Organizing health inequalities? Employee driven innovation and the transformation of care

This paper responds to calls for new approaches to understanding and intervening in health inequalities and in particular for attention to the processes and relations that mediate structural inequality and everyday outcomes. Our contribution focuses on the part that healthcare organizations play in this. We draw on organizational sociology, which theorizes that whilst organizational structures, cultures and practices may appear neutral - and rely for their legitimacy on this - they may, in fact, operate in the interests of some social groups and less in the interests of others. This proposition is worked through new empirical research on employee driven innovation in the UK National Health Service. In both our case studies, front-line staff working with some of the most vulnerable citizens had identified the organization of care as both part of the problem and – potentially – part of the solution. In tracing their efforts to change the organization of care, we learn more about what it might take to mobilise resources in support of those whose lives are most affected by health inequalities.