Table 1.

Constraints and emergent behaviours of health service managers supporting health innovation adoption

Constraints to innovation adoption	Emergent behaviours and capabilities —managers’ responses to constraints
Individual staff constraints
Staff’s lack of understanding of the innovation and its potential benefits	Influencing staff’s perception on the value of the innovation Communicating public health perspectives and the value of a specific innovation Communicating links between innovations and Department of Health goals
Staff personalities, attitudes and behaviours lead to resistance to change	Understanding staff’s personalities, motivations, skills and interests Working with gatekeepers to influence perceptions and practices Role modelling positive attitude to change and commitment to the community Employing strategies to motivate staff Gaining community perspectives on innovation and communicating these with staff
Health system constraints
Workload inducing resistance to change Suboptimal communication through DOH structures Hierarchy of health system limits managers decision-making innovations Frequency and pace of change is overwhelming	Communicating the ‘bigger picture’ of reduced patient visits (benefit to facility and staff) Working with staff unions to influence perceptions of innovation Responding quickly to staff concerns Providing positive feedback and regular communication about innovation adoption Facilitating teambuilding Finding non-financial ways to reward staff Rapidly internalizing and packaging innovation information for presentation to frontline staff Employing appropriate planning strategies to facilitate consultation with staff and implementation Using a participatory management style Adopting a collaborative planning approach to strengthen staff support while following policy directives. Executing a review mechanism for implementation of innovations to ensure sustained support Harnessing appropriate planning skills to drive the consultative planning process, piloting, engagement, response and feedback