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the process in ways that suit their particular knowledge and interests. The role-
play at the end of this chapter provides, albeit in a limited way, an experience of
this socially mediated, and highly politicized, innovation process.
The process view is clearly a useful lens through which to see the issues
encountered at Medico. It stresses, for example, the inherently uncertain, open-
ended and politicized nature of knowledge and innovation and the recursive
interactions among different sub-groups, agendas and forms of knowledge (e.g.
consultant urologists, radiation oncologists and Medico staff). Process approaches
assume a ‘knowledge as practice’ view and, in so doing, remind us of the subjective
nature of knowledge and its deployment in such ways that privilege the interests
of particular powerful social and professional groups. The ability of consultant
urologists to effectively resist the new system, for example, was a reflection of their
power compared to other professional groups. Attempts to manage knowledge by
the Medico team needed, then, to be sensitive to the interests and interpretations
of the different groups involved. For example, the use of key opinion leaders and
Medico staff that had been medically trained to communicate the technology
played an important role in persuading the medical community of its value. In
contrast, the failure to transfer, the apparently successful, new treatments seen in
the Cataracts case in Chapter 8 can be explained as a failure to take proper account
of the culturally and politically mediated nature of organizational life (Newell et al.,
2003). As Dougherty and Heller (1994) note, many innovations fail because they
‘violate the existing systems of thought and action, or fall into a vacuum where no
shared understandings exist to make them meaningful’ (p. 201).
Process approaches also alert us to the need to tailor the management of
knowledge to particular activities and episodes of innovation. Hendriks (2003)
describes, for example, how, in order to innovate, particular knowledge processes
(development, application, distribution, evaluation) need to be aligned with
particular innovation activities (in his terms, creative/shared problem solving,
market-technology linking, experimenting and prototyping, commitment and
development, monitoring and evaluation) and, in turn, with knowledge-based
measures and Knowledge Management practices. For example, ‘creative problem
solving’ was found to be more dependent on ‘knowledge creation and sharing’ but
less so on ‘knowledge distribution’. In other words, different innovation activities
invoke different knowledge processes and, therefore, pose different requirements for
managing knowledge work. In the Medico case the summaries reporting scientific
data on the use of their technology were effective in raising awareness of the
innovation amongst the medical community but not in securing commitment to its
use. The latter required, by contrast, that the Medico technology be framed as part of
a wider discourse of ‘care’, legitimated by the development of professional standards
and the active networking of key opinion leaders in the medical community.
Finally, the process view is, we suggest, a much more relevant model for
understanding innovation in services (Miles, 2003). This is because service inno-
vations fundamentally shift the locus of innovation from R&D departments and
product designers to wider networks of producers, consumers and service users
(Coombs, 2003; Powell et al., 1996). Knowledge-intensive business firms and

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