A formative evaluation of Collaboration for Leadership in Applied Health Research and Care (CLAHRC): institutional entrepreneurship for service innovation

BackgroundCollaborations for Leadership in Applied Health Research and Care (CLAHRCs) are a time-limited funded initiative to form new service and research collaboratives in the English health system. Their aim is to bring together NHS organisations and universities to accelerate the translation of evidence-based innovation into clinical practice. In doing so, CLAHRCs are positioned to help close the second translation gap (T2), which is described as the problem of introducing and implementing new research and products into clinical practice.ObjectivesIn this study, we draw on ideas from institutional theory and institutional entrepreneurship to examine how actors may engage in reshaping existing institutional practices in order to support, and help sustain efforts to close the T2. Our objective was to understand how the institutional context shapes actors’ attempts to close the T2 by focusing on the CLAHRC initiative.MethodsThe study employed a longitudinal mixed-methods approach. Qualitative case studies combined interview data (174 in total across all nine CLAHRCs and the four in-depth sites), archival data and field notes from observations, over a 4-year period (2009–13). Staff central to the initiatives were interviewed, including CLAHRC senior managers; theme leads; and other higher education institution and NHS staff involved in CLAHRCs. Quantitative social network analysis (SNA) employed a web-based sociometric approach to capture actors’ own individual (i.e. ego) networks of interaction across two points in time (2011 and 2013) in the four in-depth sites, and their personal characteristics and roles.ResultsWe developed a process-based model of institutional entrepreneurship that encompassed the different types of work undertaken. First, ‘envisaging’ was the work undertaken by actors in developing an ‘embryonic’ vision of change, based on the interplay between themselves and the context in which they were situated. Second, ‘engaging’ was the work through which actors signed up key stakeholders to the CLAHRC. Third, ‘embedding’ was the work through which actors sought to reshape existing institutional practices so that they were more aligned with the ideals of CLAHRC. ‘Reflecting’ involved actors reconsidering their initial decisions, and learning from the process of establishing CLAHRCs. Furthermore, we employed the qualitative data to develop five different archetype models for organising knowledge translation, and considered under what founding conditions they are more or less likely to emerge. The quantitative SNA results suggested that actors’ networks changed over time, but that important institutional influences continued to constrain patterns of interactions of actors across different groups.ConclusionThe development of CLAHRCs holds important lessons for policy-makers. Policy-makers need to consider whether or not they set out a defined template for such translational initiatives, since the existence of institutional antecedents and the social position of actors acted to ‘lock in’ many CLAHRCs. Although antecedent conditions and the presence of pre-existing organisational relationships are important for the mobilisation of CLAHRCs, these same conditions may constrain radical change, innovation and the translation of research into practice. Future research needs to take account of the effects of institutional context, which helps explain why many initiatives may not fully achieve their desired aims.FundingThe National Institute for Health Research Health Services and Delivery Research programme.