is designed to be perfect and standardized. The second element is selection and training. This step is important because Taylor wants an employee who is “first class,” meaning that they are the best at what they do, follow instructions and will not refuse to listen or adopt the new methods that management is executing. The third element is teaching the first class employee the science of bricklaying broken down by management. At this stage management is instructing the employee what to do, how to do it, and the best way to do it. Management is there to help them and watch that they are doing it “their” way and not

Change Management Literature Review

With our main research question we aim at exploring the importance of effective change management and the characteristics of a successful change management program in a hospital. The main research question can be formulated as: To what extend is change management necessary and how can it most efficiently be implemented in a hospital?

Innovation and Leading Change

Not only innovation lead to change inside organizations, but also some changes in side organizations can lead to innovation. Moreover, managing innovation and change is not an absolute easy process as it seems, as it requires lots of human interaction with different backgrounds, contexts, cultures that require aligning all your human resources to respond to new innovations, and related changes and this will only be done via good and efficient leadership. Generally, innovations and related changes may include change in organization structure workforce planning, marketing strategy, geographical distribution , culture, …ect which directly impact human resources in any organization , therefore the role of the leader is so crucial to manage tensions, conflicts, resistances, uneasiness and development areas that usually appear with new changes and innovations. Leading Innovation and change being part of managing human and organization behaviors is kind of a complex processes that include several factors, stages, models, perceptions and definitely outcomes. In this paper I will get a deep dive and close up view stating the various definitions, different related models, how they work in practical life and what kind of failures such models face in real life implementation; along with a self reflection to the applied experiences of such study and what will be the development plan leading to more successful practices in future.

Ford Pinto Code Of Ethics Essay

With the constant discovery of scientific principles and new engineering designs, the responsibility often lies in the hands of engineers to decide what is in the best interest of the public. Millions of people around the world use products and structures developed by engineers, every day. Before accepting work from a client, it is important that engineers have a good understanding of their own personal limitations. If work is accepted that they are “not competent to perform by virtue of [their] training and experience” , there is a clear disregard for public welfare and potential for a serious safety hazard. It is again evident that the

Change Management - Theories of Changes

Organizational change is usually triggered by relevant environment shift, either internal or external, that sensed by companies and leads to intentionally generated response (French, Bell & Zawacki, 2006). This paper will discuss several organization development models..

The Role Of An Engineer Essay

As mentioned above, it is very important for engineers to understand their own responsibilities. In 1960, the Conference of Engineering Societies of Western Europe and the United States of America defined "professional engineer" as follows:1 “A professional engineer is competent by virtue of his/her fundamental education and training to apply the scientific method and outlook to the analysis

Process of Innovation and Change Management

Using the Pirelli Cables Study, the organisation selected Total Quality Management (TQM) to help solve ongoing operational problems, such as staff turnover, quality problems and also develop customer and employee relationship.

Scientific Management And Human Relations Theory

The scientific management theory have an assumption that workers are lazy, not smart in analyzing tasks, only prefers simplified work and only works for money (Miller & Form, 1964). According to Taylor (2004), workers are unable figure out the most efficient way in doing work. Therefore, they are thought as replaceable working parts like a machine in the production line and can be trained to specialize in a certain procedure in the production. They are assumed to adopt the Protestant work ethic, working for long hours and not taking any breaks. Whenever a worker or a ‘part’ failed to perform its tasks, they

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