The eight papers below each relate to different dimensions of the same problem: how organisational innovation can ride the tensions that proposals for change inevitably generate.

The papers can be divided into three areas:

(1) efforts still being developed to improve patient and public involvement in health services;

(2) more established attempts to diffuse innovation through structural change, a performance assessment system, the use of clinical guidelines, and through exploiting organisational culture and shaping individual identity; and

(3) a systematic review of the diffusion of innovation and a catalogue of the complexities involved and tensions that different approaches generate; some interesting suggestions are made about how to engage with these.

Improving patient and public involvement

▸ Some innovations strive to fundamentally change relationships between patients and health professionals, health services and their users.

Citizens’ juries to set local health needs? ▸

Involving the public has become so important that, according to Kashefi and Mort, it has become a “bureaucratic preoccupation for every health agency in the UK”. The problem is that health agencies tend to approach consultation in a tick box fashion rather than genuinely gather views to improve local services. The authors testify this routine: “we are repeatedly invited to submit proposals for consultation projects knowing what is being sought is the public view at a competitive price rather than critical engagement and identification of complexities”.

This paper explores “an innovative approach for local participation” through the development of “a grounded citizens’ jury”, which was promoted by the IPPR on the basis of research into similar models in the US and Germany. In south west Burnley (a town in Northern England) 12 local people were recruited to a citizens’ jury to set questions, invite evidence and deliberate on what they felt would improve the health and well being of people living in the area. The question chosen was simply: “What would improve …