Innovating toward a patient centred (PC) model presents great potentialities for the improvement of the health care delivery system, but, at the same time, it challenges hospitals’ pre-existing organizational and professional structure. This study examines the social processes that underpin and shape the PC innovation during its actual implementation, so far poorly explored by the literature. Based on the findings of an ethnographic research, the study shows that the PC innovation is not merely a process of adaptation, but rather consists in a complex interaction between a new formal model and the informal social organization of the hospital (e.g. hierarchies, behavioural norms, jargon in use, implicit rules for balancing autonomy and power). This interaction gives rise to desired outcomes but also to unexpected effects. For example, the creation of new teams and care settings may lead to the renegotiation of the implicit agreements concerning nurses’ autonomy and jurisdiction, thus affecting the integration and quality of the delivered care. The contribution provides an in-depth exploration of these processes and offers some suggestions to decision makers and managers that are aimed at bridging the gap between the innovation formal program and daily care practices, thus fully exploiting the potentiality of the innovation.
Keywords: Innovation, Hospital, Patient Centred Model, Ethnography, Practices, Social structure.