Sharing Stories or Co-Constructing Practice? Challenges to Undertaking and Researching Innovation Using Evidence from the English NHS

Abstract

A network theory of governance situates learning processes in the sharing of stories (which we might call ‘agency’) against a background of traditions and norms (which could be seen as ‘structure’). This perspective has implications for both the conceptualisation and study of learning and innovation as a distributed process within organisations. This chapter explores, and develops further, the role of stories in innovation by drawing on aspects of practice theory, in particular, John Shotter’s concept of ‘dialogical practice’ which explores the co-construction of agency through dialogue which represents a ‘third’ way of knowing that does not belong to any one individual, but is a shared, creative act. If such stories are co-constructed through interaction, rather than being formulated and shared by individuals, this has implications for how we conceptualise agency in learning and innovation processes. When considered dialogically, stories can be seen as enduring or ephemeral, and to support or impede change, depending on the networks though which they are co-constructed. This chapter explores this idea using ethnographic evidence from an NHS provider in England of specialist eye services managing a network of clinics. It examines the planning and implementation of innovation through this network and the ways in which the co-construction of stories draws on professional power, and the potential for both creativity and breakdown as they unfold, influence the resulting innovation processes. This perspective also has practical implications for the use of ethnography as a method for inquiring into innovation processes through stories.