Predictors of successful organizational change: the alignment of goals, logics of action and leaders' roles to initiate clinical pathways

Schmit, Cécile; D’Hoore, William; Lejeune, Christophe; Vas, Alain

doi:10.1258/jicp.2010.010m09

Cited by 6 publications

(16 citation statements)

References 23 publications

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“…Some have advocated for the use of models and change management theories to design successful CP implementation [ 35 ] . In a retrospective study of managerial factors associated with failed and successful CP implementations, key success factors included alignment of goals, choice of CP, and leaders’ roles [ 36 ]. However, few studies have prospectively tested and associated specific intervention components with successful implementations.…”

Section: Introductionmentioning

confidence: 99%

Defining barriers and enablers for clinical pathway implementation in complex clinical settings

et al. 2018

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BackgroundWhile clinical pathways have the potential to improve patient outcomes and reduce healthcare costs, their true impact has been limited by variable implementation strategies and suboptimal research designs. This paper explores a comprehensive set of factors perceived by emergency department staff and administrative leads to influence clinical pathway implementation within the complex and dynamic environments of community emergency department settings.MethodsThis descriptive, qualitative study involved emergency health professionals and administrators of 15 community hospitals across Ontario, Canada. As part of our larger cluster randomized controlled trial, each site was in the preparation phase to implement one of two clinical pathways: pediatric asthma or pediatric vomiting and diarrhea. Data were collected from three sources: (i) a mediated group discussion with site champions during the project launch meeting; (ii) a semi-structured site visit of each emergency department; and (iii) key informant interviews with an administrative lead from each hospital. The Theoretical Domains Framework (TDF) was used to guide the interviews and thematically analyze the data. Domains within each major theme were then mapped onto the COM-B model—capability, opportunity, and motivation—of the Behaviour Change Wheel.ResultsSeven discrete themes and 58 subthemes were identified that comprised a set of barriers and enablers relevant to the planned clinical pathway implementation. Within two themes, three distinct levels of impact emerged, namely (i) the individual health professional, (ii) the emergency department team, and (iii) the broader hospital context. The TDF domains occurring most frequently were Memory, Attention and Decision Processes, Environmental Context and Resources, Behavioural Regulation, and Reinforcement. Mapping these barriers and enablers onto the COM-B model provided an organized perspective on how these issues may be interacting. Several factors were viewed as both negative and positive across different perspectives. Two of the seven themes were limited to one component, while four involved all three components of the COM-B model.ConclusionsUsing a theory-based approach ensured systematic and comprehensive identification of relevant barriers and enablers to clinical pathway implementation in ED settings. The COM-B system of the Behaviour Change Wheel provided a useful perspective on how these factors might interact to effect change.Trial registrationClinicalTrials.gov, NCT01815710.

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Section: Introductionmentioning

confidence: 99%

Defining barriers and enablers for clinical pathway implementation in complex clinical settings

et al. 2018

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“…• 'direction' -the agreement on the overall goals, aims and mission • 'alignment' -the coordination of actions towards achieving the goals • 'commitment' -the willingness to subsume own efforts and benefits within the shared ones (Drath et al, 2008). For transformation to succeed, leadership has to have 'direction, alignment, and commitment' embedded throughout the system (Aarons et al, 2014;Lejeune & Vas, 2011), with support for change and coordinated action to implement the new ways of working at all levels:…”

Section: Leadership In the Health Systems Undergoing Integrationmentioning

confidence: 99%

“…For transformation to succeed, leadership has to have "direction, alignment, and commitment" embedded throughout the system (Aarons et al, 2014;Lejeune and Vas, 2011), with support for change and coordinated action to implement the new ways of working at all levels: System level: Political leaders and the government must provide an environment that is conducive to change in relation to payment and regulatory policies.…”

Section: Theoretical Backgroundmentioning

confidence: 99%

“…However, those working on the integration projects are faced with a difficult task with little or no guidance. Advice on how to organise transformation teams to enable clinically driven leadership, develop effective multi-organisational leadership and secure support for the project at the organisational and system levels, are a rarity within the field of service transformation (Lejeune and Vas, 2011). More practical guidance is needed to support those driving change including clinicians.…”

