Institutional Work and Innovation in the NHS: The Role of Creating and Disrupting

We use the lens of ‘institutional work’ to explore the implementation of innovative projects within the NHS in England, designed to improve access to primary care services. We report a qualitative process evaluation of their implementation. We highlight the conflicting institutional logics at work across the field, and provide some examples of ‘creating’ and ‘disrupting’ institutional work required to bridge them. We explore the enabling conditions which may have allowed our participants to temporarily transgress the institutional constraints within which they worked. We provide evidence which may be of practical use for those seeking to innovate in this way, and ask whether or not these micro-level acts of creation and disruption may, in the longer term, accumulate towards wider institutional change.