Nobody in charge: Distributed change agency in healthcare

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.

[1]  J. Kotter.  Leading change: why transformation efforts fail , 2009, IEEE Engineering Management Review.

[2]  David A. Buchanan,et al.  The sustainability and spread of organizational change: modernizing healthcare , 2007 .

[3]  E. Ferlie,et al.  Networks, Organizational Learning and Knowledge Management: NHS Cancer Networks , 2006 .

[4]  A. Bryman,et al.  Leadership in organizations , 2006 .

[5]  E. Ferlie,et al.  Managing Change and Role Enactment in the Professionalized Organization , 2006 .

[6]  R. Burke,et al.  Leadership in organizations , 2006 .

[7]  Raymond Caldwell.  Agency and Change: Rethinking Change Agency in Organizations , 2005 .

[8]  E. Ferlie,et al.  The Nonspread of Innovations: the Mediating Role of Professionals , 2005 .

[9]  James P. Spillane.  Distributed Leadership , 2005 .

[10]  Kim Hoque,et al.  Freedom to do What you are Told: Senior Management Team Autonomy in an NHS Acute Trust , 2004 .

[11]  D. Robinson,et al.  Recruiting and developing an effective workforce in the British NHS , 2004, Journal of health services research & policy.

[12]  Mike Hayward.  Champions of change. , 2004, Nursing standard (Royal College of Nursing (Great Britain) : 1987).

[13]  Raymond Caldwell.  Models of Change Agency: A Fourfold Classification , 2003 .

[14]  David A. Buchanan,et al.  Demands, Instabilities, Manipulations, Careers: The Lived Experience of Driving Change , 2003 .

[15]  J. Øvretveit,et al.  Using research to inform quality programmes , 2003, BMJ : British Medical Journal.

[16]  David H Gustafson,et al.  Developing and testing a model to predict outcomes of organizational change. , 2003, Health services research.

[17]  H. Davies,et al.  Trends in doctor-manager relationships , 2003, BMJ : British Medical Journal.

[18]  J. Goldstone.  Comparative Historical Analysis in the Social Sciences: COMPARATIVE HISTORICAL ANALYSIS AND KNOWLEDGE ACCUMULATION IN THE STUDY OF REVOLUTIONS , 2003 .

[19]  D. Rueschemeyer.  CAN ONE OR A FEW CASES YIELD THEORETICAL GAINS , 2003 .

[20]  James Mahoney,et al.  Comparative Historical Analysis in the Social Sciences: Cambridge Studies in Comparative Politics , 2003 .

[21]  James Mahoney,et al.  Comparative Historical Analysis in the Social Sciences , 2004, Perspectives on Politics.

[22]  Peter C. Gronn.  Distributed leadership as a unit of analysis , 2002 .

[23]  Harlan Cleveland,et al.  Nobody in charge : essays on the future of leadership , 2002 .

[24]  A. Langley,et al.  The Dynamics of Collective Leadership and Strategic Change in Pluralistic Organizations , 2001 .

[25]  D. Hughes,et al.  Talking contracts and taking care: managers and professionals in the British National Health Service internal market. , 2000, Social science & medicine.

[26]  J. Øvretveit.  TOTAL QUALITY MANAGEMENT IN EUROPEAN HEALTHCARE , 2000 .

[27]  P Spurgeon,et al.  Waiting times for cancer patients in England after general practitioners' referrals: retrospective national survey , 2000, BMJ : British Medical Journal.

[28]  Michael Powell,et al.  The changing professional organization , 1999 .

[29]  Raghu Garud,et al.  The innovation journey , 1999 .

[30]  D. Buchanan.  The Logic of Political Action: an Experiment with the Epistemology of the Particular , 1999 .

[31]  C. Warwick.  The new NHS: modern dependable , 1998 .

[32]  Y. Dufour,et al.  Clinical management as boundary management. A comparative analysis of Canadian and UK health-care institutions. , 1997, Journal of management in medicine.

[33]  Richard J. Butler,et al.  Stories and Experiments in Social Inquiry , 1997 .

[34]  Y. Dufour,et al.  Clinical management as boundary management , 1997 .

[35]  E. Schneller,et al.  The Physician Executive: Role in the Adaptation of American Medicine , 1997, Health care management review.

[36]  I. Brooks,et al.  Leadership of a cultural change process. , 1996, Health manpower management.

[37]  Jean-Louis Denis,et al.  Leadership and Strategic Change under Ambiguity , 1996 .

[38]  Thomas A. Kochan,et al.  What works at work : overview and assessment , 1996 .

[39]  Philip Hallinger,et al.  Second international handbook of educational leadership and administration , 1996 .

[40]  Andrew Pettigrew,et al.  The New Public Management in Action , 1996 .

[41]  M. Whitehouse,et al.  A policy framework for commissioning cancer services , 1995, BMJ.

[42]  Ann Taket,et al.  SHAPING STRATEGIC CHANGE - MAKING CHANGE IN LARGE ORGANIZATIONS - THE CASE OF THE NATIONAL-HEALTH-SERVICE - PETTIGREW,A, FERLIE,E, MCKEE,L , 1994 .

[43]  Patrick Dawson,et al.  Organizational change : a processual approach , 1994 .

[44]  D. Stace,et al.  Beyond the Boundaries: Leading and RE-Creating the Successful Enterprise , 1994 .

[45]  Relationships between doctors and managers: the Scottish experience. , 1994, Journal of management in medicine.

[46]  Torbjörn Stjernberg,et al.  Organizational Innovations in a Long-Term Perspective: Legitimacy and Souls-of-Fire as Critical Factors of Change and Viability , 1993 .

[47]  W. Gibb Dyer,et al.  Better Stories, Not Better Constructs, To Generate Better Theory: A Rejoinder to Eisenhardt , 1991 .

[48]  M. Beer,et al.  Why change programs don't produce change. , 1990, Harvard business review.

[49]  H. Tsoukas.  The Validity of Idiographic Research Explanations , 1989 .

[50]  Carol A. Beatty,et al.  Preaching the Gospel: The Evangelists of New Technology , 1991 .

[51]  James W. Fairfield-Sonn,et al.  The Awakening Giant: Continuity and Change in ICI. , 1987 .

[52]  P. Grinyer.  Book reviewThe awakening giant: Continuity and change at ICI : Andrew W. Pettigrew, Basil Blackwell (1985), 519 pp. £25.00 (hardback) , 1986 .

[53]  Ian Wilkinson,et al.  Patterns of managerial influence: Shotgun managers, tacticians, and bystanders , 1984 .

[54]  J. Mitchell,et al.  Case and Situation Analysis , 1983 .

[55]  Richard N. Ottaway,et al.  The Change Agent: A Taxonomy in Relation to the Change Process , 1983 .

[56]  G. Yukl,et al.  Leadership in Organizations , 1981 .

[57]  Henry Mintzberg,et al.  The structuring of organizations : a synthesis of the research , 1980 .