Divergent Organizational Change in Hospitals: Exploring how hospital leaders and employees can contribute to successful outcomes.

Abstract

This thesis consists of three papers that aim to increase our understanding of how divergent changes to organizational structures and management systems in hospitals may be handled by leaders and employees in order to achieve outcomes that contribute towards organizational goals of service quality improvement. Reforms, new policies and the continuous large- and/or small-scale changes aiming for service quality improvement that they manifest in within hospital organizations have been identified as a move away from professional dominance and autonomy, and a move towards a health care system where managerial and market logics are influential. These changes have challenged the organizing principles of professional power in decisions regarding hospital organizational structures and management systems, and professional services are increasingly subject to organizational reform, budgetary control and managerial supervision. Organizational changes that break with existing institutions in a field of activity are defined as divergent. Despite decades of managerial logic initiatives, health care organizations are still heavily influenced by the professional logic. Introducing changes that are based in a managerial or market logic into the work of health service professionals could therefore be considered as divergent, and potentially conflictual, organizational change which would be met with resistance rather than readiness for change and willing participation. We know from previous research that quality improvement initiatives in hospitals very often fail to produce the intended results. We also know that involving health care professionals in processes aimed at improving hospital services is widely considered as a critical factor for achieving goals of quality improvement. However, the most widely documented reaction to divergent change from clinical staff is resistance or active opposition to new arrangements, and this is often identified as the reason for failure in achieving the improvements that change projects aim for. There are few studies of successful outcomes of divergent changes in health care organizations. There are also few empirical studies of professional engagement in such organizational change efforts. This means that there is an identified need for studies that shed light on how successful outcomes occur in a variety of contexts and related to a variety of different types of changes, as well as for more in-depth research on how divergent changes may be handled by hospital leaders and employees in order to achieve outcomes that contribute towards organizational goals of service quality improvement. This thesis raises the two following research questions: How are frequent organizational changes in hospitals and middle manager change-oriented leadership related to organizational and employee outcomes relevant to hospital service quality? How can hospital leaders and employees contribute to processes of implementing divergent changes to organizational structures and management systems in order to achieve outcomes that contribute towards organizational goals of service quality improvement? The first question is answered by Paper 1, titled “Changing to improve? Organizational change and change oriented leadership in hospitals.” The second question is answered by Papers 2 and 3, and an overall discussion of the findings from all three papers.