Healthcare Innovation

Centre for Healthcare Innovation Research

Welcome to CHIR, the interdisciplinary Centre for Healthcare Innovation Research - bringing a fresh perspective to the challenges of embedding health and social care innovations, sustainably and at scale.

About us

We are a unique interdisciplinary venture, jointly set up in January 2019 by CASS Business School and the School of Health Sciences at City, University of London.

Our team works across a range of academic fields such as health sciences, organisational studies, implementation research and social sciences. We seek to build a strong community that bridges disciplines and professions to support the embedding of innovations in healthcare.

Our research serves the needs of policy-makers who seek to improve the efficiency and effectiveness of healthcare services, and the demands of practitioners and service users who aim to ensure the availability of the best possible services and treatments.

CHIR is developing new professional and executive development courses which build on the extensive experience and reputation of City in the education of professionals in various disciplines such as nursing, language and communication, business and management, and now also medical leadership. CHIR is already providing novel modules in the existing programmes taught by the two schools; the recently launched Executive Master’s in Medical Leadership and the highly regarded MSc in Health Management.

Get involved

For more information and any queries, please get in touch with us:

Centre for Healthcare Innovation Research (CHIR)
City, University of London
Northampton Square
London, EC1V 0HBZ
+44 (0) 20 7040 4032
Follow us @CHIR_City

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CHIR core team: Dr Yaru Chen, Dr Alexandra Ziemann, Dr Charitini Stavropoulou, Prof Harry Scarbrough

CHIR is led by a core team of researchers at both CASS Business School and the School of Health Sciences. We seek to build a strong community around the topic of embedding innovations with scholars across different schools at City and other universities, and with health and social care practitioners, policymakers, and service users.

Core team

Dr Yaru Chen

Dr Yaru Chen

Yaru Chen is Research Fellow at CHIR. Yaru’s research focuses on exploring innovation diffusion in healthcare organizations, informed by a number of theoretical perspectives, including professional identity, sensemaking, sensegiving, and job crafting. Yaru has led a few projects including the spread and scaling up of a healthcare innovation called StarTBack, which helps GPs and physiotherapists to stratify care for patients with lower back pain, and the spread and scaling up of system level innovation Medical Alliances (MAs) introduced to the Chinese healthcare system in its recent reforms.

Follow Yaru Chen @yaru_emma

Prof Harry Scarbrough

Prof Harry Scarbrough

Harry Scarbrough is Co-director of CHIR, and brings a wealth of experience in research on healthcare innovation and knowledge translation. This includes the role of Principal Investigator on a major NIHR-funded study of the role of social networks in bridging the gap between research and practice in healthcare settings. He was Director of the ESRC research programme on ‘The Evolution of Business Knowledge’, and has also led ESRC and EPSRC-funded studies of innovation in a range of other sectors, including manufacturing, financial services, and video games. His work has been published in leading international journals, including Organization Studies, Social Science and Medicine, and Information Systems Research.

Follow Harry Scarbrough @HarryScarbroug1

Dr Charitini Stavropoulou

Dr Charitini Stavropoulou

Charitini Stavropoulou is Co-director of CHIR. She is a health services researcher, with a background in health economics and policy. She has been interested in the role patients play in health and health care and she has more recently started doing research on the impact that funded health research has on academic, economic and social outcomes and innovation in the UK. Charitini’s work has appeared in leading international journals, including The BMJ, The Lancet Public Health, Milbank Quarterly, Social Science and Medicine and Journal of Health Economics among others. She has received funding from different bodies, including The Health Foundation, NIHR and The Royal Marsden.

Follow Charitini Stavropoulou @CharitiniSt

Dr Alexandra Ziemann

Dr Alexandra Ziemann

Alexandra Ziemann is Senior Research Fellow at CHIR. Her research focuses on improving the spread of innovations in health and social care. Alexandra’s current work investigates the influence of external contextual factors on the implementation of innovations, and the adaptation of innovations that spread from high to low- and middle-income countries. She brings several years of experience working in the fields of implementation science, public health, and health services research with a special focus on improving ambulance services.

Follow Alexandra Ziemann @_aziemann


CHIR Collaborative

Calling all City scholars interested in health and social care innovation research! The CHIR Collaborative brings together scholars at City who are interested in collaborating on research activities around embedding innovations. The CHIR Collaborative discusses innovation research ideas, grant applications, or publication drafts either on their bespoke virtual exchange platform or face-to-face in a monthly meeting. If you are a City scholar interested in joining the CHIR Collaborative, please get in touch!

CHIR Partners

CHIR is convening a wider community of stakeholder organisations and research partners including professional groups, service users and policymakers to inform and collaborate in research projects and connect to the challenges facing health and social care practice. Please get in touch if you are interested in connecting with us.


CHIR produces research which supports practitioners, policy-makers, and other stakeholders facing the complex challenges of embedding healthcare innovations; that is, implementing innovations sustainably and at scale.

