Literature Review: Innovation in Third Sector Organisations
Third Sector Organizations and the co-production of health innovations - Windrum, 2014
Illustrated by four case studies, Windrum’s ‘Third sector organizations and the co-production of health innovations’ (2014) provides a discussion of the existing literature surrounding the role of TSOs in innovation. The author puts forward possible explanations for the way TSOs are perceived and positioned within healthcare innovation, and makes recommendations for capitalising on their strengths.
Windrum divides his research between a critique of the co-production of health services involving TSOs, and a narrower investigation of the ways in which TSOs contribute to the ‘organisation and management of the innovation networks which co-produce new health services’ (Windrum, 2014, p. 1047).
He begins by discussing the key characteristics of organisations within the third sector. However, rather than identifying any shared characteristics in organisational processes, cultures, and values, which would be expected in similar papers about either the public or private sector, he highlights that any attempt to define ‘key characteristics’ would likely be futile, as it vastly underestimates the complexity and variety of organisations and roles which can be found. There then follows an explanation of the definition of ‘co-production of public service provision’ which emphasises the shared role of government and organisations/citizens in the development (and even implementation) of policy.
The theoretical framework established, Windrum moves on to specific case studies, selected to support a spread of innovation examples: ‘knowledge services which are intangible’ (a category with no direct analogy in the OECD’s 2005 definition); ‘technology mediated services’ (product innovation); organisational/process innovations; and the construction of innovation networks (Windrum, 2014).
This categorisation allows the author to draw a range of conclusions. Primarily, that the building of the innovation networks is itself an effective form of organisational innovation, and one which TSOs are well suited to facilitating.
Returning to the definition of co-production provided previously, Windrum notes that there is a lack of direct end-users (patients) within these innovation networks, despite the need for collaboration between end-user and producer if his presentation of these case studies as examples of co-production is to be accurate. At first glance, this seems logical, given the level of knowledge patients may be expected to have of medical or project management skills in a network based on a ‘competence fit between partners’ (Windrum, 2014). However, as Windrum notes earlier in the paper, it is increasingly common for patients to be expected to manage their own healthcare (particularly with the notion of ‘empowered’ patients (Hibbard, 2007). For Windrum, then, the lack of end user involvement in innovation networks is a source of competency gaps which TSOs are particularly well-suited to fill.
More than that, the author argues that stakeholders often consider TSOs to be best placed to manage the network as a whole, on the basis of perceived prioritisation of end-user experiences over financial profit. TSOs are, then, the best solution to both the management of innovation networks and the expansion and cultivation of direct engagement with those networks.
This was, in part, verified by Windrum’s case studies, all of which showed the TSO as the principal initiator of the innovation network.
Because of this, success factors from the case studies becomes a new focus, beginning with finance. For the author, a successful network must be appropriately financed, which the TSO can often play a role in. The network must also be constructed with a sufficient range of competencies (whereby elements in the network must be neither too dissimilar in terms of technical competency and approach, nor too similar, such that they have nothing to learn from each other). Finally, Windrum concludes that, in any innovation network, success is dependent on all constituent elements having a high level of trust in each other (which is particularly applicable in healthcare contexts).
Evaluation
The purpose of the paper is to characterise the formation and management of innovation networks in healthcare, and the role of TSOs in co-producing innovation, which the author describes as an ‘important, but under researched issue’ (Windrum, 2009). This sentiment is shared by both researchers of innovation (Llewelyn, 2008) and healthcare professionals (Batalden, et al, 2016).
As such, any contribution, however minor is likely to be significant. The primary contribution of this article to the study of innovation networks is in its concise explanations of a selection of extant literature surrounding the difficulty in defining the third sector, the definition of co-production in the private sector, and the adjustment of the definition to suit voluntary organisations.
Further, the case studies are selected to allow for a wide range of innovation outputs to be discussed. While the categories of innovation described subscribe to a definition of innovation based upon output, they don’t limit themselves to the OECD (2005) categorisations, instead employing more sector-specific examples. This puts into practice one of the key messages of the paper, that the heterogeneous nature of the third sector (and healthcare providers) means that flexibility of approach is often required.
Additionally, as Deputy Director of the Centre for Health Innovation Leadership & Learning at Nottingham University Business School, Prof. Windrum has considerable research experience on the interface between public and private innovation and the development of innovation networks, including in his authorship of the 2008 book ‘Innovation in Public Services: Entrepreneurship, Creativity and Management’ on which the UK case study in this paper is based.
However, the paper has significant limitations.
The primary mechanism by which Windrum attempts to achieve his aim of examining the roles played by TSOs is in the discussion of four case studies. This limitation of the paper is perhaps the most obvious, and also the most significant. Demonstrating theoretical principles with case studies is often central to contextualising and successfully communicating findings, and would be a contribution to the field. However, that is not what this paper seeks to achieve. Instead, conclusions are drawn based on only four case studies from a range of countries and fields of innovation, and are communicated as ‘stylized facts’ about the work of TSOs in healthcare as a whole, and are, on occasion, stated as applicable to wider network formation and management issues.
An aside, which perhaps limits the utility of one of the case studies even further, is Windrum’s role in the project described in one of the studies (which is not immediately obvious within the paper). This has clear consequences for the level of objective analysis which can be expected for this case study. In a paper which only contains four case studies, and which analyses the studies with a very high-level qualitative approach, based on the opinions of the stakeholders involved, this restricts the conclusions which can be drawn from an already significantly limited paper.
Though the conclusion of the paper returns to a more restrained or cautious approach, talking about the features of ‘the health networks studied in this paper’ specifically, this is not always apparent throughout the paper. Even in this case more significance is often inferred than would reasonably be merited. For example, statements such as ‘formal contracts were only drawn up in half of the case studies’ are used to justify the author’s conclusions about the importance of trust in successful partnerships. While these conclusions may be supported by other evidence in the field (for example, from Milbourne and Cushman, 2012) they aren’t supported within this research. Half of the case studies showing a characteristic is, here, two. Assuming that drawing up a contract occurred at random 50% of the time, it would be expected that for any group of 4 case studies, 2 or fewer contracts being drawn up would happen approximately 70% of the time. Drawing any conclusion from this is ambitious, and overestimates the value of the case studies for this kind of extrapolation.
The paper itself, when contextualising the sector, provides much of the evidence required to support an over- rather than under-cautious approach to data extrapolation as mentioned above. Whether in the inclusion of Kendal and Knapp’s (1995) characterisation of the third sector as a ‘loose and baggy monster’, or the mention of the hybridised organisational forms which TSOs often take, it is clear that the third sector is as far from homogenous as could be. It is therefore even less appropriate than ‘normal’ to apply the data from individual cases to the whole.
Similarly, the paper is referred to by its author as a meta analysis, however drawing conclusions with statistical significance from such a small number of case studies, with little (if any) quantitative data, would be unwise. Quantitative data outside of the number of case studies each factor appeared in is also not provided. This suggests that the strengths of the article would be in its illustration of already established facts via exemplar, and not in the development of any new generalisations or findings.
However, there is also a lack of these required links between the case studies and the previously established theories which would be the paper’s strength. In a review of the book from which many of the case studies and conclusions are drawn (‘Innovation in Public Services: Entrepreneurship, Creativity, and Management’, Windrum, 2008), Professor Sue Llewellyn of Manchester Business School argues that among the weaknesses of the case studies is the fact that they ‘are rather under-theorized, having read the book I didn’t feel that I had an enhanced conceptual understanding of how entrepreneurship, creativity, and management relate to innovation’ (Llewelyn, 2008). This is similarly true in this article.
