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This article illustrates how distributed change agency can implement complex organizational changes in the absence of formal management plans, roles, and structures. Distributed change agency typically involves small teams and senior groups. In this qualitative study of service improvements in the treatment of prostate cancer at an acute hospital, Grange, change roles were distributed more widely, with responsibilities `migrating' among a large informal cast supporting four central characters. This distribution appears to have been triggered by the change goals and substance, and by the network organization through which services were delivered. Cross-case comparisons with other hospitals, Henley and Norwood, suggest that a combination of factors contributed to the development of a distributed approach. Analytical generalization invites speculation concerning the transferability of this model, with `nobody in charge', to other settings. One policy implication concerns the provision of development in change agency competencies to staff other than those in senior positions.
This article uses the stream of literature relating to receptive contexts for change to explore the variations in progress on change implementation between different organisations within healthcare. The aim of the article is to develop our understanding of change processes as they unfold in complex organisations. The article uses empirical data from 11 healthcare sites in the UK to explore how variations can be explained and what impacts on an organisation's capacity to manage changes effectively . Analysis of the data identified three contextual features common to all sites which impacted on progress in organisational change.
These features were:
the presence or absence of change leaders,
at several levels throughout the organisation a coherent change strategy
a sound foundation of relationships between managers and clinical professional groups.
Using these empirical results, we review and refine the concept of 'receptive contexts' for change in healthcare and develop ideas about how contextual characteristics impact change implementation.