Our work connects the introduction of innovations to the shifting work patterns and organizational changes required to scale and sustain them in practice. By drawing on the expertise of two highly ranked Schools at City, University of London - CASS Business School and the School of Health Sciences – the Centre provides the interdisciplinary approach needed to analyse, evaluate and improve this dynamic process of embedding innovation. This involves the deployment of a range of methodological tools, including both the tracking of innovation journeys over time, and cross-sectional comparison of innovations.

Our research aims to develop the evidence base for improving the sustainable implementation and spread of healthcare innovations by identifying generalisable aspects and mechanisms of the way such innovations are adopted, adapted and embedded across different contexts. Our work therefore involves multiple projects which reflect the major themes of our approach as being;

  • Evidence-based and interdisciplinary;
  • Encompassing different types of innovation across multiple levels of healthcare systems;
  • Addressing different national and organizational contexts for innovation spread and implementation.

A selection of current projects are outlined below:

Evidence-based and interdisciplinary

Systematic reviews conceptualising implementation depth and innovation diffusion

Healthcare innovations are often not sustained after adoption and vary in their effectiveness when scaled-up across different sites. Diverging research strands focus on either implementation or scale-up/diffusion. These strands typically have different analysis levels, focus on different implementation phases and are conducted in different research fields, e.g., health research (implementation), organisation studies (diffusion). This systematic review aims at synthesising evidence on implementation depth and innovation diffusion published in these diverging research fields. It is expected to shed light on the blind spot in our understanding of how to achieve both, the widespread and sustainable implementation of innovations, or the ‘embedding of innovations’.

Multi-level analysis

System innovation scale-up in China

A system level innovation - Medical Alliance (MA) – was established throughout China in recent years following the 2009 health care reform, and has received considerable attention from policy makers, academics and international development organisations. MAs are collaborative alliances involving the integration of primary and community care organisations with secondary and tertiary care hospital providers. The objective of MAs is to promote the usage of the newly established Community Health Centres (CHCs) and to reduce demand for hospital-based secondary and tertiary care to achieve more effective healthcare delivery. However, there are significant obstacles to adopting and scaling up such a large-scale change or system innovation. This project allow us to gain an ‘insider look’ at a few MA models across three different cities in China to examine the scale up and spread of such complex system-level innovation.

Different types of innovation

Spread of a social prescribing tool in the NHS

GP practices in the UK face significant increases in workload due to a combination of staff shortages and the escalating pressures posed by chronic conditions and illness. In response to this growing demand, the NHS long-term plan mandates much greater use of digitally-based services in the coming period. The widespread popularity of social media as a means of exchanging information also indicates the potential acceptability and benefits of new digital services for patients. The primary aim of the study is to understand how such a digitally-based service – a social prescribing tool, is being adopted and applied in GP practices by multiple health professionals working in the practice. Greater understanding of the factors enabling or constraining effective adoption and implementation will be of benefit to the developers and users of this particular service by helping to improve its further development, and supporting take up amongst patient groups. The study will also serve a wider need in the UK healthcare community by showing how an innovative tool can be more effectively embedded into existing healthcare organizations and practices to secure significant benefits for staff and patients.


The Startback tool is an innovative triage screening tool. It is developed for GPs and physiotherapists to help assess patients with lower back pain, stratify them into low, medium, or high risk categories, and provide them with matched treatments. We follow the journey of the tool diffusion from 2015 to 2018, and show the variation in different professional groups’ responses (GPs, physiotherapists) to the innovation and the way it is adapted. In doing so, we are able to demonstrate dynamics of distributed leadership in the spread of innovations and the interplay between innovation adaptation and professional practice. This project not only contributes to the literature on innovation diffusion in public service, but also provides valuable implications for policy and practice.

Innovation in different contexts

Contextualised adaptation of social care innovations spreading from high to low- and middle-income countries

Given the cost and time involved in developing and testing new interventions, low- and middle-income countries are adopting proven interventions from elsewhere. The challenge remains how to adapt and implement such interventions to fit the local context. This project develops a new practical implementation framework to support the adaptation of social work interventions in low- and middle-income countries through a scoping review and workshops with international experts and local practitioners in South Africa and Tanzania. The framework is expected to allow for the development of practical guidance and tools targeting social care practitioners to facilitate and evaluate the adaptation process in the future.

Understanding external implementation context – A best-fit framework synthesis

Variations in the external context such as the political and funding environment, cultural context, location, historical developments or population demographics can influence implementation outcomes but this influence is little understood. We aim to develop a framework conceptualising the influence of external contextual factors on the implementation of health and social care interventions. The framework is developed based on a two-stage systematic review following the ‘best fit’ framework synthesis approach. The first stage of the review examines existing frameworks, models, and theories on external contextual factors and their influence on implementation from a variety of sectors and disciplines such as health and social care, education, environmental studies, and international development. The resulting meta-framework is then tested and refined in the second review stage by synthesising evidence from empirical studies focusing on the implementation of health and social care interventions that spread within or across countries. The final framework can be used to identify factors explaining the decline and variability in effectiveness of interventions but also the prospects of implementation success when spreading interventions within or across countries.

