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Journal cover: Journal of Health Organization and Management

Journal of Health Organization and Management

ISSN: 1477-7266
Previously published as: Journal of Management in Medicine

Online from: 2003

Subject Area: Health Care Management/Healthcare

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Radical change in healthcare organization: Mapping transition between templates, enabling factors, and implementation processes


Document Information:
Title:Radical change in healthcare organization: Mapping transition between templates, enabling factors, and implementation processes
Author(s):Samia Chreim, (Telfer School of Management, University of Ottawa, Ottawa, Canada), B.E. (Bernie) Williams, (Faculty of Management, University of Lethbridge, Lethbridge, Canada), Kristene E. Coller, (Faculty of Management, University of Lethbridge, Lethbridge, Canada)
Citation:Samia Chreim, B.E. (Bernie) Williams, Kristene E. Coller, (2012) "Radical change in healthcare organization: Mapping transition between templates, enabling factors, and implementation processes", Journal of Health Organization and Management, Vol. 26 Iss: 2, pp.215 - 236
Keywords:Canada, Change management, Enabling dynamics, Managing implementation process, Health care, Health organization and management, Integration of services, Radical change, Alternative health delivery templa
Article type:Research paper
DOI:10.1108/14777261211230781 (Permanent URL)
Publisher:Emerald Group Publishing Limited
Abstract:

Purpose – The purpose of this paper is to examine: the content of radical change by mapping differences between two templates for organizing delivery of healthcare; the enabling and constraining mechanisms underlying major change from one template to another; and the processes implicated in change implementation.

Design/methodology/approach – Longitudinal, qualitative case study design allowed the tracking, over a four-year period, of the transformation of healthcare service in a community from provider-centered, fragmented delivery to patient-centered, integrated delivery. The authors conducted 90 interviews at three intervals, observed meetings, and analyzed internal and external documents. Concepts on content, process and mechanisms were used to analyze the data.

Findings – Transition from one template to another involves radical change in structures/systems and underlying values. Mechanisms precipitating and enabling change include: powerful stakeholders' dissatisfaction with current template and commitment to a new one, willingness to resource the change, provision of credible leadership, and manipulation of incentive programs. Radical change is underlain by a series of micro change processes that involve emergent, non-linear dynamics, and that follow their own track with enabling and constraining mechanisms.

Originality/value – The paper describes a case of positive, successful change. Implications include importance of: attention to power dynamics, persistent leadership, elimination of boundaries between collaborating groups, and aligning incentives with desired practice changes; and attending to both variance and process in understanding healthcare change.



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