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Patterns of Discomfort with Organizational Change

Abstract It is generally believed that individuals are predisposed to organizational change and have a natural tendency to react in the same way, regardless of the change. This study deals with this popular belief by determining the level of discomfort experienced by 321 employees of the same organization who were simultaneously confronted with three organizational changes: a structural reorganization, a relocation of the workplace, and a technological change. The overall results reveal that each change creates a distinct level of discomfort. However, at an individual level, these results overshadow the presence of two patterns of discomfort with change: a dispositional pattern for almost a quarter (23%) of respondents, for whom the level of discomfort remains identical regardless of the change, and a situational pattern, prevalent among 77% of respondents, for whom the level of discomfort differs from one change to the next. In addition, regardless of the occupational group considered, the proportion of respondents who show a situational pattern of discomfort with change is always much higher than the proportion of individuals who have a dispositional pattern of discomfort. These results bring an important clarification to popular beliefs by showing that although certain individuals have a tendency to react to change in a stable manner (dispositional pattern), this pattern is prevalent only among a minority of employees. For the majority, the situational pattern predominates.

Facilitating Implementation of Interprofessional Collaborative Practices Into Primary Care: A Trilogy of Driving Forces.

EXECUTIVE SUMMARY Implementing interprofessional collaborative practices in primary care is challenging, and research about its facilitating factors remains scarce. The goal of this participatory action research study was to better understand the driving forces during the early stage of the implementation process of a community‐driven and patient‐focused program in primary care titled “TRANSforming InTerprofessional cardiovascular disease prevention in primary care” (TRANSIT). Eight primary care clinics in Quebec, Canada, agreed to participate by creating and implementing an interprofessional facilitation team (IFT). Sixty‐three participants volunteered to be part of an IFT, and 759 patients agreed to participate. We randomized six clinics into a supported facilitation (“supported”) group, with an external facilitator (EF) and financial incentives for participants. We assigned two clinics to an unsupported facilitation (“unsupported”) group, with no EF or financial incentives. After 3 months, we held one interview for the two EFs. After 6 months, we held eight focus groups with IFT members and another interview with each EF. The analyses revealed three key forces: (1) opportunity for dialogue through the IFT, (2) active role of the EF, and (3) change implementation budgets. Decisionmakers designing implementation plans for interprofessional programs should ensure that these driving forces are activated. Further research should examine how these forces affect interprofessional practices and patient outcomes.

External facilitators and interprofessional facilitation teams: a qualitative study of their roles in supporting practice change

BackgroundFacilitation is a powerful approach to support practice change. The purpose of this study is to better understand the facilitation roles exercised by both external facilitators and interprofessional facilitation teams to foster the implementation of change. Building on Dogherty et al.’s taxonomy of facilitation activities, this study uses an organizational development lens to identify and analyze facilitation roles. It includes a concise definition of what interprofessional facilitation teams actually do, thus expanding our limited knowledge of teams that act as change agents. We also investigate the facilitation dynamics between change actors.MethodsWe carried out a qualitative analysis of a 1-year process of practice change implementation. We studied four family medicine groups, in which we constituted interprofessional facilitation teams. Each team was supported by one external facilitator and included at least one family physician, one case manager nurse, and health professionals located on or off the family medicine group’s site (one pharmacist, plus at least one nutritionist, kinesiologist, or psychologist). We collected our data through focus group interviews with the four teams, individual interviews with the two external facilitators, and case audit documentation. We analyzed both predetermined (as per Dogherty et al., 2012) and emerging facilitation roles, as well as facilitation dynamics.ResultsA non-linear framework of facilitation roles emerged from our data, based on four fields of expertise: change management, project management, meeting management, and group/interpersonal dynamics. We identified 72 facilitation roles, grouped into two categories: “implementation-oriented” and “support-oriented.” Each category was subdivided into themes (n = 6; n = 5) for clearer understanding (e.g., legitimation of change/project, management of effective meetings). Finally, an examination of facilitation dynamics revealed eight relational ties occurring within and/or between groups of actors.ConclusionsFacilitation is an approach used by appointed individuals, which teams can also foster, to build capacity and support practice change. Increased understanding of facilitation roles constitutes an asset in training practitioners such as organizational development experts, consultants, facilitators, and facilitation teams. It also helps decision makers become aware of the multiple roles and dynamics involved and the key competencies needed to recruit facilitators and members of interprofessional facilitation teams.

Development of an interprofessional program for cardiovascular prevention in primary care: A participatory research approach:

Background: The chronic care model provides a framework for improving the management of chronic diseases. Participatory research could be useful in developing a chronic care model–based program of interventions, but no one has as yet offered a description of precisely how to apply the approach. Objectives: An innovative, structured, multi-step participatory process was applied to select and develop (1) chronic care model–based interventions program to improve cardiovascular disease prevention that can be adapted to a particular regional context and (2) a set of indicators to monitor its implementation. Methods: Primary care clinicians (n = 16), administrative staff (n = 2), patients and family members (n = 4), decision makers (n = 5), researchers, and a research coordinator (n = 7) took part in the process. Additional primary care actors (n = 26) validated the program. Results: The program targets multimorbid patients at high or moderate risk of cardiovascular disease with uncontrolled hypertension, dyslipidemia or diabetes. It comprises interprofessional follow-up coordinated by case-management nurses, in which motivated patients are referred in a timely fashion to appropriate clinical and community resources. The program is supported by clinical tools and includes training in motivational interviewing. A set of 89 process and clinical indicators were defined. Conclusion: Through a participatory process, a contextualized interventions program to optimize cardiovascular disease prevention and a set of quality indicators to monitor its implementation were developed. Similar approach might be used to develop other health programs in primary care if program developers are open to building on community strengths and priorities.

