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Cited by 45Organizational Change and LeadershipHealthcare Quality and ManagementHealth Services Management and Policy

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

Chreim, Samia, Williams, B.E. (Bernie), Coller, Kristene E.·2012·Journal of Health Organization and Management
DOI 10.1108/14777261211230781
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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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Crossref · 10.1108/14777261211230781

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Authors
Chreim, S., Williams, B. E. (., & Coller, K. E.
Affiliations
  • University of Ottawa (CA)
  • University of Lethbridge (CA)
ORCID
Venue
Journal of Health Organization and Management
Publisher
Emerald
Published
2012-05-18
Volume
26
Issue
2
Pages
215-236
ISSN
1477-7266 (ISSN-L)
DOI
10.1108/14777261211230781
OpenAlex
W1590613745
Cited by
45
References
47
Citations by year
2025: 1 · 2024: 2 · 2023: 1 · 2021: 8 · 2020: 4 · 2019: 3 · 2018: 5 · 2017: 4 · 2016: 6 · 2015: 4 · 2014: 5 · 2013: 1 · 2012: 1
FWCI
7.16
Type
journal article
Language
en
Open access
closed
Licence
www.emerald.com/insight/site-policies (tdm)
Locations
  • Journal of Health Organization and Management (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Organizational Change and Leadership
  • Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
  • Health Sciences › Health Professions › General Health Professions › Health Services Management and Policy
Keywords
radical change, healthcare organizations, integrated care delivery, patient-centered care, change implementation, power relations, leadership, incentive mechanisms, nonlinear dynamics, community-based care
MeSH terms
Canada, Delivery of Health Care, Diffusion of Innovation, Humans, Interviews as Topic, Longitudinal Studies, Organizational Innovation, Patient-Centered Care, Health Facility Administration

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