"There is innovation inside the NHS. But innovations tend to stay local, failing to be adopted by other healthcare organisations or diffusing very slowly. This challenge is well recognised. But what's the problem? Given the assembled talents and good intentions of NHS staff, how can the systemic sum of innovation be so much less than its parts?
The NHS is sometimes described in terms of it's hierarchical structure. For my purposes it's useful to describe the current NHS using the language of philosopher–activists Deleuze & Guattari. In their terms, the NHS is a striated space marked by linear boundaries, restricted to a particular plane of activity in the space of all possible potentials. For Deleuze & Guattari, like Foucault before them, power does not simply operate as a pyramid but in myriad multifaceted directions and relationships. Foucault said 'One doesn't have a power which is only in the hands of one person who exercises it alone... it is a machine in which everyone is caught, those who exercise power as much as those over whom it is exercised.. it becomes a machinery that noone owns'. The overall effect is an institutional environment that acts to tame energies it is a social machine that produces conformity. As Deleuze & Guattari would say, the NHS is highly codified, where a code is a pattern of repeated acts. Of course, there are many situations where this is desirable–an ICU emergency needs a practiced response. But it doesn't make for a system that diffuses innovation.
Anyone who's returned from an innovation workshop and tried to applied new ideas in their NHS workplace has experienced this striation. It's the overlap in particular experience of all the dynamics that limit change: lack of autonomy in a hierarchical structure, the expectations of colleagues, the time it takes to deliver your daily targets, the lack of incentive, the lack of peer support, lack of sense of entitlement to change the way things are done all of which can combine to deliver an experiential straitjacket which is an impersonal affect, a pattern across the system and one that stifles diffusion as effectively as individual innovation.
The alternative is a system marked by flows, connections and zones of intensity. In the abstract terminology of Deleuze & Guattari, an innovative system would include smooth as well as striated spaces. Smooth space is occupied by intensities and events, by the continuous variation of free action. The characteristic experience of smooth space is short term, up close, with no fixed points of reference. I will try to show how the combination of social movements and digital technologies could blend smooth space with the more rigid boundaries and caste structures of the NHS in a way that aids the spread of innovation."
(Dan McQuillan, 2011)
 Deleuze, Gilles and Félix Guattari (1980). A Thousand Plateaus. Trans. Brian Massumi. London and New York:Continuum, 2004.
 Foucault, Michel (1975). Discipline and Punish: the Birth of the Prison, New York: Random House.
"Attribution is giving credit where credit is due. Appropriation is the complex borrowing of ideas, images, symbols, sounds, and identity from others. ... This video is a part of Ethics Unwrapped, a free online educational video series about ethics produced by The University of Texas at Austin. Ethics Unwrapped offers an innovative approach to introducing complex ethics topics and behavioral ethics ideas in a way that is accessible to both students and instructors."
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