Crossing and creating boundaries in healthcare innovation.

Purpose - This paper reports from a qualitative case study of a change initiative undertaken in a Danish public hospital setting during national healthcare reforms. The purpose of this paper is to challenge understandings of innovations as defined by being value-adding per se. Whether the effects of attempting to innovate are positive or negative is in this paper regarded as a matter of empirical investigation. Design/methodology/approach - Narrative accounts of activities during the change initiative are analysed in order to elucidate the effects of framing the change initiative as innovation on which boundaries are created and crossed. Findings - Framing change initiatives as innovation leads to intended as well as unanticipated boundary crossings where healthcare practitioners from different organizations recognize a shared problem and task. It also leads to unintended boundary reinforcements between "us and them" that may exclude the perspectives of patients or stakeholders when confronting complex problems in healthcare. This boundary reinforcement can lead to further fragmentation of healthcare despite the stated intention to create more integrated services. Practical implications - The paper suggests that researchers as well as practitioners should not presume that intentions to innovate will by themselves enhance creativity and innovation. When analysing the intended, unintended as well as unanticipated consequences of framing change initiatives as innovation, researchers and practitioner gain nuanced knowledge about the effects of intending to innovate in complex settings such as healthcare. Originality/value - This paper suggests the need for an analytical move from studying the effects of innovation to studying the effects of framing complex problems as a call for innovation.