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Organisational innovation and control practices: the case of public-private mix in tuberculosis control in India

机译：组织创新和控制实践：印度结核病控制中的公私合营案例

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摘要

Partnerships between public and private healthcare providers are often seen as an important way to improve health care in resource-constrained settings. Despite the reconfirmed policy support for including private providers into public tuberculosis control in India, the public-private mix (PPM) activities continue to face apprehension at local implementation sites. This article investigates the causes for those difficulties by examining PPM initiatives as cases of organisational innovation. It examines findings from semi-structured interviews, observations and document analyses in India around three different PPM models and the attempts of innovating and scaling up. The results reveal that in PPM initiatives underlying problem definitions and different control practices, including supervision, standardisation and culture, continue to clash and ultimately hinder the scaling up of PPM. Successful PPM initiatives require organisational control practices which are rooted in different professions to be bridged. This entails difficult balancing acts between innovation and control. The innovators handle those differently, based on their own ideas of the problem that PPM should address and their own control practices. We offer new perspectives on why collaboration is so difficult and show a possible way to mitigate the established apprehensions between professions in order to make organisational innovations, such as PPM, sustainable and scalable.
机译：公共和私人卫生保健提供者之间的伙伴关系通常被视为在资源有限的环境中改善卫生保健的重要途径。尽管重新确认了政策支持，以将私人提供者纳入印度的公共结核病控制范围，但公私合营（PPM）活动继续在当地实施场所受到关注。本文通过检查PPM举措作为组织创新的案例来调查造成这些困难的原因。它检查了印度围绕三种不同的PPM模型进行的半结构化访谈，观察和文档分析的发现，以及创新和扩大规模的尝试。结果表明，在PPM计划中，潜在的问题定义和不同的控制实践（包括监督，标准化和文化）继续发生冲突，并最终阻碍了PPM的推广。成功的PPM计划需要根植于不同专业的组织控制实践之间的桥梁。这导致创新与控制之间难以平衡。创新者根据自己对PPM应该解决的问题的想法以及他们自己的控制实践来不同地处理这些问题。我们提供了有关为何协作如此困难的新观点，并展示了一种减轻职业之间已建立的忧虑的可能方法，以使组织创新（如PPM）具有可持续性和可扩展性。

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