A longitudinal qualitative exploration of healthcare and informal support needs among survivors of critical illness: the RELINQUISH protocol.

Introduction and background: Survival following critical illness is associated with a significant burden of physical, emotional and psychosocial morbidity. Recovery can be protracted and incomplete, with important and sustained effects upon everyday life, including family life, social participation and return to work. In stark contrast with other critically ill patient groups (eg, those following cardiothoracic surgery), there are comparatively few interventional studies of rehabilitation among the general intensive care unit patient population. This paper outlines the protocol for a sub study of the RECOVER study: a randomised controlled trial evaluating a complex intervention of enhanced ward-based rehabilitation for patients following discharge from intensive care. Methods and analysis: The RELINQUISH study is a nested longitudinal, qualitative study of family support and perceived healthcare needs among RECOVER participants at key stages of the recovery process and at up to 1 year following hospital discharge. Its central premise is that recovery is a dynamic process wherein patients’ needs evolve over time. RELINQUISH is novel in that we will incorporate two parallel strategies into our data analysis: (1) a pragmatic health services-oriented approach, using an a priori analytical construct, the ‘Timing it Right’ framework and (2) a constructivist grounded theory approach which allows the emergence of new themes and theoretical understandings from the data. We will subsequently use Qualitative Health Needs Assessment methodology to inform the development of timely and responsive healthcare interventions throughout the recovery process. Ethics and dissemination: The protocol has been approved by the Lothian Research Ethics Committee (protocol number HSRU011). The study has been added to the UK Clinical Research Network Database (study ID. 9986). The authors will disseminate the findings in peer reviewed publications and to relevant critical care stakeholder groups.

Changes in innovation styles - comprehensive study of the changes in innovation styles to identify the causes and effects of different influencing factors and capabilities to create a general innovation pattern.

An investigation in innovation management and entrepreneurial management is conducted in this thesis. The aim of the research is to explore changes of innovation styles in the transformation process from a start-up company to a more mature phase of business, to predict in a second step future sustainability and the probability of success. As businesses grow in revenue, corporate size and functional complexity, various triggers, supporters and drivers affect innovation and company's success. In a comprehensive study more than 200 innovative and technology driven companies have been examined and compared to identify patterns in different performance levels. All of them have been founded under the same formal requirements of the Munich Business Plan Competition -a research approach which allowed a unique snapshot that only long-term studies would be able to provide. The general objective was to identify the correlation between different factors, as well as different dimensions, to incremental and radical innovations realised. The 12 hypothesis were formed to prove have been derived from a comprehensive literature review. The relevant academic and practitioner literature on entrepreneurial, innovation, and knowledge management as well as social network theory revealed that the concept of innovation has evolved significantly over the last decade. A review of over 15 innovation models/frameworks contributed to understand what innovation in context means and what the dimensions are. It appears that the complex theories of innovation can be described by the increasing extent of social ingredients in the explanation of innovativeness. Originally based on tangible forms of capital, and on the necessity of pull and technology push, innovation management is today integrated in a larger system. Therefore, two research instruments have been developed to explore the changes in innovations styles. The Innovation Management Audits (IMA Start-up and IMA Mature) provided statements related to product/service development, innovativeness in various typologies, resources for innovations, innovation capabilities in conjunction to knowledge and management, social networks as well as the measurement of outcomes to generate high-quality data for further exploration. In obtaining results the mature companies have been clustered in the performance level low, average and high, while the start-up companies have been kept as one cluster. Firstly, the analysis exposed that knowledge, the process of acquiring knowledge, interorganisational networks and resources for innovations are the most important driving factors for innovation and success. Secondly, the actual change of the innovation style provides new insights about the importance of focusing on sustaining success and innovation ii 16 key areas. Thirdly, a detailed overview of triggers, supporters and drivers for innovation and success for each dimension support decision makers in putting their company in the right direction. Fourthly, a critical review of contemporary strategic management in conjunction to the findings provides recommendation of how to apply well-known management tools. Last but not least, the Munich cluster is analysed providing an estimation of the success probability of the different performance cluster and start-up companies. For the analysis of the probability of success of the newly developed as well as statistically and qualitative validated ICP Model (Innovativeness, Capabilities & Potential) has been developed and applied. While the model was primarily developed to evaluate the probability of success of companies; it has equal application in the situation to measure innovativeness to identify the impact of various strategic initiatives within small or large enterprises. The main findings of the model are that competitor, and customer orientation and acquiring knowledge important for incremental and radical innovation. Formal and interorganisation networks are important to foster innovation but informal networks appear to be detrimental to innovation. The testing of the ICP model h the long term is recommended as one subject of further research. Another is to investigate some of the more intangible aspects of innovation management such as attitude and motivation of mangers. IV