Institutionalized effects on innovation: a case study of dental care

This thesis, by observing diffusion, improves understanding of constrains to innovation. It explores dental care in detail, the nature of the market, considerations affecting throughput, introducing the field of dentistry to innovation studies to which patterns of innovation differ from medicine. It describes how the financial managers of dental-care and other institutions mediate/organize the articulation of demand and the decisions of clinical care firms as they seek to drive profitability from dental implant technology. The research followed knowledge at the level of a technique, where transformative effects of technology are understood in terms of technique Pavitt (1987a,c), Rosenberg (1976b, 1982) and Nightingale (2008), in real time, drawing on Granberg’s (1997) mapping technique. The research highlights the value of Chandler’s (1977, 1990) emphasis on “throughput” to the dental sector (Nightingale, 2000; Lazonick, 2005: 40) and the notion that institutions make sense of the stability and structure of the collective action Lundvall (2007) and Johnson (2010), supported by Nelson (2008) and others. For effect on capacity utilization, the research drew on medical economic efficiency literature, Gelijns & Rosenberg (1994) and others of Rosenberg, in other sectors, to draw attention to the interconnectedness of efficiency and utilization to the medical specializations, institutions, bottlenecks, model of delivery and benefits of iterative learning Arrow (1962), Rosenberg (1982), David (1986), and Johnson (2010), that laid the basis to exploring bottlenecks to delivery of dental care, to medical care. The constraint to innovation is the insurance-based financial system, as it changes the direction of learning. Trajectories of technical change have sub-sector, process-level influences that vary with dentist specialty. Learning is directed toward capacity utilization, by increasing throughput to spread costs at a given level of reimbursement, and the prime influence to practical knowledge and change to technique, is the institutionalized continuing education. The thesis shows post-adoption risks to transformation of technique are important to understanding innovation, because it can change the direction of learning, thus challenging the notion of research-based discovery as the preliminary driver of innovation.