Sustaining organizational culture change in health systems
Abstract
PURPOSE: The questions addressed by this review are: first, what are the guiding principles underlying efforts to stimulate sustained cultural change; second, what are the mechanisms by which these principles operate; and, finally, what are the contextual factors that influence the likelihood of these principles being effective? The paper aims to discuss these issues. DESIGN/METHODOLOGY/APPROACH: The authors conducted a literature review informed by rapid realist review methodology that examined how interventions interact with contexts and mechanisms to influence the sustainability of cultural change. Reference and expert panelists assisted in refining the research questions, systematically searching published and grey literature, and helping to identify interactions between interventions, mechanisms and contexts. FINDINGS: Six guiding principles were identified: align vision and action; make incremental changes within a comprehensive transformation strategy; foster distributed leadership; promote staff engagement; create collaborative relationships; and continuously assess and learn from change. These principles interact with contextual elements such as local power distributions, pre-existing values and beliefs and readiness to engage. Mechanisms influencing how these principles sustain cultural change include activation of a shared sense of urgency and fostering flexible levels of engagement. PRACTICAL IMPLICATIONS: The principles identified in this review, along with the contexts and mechanisms that influence their effectiveness, are useful domains for policy and practice leaders to explore when grappling with cultural change. These principles are sufficiently broad to allow local flexibilities in adoption and application. ORIGINALITY/VALUE: This is the first study to adopt a realist approach for understanding how changes in organizational culture may be sustained. Through doing so, this review highlights the broad principles by which organizational action may be organized within enabling contextual settings.
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In complex organizations, a guiding principle for achieving change is to aim for incremental improvements within a comprehensive strategy.
“In complex organizations, a guiding principle for achieving change is to aim for incremental improvements within a comprehensive strategy (20).”
From An Ecological Study of a Universal Employee Depression Awareness and Stigma Reduction Intervention: “Right Direction” (2021) · cites this paper as [20]
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- Authors
- Willis, C. D., Saul, J., Bevan, H., Scheirer, M. A., Best, A., Greenhalgh, T., Mannion, R., Cornelissen, E., Howland, D., Jenkins, E., & Bitz, J.
- Affiliations
- University of British Columbia (CA)
- National Health Service (GB)
- Queen Mary University of London (GB)
- University of Birmingham (GB)
- Saskatchewan Health (CA)
- Venue
- Journal of Health Organization and Management
- Publisher
- Emerald
- Published
- 2016-03-21
- Volume
- 30
- Issue
- 1
- Pages
- 2-30
- ISSN
- 1477-7266 (ISSN-L)
- OpenAlex
- W2286182763
- Cited by
- 178
- References
- 87
- Citations by year
- 2026: 14 · 2025: 10 · 2024: 21 · 2023: 15 · 2022: 20 · 2021: 28 · 2020: 24 · 2019: 16 · 2018: 19 · 2017: 8 · 2016: 2
- FWCI
- 3.99
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Health Organization and Management (publishedVersion)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- Funders
- National Institute for Health and Care Research (NF-SI-0512-10031)
- Canadian Institutes of Health Research
- 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
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Appreciative Inquiry and Organizational Change
- Keywords
- organizational culture change, sustainability of change, health care system, guiding principles, distributed leadership, employee engagement, collaborative relationships, sense of urgency, organizational readiness, power distribution, organizational values and beliefs, organizational change, realist review
- MeSH terms
- Health Facilities, Organizational Innovation, Organizational Culture, Guidelines as Topic
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