The prevention and management of chronic disease in primary care: recommendations from a knowledge translation meeting

BackgroundSeven chronic disease prevention and management programs were implemented across Quebec with funding support from a provincial-private industry funding initiative. Given the complexity of implementing integrated primary care chronic disease management programs, a knowledge transfer meeting was held to share experiences across programs and synthesize common challenges and success factors for implementation.MethodsThe knowledge translation meeting was held in February 2014 in Montreal, Canada. Seventy-five participants consisting of 15 clinicians, 14 researchers, 31 knowledge users, and 15 representatives from the funding agencies were broken up into groups of 10 or 11 and conducted a strengths, weaknesses, opportunities, and threats analysis on either the implementation or the evaluation of these chronic disease management programs. Results were reported back to the larger group during a plenary and recorded. Audiotapes were transcribed and summarized using pragmatic thematic analysis.Results and discussionStrengths to leverage for the implementation of the seven programs include: (1) synergy between clinical and research teams; (2) stakeholders working together; (3) motivation of clinicians; and (4) the fact that the programs are evidence-based. Weaknesses to address include: (1) insufficient resources; (2) organizational change within the clinical sites; (3) lack of referrals from primary care physicians; and (4) lack of access to programs. Strengths to leverage for the evaluation of these programs include: (1) engagement of stakeholders and (2) sharing of knowledge between clinical sites. Weaknesses to address include: (1) lack of referrals; (2) difficulties with data collection; and (3) difficulties in identifying indicators and control groups. Opportunities for both themes include: (1) fostering new and existing partnerships and stakeholder relations; (2) seizing funding opportunities; (3) knowledge transfer; (4) supporting the transformation of professional roles; (5) expand the use of health information technology; and (6) conduct cost evaluations. Fifteen recommendations related to mobilisation of primary care physicians, support for the transformation of professional roles, and strategies aimed at facilitating the implementation and evaluation of chronic disease management programs were formulated based on the discussions at this knowledge translation event.ConclusionThe results from this knowledge translation day will help inform the sustainability of these seven chronic disease management programs in Quebec and the implementation and evaluation of similar programs elsewhere.

Excessive change and coping in the working population

Purpose – Two complementary objectives are addressed in this paper. First, several studies are introduced based on the assumption that organizational change is now excessive. The purpose of this paper is to propose an operational definition to change excessiveness, and the authors assess whether it is a generalized phenomenon at a societal level. Second, these studies are habitually mobilizing coping theories to address their purpose. However, an integrated model of coping, including appraisals and coping reactions towards change is still to be tested. Thus, the assessment is anchored in an application of the Stimulus-Response Theory of Coping (SRTC). Design/methodology/approach – A quantitative study is conducted by administering questionnaires to a nationwide representative sample (n=1,002). Anderson and Gerbing (1991) two-step approach is used to validate the study and tests its hypothesized model. Change excessiveness is measured in order to observe if it is a generalized phenomenon in the working pop...

Comment réussir son projet de transformation

Vouloir transformer son organisation peut s’averer soit un long periple seme d’embuches organisationnelles et humaines, soit un voyage stimulant qui permettra d’obtenir les benefices escomptes. Pour reussir, une approche structuree qui integre le volet humain est un aspect incontournable.

Facteurs d’invention, de dissémination et de diffusion d’une innovation : leçons d’une triple étude de cas

Resume Cet article vise a approfondir les facteurs facilitant les phases d’invention, de dissemination et de diffusion du processus complet d’innovation. Une recherche-action menee en contexte hospitalier a utilise des methodes mixtes (observation participante, entrevues et questionnaires). Une triple etude de cas illustre l’invention d’une methodologie en conduite du changement, sa dissemination a l’aide d’un parcours d’apprentissage interactif et sa diffusion dans l’organisation puis dans d’autres systemes organisationnels. Dix facteurs provenant de traditions de recherche variees ont emerge. Aucun modele n’a reussi a expliquer a lui seul, tous les facteurs d’une meme phase. Les phases du processus innovant auraient tendance a se deployer de facon dynamique, dans un processus sans cesse reactive.

Les pratiques renouvelées de gestion des ressources humaines dans le réseau montréalais de la santé et des services sociaux

Les medias font leurs manchettes des deboires apparents du reseau de la sante et des services sociaux. C’est a se demander s’il existe des pratiques modernes de gestion dans ce secteur de l’activite economique, d’autant plus que la gestion renouvelee des ressources humaines est sans contredit une tendance moderne en gestion et son importance semble dorenavant reconnue tant dans le secteur public que dans le secteur prive. Notre etude s’est portee a la recherche des diverses pratiques de gestion des ressources humaines aupres d’un echantillon de 19 etablissements du reseau montrealais de la sante et des services sociaux. Les resultats sont suffisamment eloquents pour qu’on y fasse etat d’illustrations de pratiques renouvelees en GRH, pratiques bien etablies, depuis nombre d’annees et d’une grande modernite. Des facteurs critiques de succes ont pu etre degages de meme qu’un certain nombre de constats qui interpellent autant les dirigeants du reseau que les acteurs du secteur de la sante et des services sociaux.