The influence of external context on the implementation of the London Ambulance Service’s Maternity Screening and Action Tool

This spread of an innovation often results in large variation of how well the innovation works in different areas. There is only a limited understanding of what role the characteristics of these different places or external contexts (e.g. political and financial context, geography and location, demographics of the service population, networks between service providers, historical developments) play when implementing an innovation in different areas. This study will explore the impact of external context characteristics on implementation outcome using the Maternity Screening and Action Tool (maternity card) developed by the London Ambulance Service NHS Trust (LAS) as an example. The LAS introduced the maternity card as a prompt for frontline staff to improve the delivery of emergency maternity care. The card was rolled out across London in 2016. This qualitative realist evaluation study aims at understanding what it is about the external context that make the maternity card work in different areas in London. The study is expected to result in a middle range theory formulated as context-mechanism-outcome construct(s) which can inform the spread and implementation of similar innovations. The results of the study are also intended to inform the refinement of a conceptual framework on the influence of external implementation context which is currently being developed.


23 September 2019: 4th CHIR Collaborative meeting
At the monthly CHIR Collaborative meeting, we are discussing 1-2 ideas/proposals for research projects, grant applications or publications in the area of embedding innovations, led by a City colleague. If you are a City scholar interested in joining the CHIR Collaborative, please get in touch.

6 June 2019: 3rd CHIR Collaborative meeting
At the monthly CHIR Collaborative meeting, we are discussing 1-2 ideas/proposals for research projects, grant applications or publications in the area of embedding innovations, led by a City colleague. If you are a City scholar interested in joining the CHIR Collaborative, please get in touch.

8 May 2019: Innovation in Cancer Care – the journey to improving outcomes for all
The Centre for Healthcare Innovation Research (CHIR) and Bupa UK brought together some of the United Kingdom's leading healthcare practitioners and researchers for their first co-sponsored event on delivering innovation in cancer care.
Read a news article about the event.

2 April 2019: 2nd CHIR Collaborative meeting
At the monthly CHIR Collaborative meeting, we are discussing 1-2 ideas/proposals for research projects, grant applications or publications in the area of embedding innovations, led by a City colleague. If you are a City scholar interested in joining the CHIR Collaborative, please get in touch.

13 February 2019: Inaugural CHIR Collaborative workshop
Collagues from CASS Business School and School of Health Sciences interested in collaborating with CHIR on research activities around embedding innovations meet for the first time to help shape CHIR’s research agenda.


16-17 September 2019: CHIR co-hosts workshop at the 5th Global Implementation Conference
CHIR is co-hosting a workshop with the Department of Social and Policy Sciences, University of Bath and the MST Institute on adapting innovations into different contexts at the 5th Global Implementation Conference in Glasgow, United Kingdom. Alexandra Ziemann is presenting findings of the project Contextualised adaptation of social care innovations spreading from high to low- and middle-income countries .

25 July 2019: All new and shiny CHIR website is online
We have a (this) new website. Please visit again for updates on our research, activities, and events!

18 July 2019: CHIR presents a poster at the 2nd UK Implementation Science Research Conference
We present preliminary results from our multidisciplinary systematic reviews on implementation depth and diffusion of innovations at the 2nd UK Implementation Science Research Conference in London, United Kingdom.

4-6 July 2019: CHIR presents at the 35th EGOS Colloquium
CHIR is attending the 35th European Group for Organizational Studies Colloquiumin Edinburgh, United Kingdom. Yiannis Kyratsis, Alexandra Ziemann and Harry Scarbrough present the paper “Beyond Barriers: The role of the implementation process in shaping technology innovation outcomes in healthcare” in sub-theme 32: Technological Innovation in Healthcare Organizations: Panacea or Pandora’s Box?

2-3 July 2019: CHIR hosts workshop on interdisciplinary innovation research at HSRUK 2019
CHIR hosts a workshop entitled “Can an interdisciplinary approach help improve sustainable implementation and spread of healthcare innovations?” at the Health Services Research UK 2019 Conference in Manchester, United Kingdom. Chaired by Yiannis Kyratsis, the workshop saw presentations by Yaru Chen on the Startback study Alexandra Ziemann on the London Ambulance Service Maternity Card implementation study and Radhika Sriskandarajah on Artificial Intelligence adoption in breast cancer screening, followed by an interactive discussion with the audience on the pros and cons of interdisciplinary innovation research.

1 July 2019: CHIR has a new co-director
CHIR co-founder and co-director Dr Yiannis Kyratsis leaves City, University of London, for a new post as Head of the Organization Theory Group and Associate Professor Organization Theory at Vrije Universiteit Amsterdam, The Netherlands. Dr Charitini Stavropoulou is succeeding him as our new co-director.

13 February 2019: You can now follow us on Twitter @CHIR_City
CHIR is now on Twitter – follow us on @CHIR_City!

1 January 2019: CHIR is officially starting its work
CHIR is officially starting its work and welcomes two new members to the core team: Research Fellow Dr Yaru Chen and Senior Research Fellow Dr Alexandra Ziemann.