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As we compare the models, we can see certain common concepts related to the need for change. These concepts include strong leadership, effective communication and people involve- ment, and system-wide unity. The first three models (Kanter et al., Kotter, and Luecke) stress the importance of a shared vision and strategies that direct us to that shared vision. Two models (Kanter et al. and Young) stress the need for a well-aafted implementation plan, while the other two models (Kotter and Luecke) stress flexibility, empowered action, and the ability to adjust strategy in implementing change. These four models of successful change, including success factors and lessons learned from the implementation of organization- wide change initiatives, became the backdrop for our qualitative research results, which address success factors for the implementation of strategic change initiatives in healthcare.
iVIETHODS This study presents an assessment of various strategic change initiatives at two large healthcare organizations: a stand-alone children’s health system and a metropolitan, regional, mul- tihospital system. We conducted 61 in-person, semistructured interviews with healthcare leaders at these settings. Inductive qualitative content analysis was employed to identify themes related to success factors for strategic change initiatives as described by interviewees. Study participants’ responses also gener- ated answers to questions relating to the number and nature of strategic change initiatives.
Data Coilection and Participants The interview process was a focused, open-ended discussion designed to prompt the participants to share infor- mation about the organization’s initia- tives while focusing on initiative success factors (Blumer, 1969; Bogdan & Biklen, 1992). Of the 61 interviews conducted, 32 took place at the children’s health system and 29 took place at the mul- tihospital system. The interviews were administered from June to September 2009. Four interviewers—an assistant professor, an associate professor, a full professor, and a PhD student—were deployed in teams of two to conduct the interviews. At both organizations, the research team used a snowball sample approach whereby it started with the senior executive team and progressed through the organizational hierarchy as interviewees identified other individuals who played important roles in one or more initiatives. Additional interviews ceased when no new individuals were identified as key to the initiatives (Bier- nacki & Waldorf, 1981). The final list of interviewees included administrators who held titles from assistant director to chief executive officer and physician leaders who served as chief medical offi- cer or chief of a department.
Initial meetings were held with several top leaders of each organiza- tion to identify, name, and define a set of change initiatives for each system. On the basis ofthat information, the researchers developed a script of 15 questions and commenced the indi- vidual interviews. Each participant was also allowed time to add information or provide related information that the
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