Table 3 The factors that impeded intended innovation

Context

Resource limitations and high workload

6

Resistance from corporate departments (such as finance and HR)

5

Lack of stability in the system (restructuring and rapid policy changes)

7

Large size of organisation results in general inertia within the system

4

Hierarchy in host organisation or NHS (e.g., support at top not filtered down and middle managers, which protects the status quo)

4

Internal politics/bureaucracy (policies and procedures developed for routine practice not innovation)

4

A cultural norm of risk minimisation

2

Poor service user access to the internet

2

Lack of awareness of intellectual property, branding and business processes

2

High staff turnover

2

Process/Outcome

Initial resistance from front line staff

7

Initial resistance from service users

4

The new role of entrepreneur in NHS (little history and knowledge of the role)

4

Initial low expectations amongst staff

4

Resistance from middle managers

3

Underestimation of costs

3

Professional jealousy/resource envy

3

Poor communication within host organisation (especially in the NHS)

3

Tensions between rhetoric at the top and action on the ground

2

Tension between artistic integrity and therapeutic benefit

2

Newness and complexity of idea (judged to be 'too left field')

2

Funding body had little influence on statutory services

2