Section: Theoretical Backgroundmentioning

confidence: 99%

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Leadership for integrated care: a case study

Kozłowska

Gombau

Rea

2020

LHS

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Purpose Integration of health services involves multiple interdependent leaders acting at several levels of their organisation and across organisations. This paper aims to explore the complexities of leadership in an integrated care project and aims to understand what leadership arrangements are needed to enable service transformation. Design/methodology/approach This case study analysed system and organisational leadership in a project aiming to integrate primary and specialist care. To explore the former, the national policy documents and guidelines were reviewed. To explore the latter, the official documents from the transformation team meetings and interview data from 17 health-care professionals and commissioners were analysed using thematic analysis with the coding framework derived from the comprehensive and multilevel framework for change (Ferlie and Shortell, 2001). Findings Although integration was supported in the narratives of the system and organisational leaders, there were multiple challenges: insufficient support by the system level leadership for the local leadership, insufficient organisational support for (clinical) leadership within the transformation team and insufficient leadership within the transformation team because of disruptions caused by personnel changes, roles ambiguity, conflicting priorities and insufficient resources. Practical implications This study provides insights into the interdependencies of leadership across multiple levels and proposes steps to maximise the success of complex transformational projects. Originality/value This study’s practical findings are useful for those involved in the bottom-up integrated projects, especially the transformation teams’ members. The case study highlights the need for a toolkit enabling local leaders to operate effectively within the system and organisational leadership contexts.

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“…Implementation is the process of putting the service charter into use, making the service charter work in daily practice and institutionalizing it [17]. Implementing a service charter often requires a new set of behaviours, routines and ways of working that are directed at improving patients’ experiences.…”

Section: Introductionmentioning

confidence: 99%

Developing and implementing a service charter for an integrated regional stroke service: an exploratory case study

Thomassen

Ahaus

Walle

2014

BMC Health Serv Res

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BackgroundBased on practices in commercial organizations and public services, healthcare organizations are using service charters to inform patients about the quality of service they can expect and to increase patient-centeredness. In the Netherlands, an integrated regional stroke service involving five organizations has developed and implemented a single service charter. The purpose of this study is to determine the organizational enablers for the effective development and implementation of this service charter.MethodsWe have conducted an exploratory qualitative study using Grounded Theory to determine the organizational enablers of charter development and implementation. Individual semi-structured interviews were held with all members of the steering committee and the taskforce responsible for the service charter. In these twelve interviews, participants were retrospectively asked for their opinions of the enablers. Interview transcripts have been analysed using Glaser’s approach of substantive coding consisting of open and selective coding in order to develop a framework of these enablers. A tabula rasa approach was used without any preconceived frameworks used in the coding process.ResultsWe have determined seven categories of enablers formed of a total of 27 properties. The categories address a broad spectrum of enablers dealing with the basic foundations for cooperation, the way to manage the project’s organization and the way to implement the service charter. In addition to the enablers within each individual organization, enablers that reflect the whole chain seem to be important for the effective development and implementation of this service charter. Strategic alignment of goals within the chain, trust between organizations, willingness to cooperate and the extent of process integration are all important properties.ConclusionsThis first exploratory study into the enablers of the effective development and implementation was based on a single case study in the Netherlands. This is the only integrated care chain using a single service charter that we could find. Nevertheless, the results of our explorative study provide an initial framework for the development and implementation of service charters in integrated care settings. This research contributes to the literature on service charters, on patient-centeredness in integrated care and on the implementation of innovations.

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Predictors of successful organizational change: the alignment of goals, logics of action and leaders' roles to initiate clinical pathways

Cited by 6 publications

References 23 publications

Defining barriers and enablers for clinical pathway implementation in complex clinical settings

Defining barriers and enablers for clinical pathway implementation in complex clinical settings

Leadership for integrated care: a case study

Developing and implementing a service charter for an integrated regional stroke service: an exploratory case study

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