Addressing complex healthcare problems in diverse settings: Insights from activity theory

In the UK, approaches to policy implementation, service improvement and quality assurance treat policy, management and clinical care as separate, hierarchical domains. They are often based on the central knowledge transfer (KT) theory idea that best practice solutions to complex problems can be identified and ‘rolled out’ across organisations. When the designated ‘best practice’ is not implemented, this is interpreted as local – particularly management – failure. Remedial actions include reiterating policy aims and tightening performance management of solution implementation, frequently to no avail.