Strategic Change in the Facilities of Healthcare

Question: Describe about the Strategic Change in the Facilities of Healthcare. Answer: Summary This qualitative study was carried out for exploring the perceptions of the healthcare managers on their initiatives of strategic change in the facilities of healthcare. The interview questions were developed and the midlevel managers were involved in the study blended with the experiences of the researching SMEs, authors knowledge of change management and theoretical literature (Stake, 2013). For this multiple case study design, five in-depth face to face interviews were carried out with five managers and administrators from the healthcare organizations. Data was collected by semi-structured interviews over the telephone or face-to-face and recording with a digital recording device. A comparative study was carried out between the actual findings and the theoretical framework for revealing the knowledge gained and variances from this study (Yin, 2014). The interview protocol was thoroughly aligned with the research questions and the reports were generated after data analysis. A set o f central research questions were aligned with the interview protocol and six questions were framed for interviewing the health administrators. The interpretations of the findings focused on the responses of the participants for answering the interview questions during the process of narrative inquiry (Hancock Algozzine, 2015). Based on the first research question, the participants were asked to explore five different themes of their experiences and from the second research question and from the second research question, they explored another five different themes. This qualitative study aimed at exploring the perceptions of the healthcare managers on the nature of the strategic initiatives in the facilities of healthcare. There have been several studies conducted to explore the contextual factors that are specific to the sector of healthcare however, these studies failed to deliver the appropriate change management models that are to be practiced by the healthcare administrators. From the semi-structured interview of the participants, ten themes were identified through the cross-case synthesis and thematic analysis (Yin, 2014). The reported experiences, attitudes and comments of the managers were gathered in the study as first hand information and these were compared with the data generated from other similar studies. The evaluation of the study findings was dependent on the textual data analysis that was presented in the earlier section of the study and the results obtained were addressed which were from the existing literature in the context of management profession and healthcare facilitates. The generated themes in this study were based on the change management that the participants had implemented within their respective organizations being a part of the management team. Discussion In the management of the healthcare sector, one of the key aspect is change management and the and the healthcare professionals are obligated for maintaining and acquiring the expertise required for undertaking the professional tasks that are within their competence. Handling the complexity of the process reflects the ability to manage change. It is about the process of implementing, planning and evaluating operations, strategies and tactics that makes sure that the relevant and worthwhile (Cummings Worley, 2014). Change management is a challenging, dynamic and complex process and is not a choice between people-oriented or technological solutions but is a combination of all of them. This is evident from this qualitative and multiple case study that explored the perceptions of the healthcare managers and the strategic change initiatives undertaken by them in their healthcare facilities. In response to the first research question of the perception of the healthcare managers regarding the nature of the successful initiatives of strategic change, there were five different themes on which the participants responded. For the first theme that stated about the requirement of research to get rid of the old, all the participants emphasized on the factors on which a successful initiative of strategic change depends on and it includes flexibility, security and self-confidence of the leader. The leader have to be open to the concept that the old ways are not good enough to work with and new ways have to be adopted and this will lead to the successful change initiatives in their respective organizations. Effective change is characterized as the unfreezing of the old behaviors which is followed by the introduction of the new behaviors (Grol et al., 2013). Change can be rare, occasional, sporadic and continuous. Predictable change provides the preparative time whereas unpredictable change is a tougher process as it is difficult to respond to such changes effectively. Most of the changes in the healthcare sector occurs rapidly and falls under the category of unpredictable changes (Longest Jr Darr, 2014). The participants agreed to the fact that the healthcare organizations often suffers due to the lack of the capacities of the administrators to successfully adapt the change initiative in the rapidly changing scenario of healthcare systems. Therefore, it was a combined suggestion from them that the managers of healthcare must be apprised of the recent policies in healthcare and the changing demographic populations for bringing a new vision to their respective organization. The second theme of the first research question focused on building of effective strategies of communication with the organization and in response to this, all the participants stated that it is crucial to implement such strategies and review periodically for keeping the change initiatives going. Promotion of change is fatiguing and demanding and requires the managers to exhibit perseverance against the norms and habits of the existing behaviors along with challenging the precedent. Bringing about the change is a time consuming process and requires the time and commitment of the managers (Goetsch Davis, 2014). They should realize the values that matters to the organization and focus on changing only those aspects that are essential rather than responding to every change invitation. The managers should be able to identify the changes and be judgmental of the appropriate changes. They should have a clear conscience of what is really important and develop the proactive actions and resp onses accordingly. During the study, all the participating managers agreed to the fact that the credibility of the leader for managing the initiatives of change pivots on the ability of the leader to communicate clearly about the rationale of the change. The next theme included involvement of the team members in the initiatives of change initiative in response to which, the participants stated that it is required by the organization to define clearly the expectations, roles and goals of the individual team members. Change initiatives are incomplete without the involvement of the team members in the process of decision making. Even if the change has been endorsed, the employees try to understand the requirement of the change and the result of the change, particularly its effect on them (Ottersen et al., 2014). Organizational changes like layoffs can lead to disastrous consequences like insecurities, anger, confusion and paranoia among the employees under the change auspices. The lead er might also face stagnation, de-motivation and resistance within the team and the change initiative might prove to be faulty. Therefore, the leader should take up the responsibility to set the example of collaborative teamwork and this will facilitate the change as the team members follow the guidance. The next theme advised to be transparent about the long term vision for the organization and in response to this, three out of a total of five participants discussed the transparency issue and its effect on the initiatives of change management. A feeling of mistrust is generated among the team members for the manager initiated changes due to lack of complete disclosure and the consequences of the initiatives of change makes the team members worried. In perspective to this, it can be stated that the only competitive advantage that is sustainable in todays business world is the ability to follow the cycle of change, adapt and evolve. It should also be done better than the rest of the competitors. A number of different factors can be attributed to the failure rates which include lack of commitment and vision from the senior managers, poorly conceived plans of implementation and limited integration with the other processes and systems within the organization (Kuipers et al., 2014). If th e organizations desire to experience higher success levels in their efforts for development, the managers along with their team members need to have better thinking framework regarding change and a detailed understanding is required of the critical issues that accompanies the process of change initiatives. Establishment of a clear vision regarding the direction of the process of change is a crucial element for the assurance of successful change. Monitoring and measuring the change outcomes is important for recognizing whether the process of change has met its purpose. Transparency adds to the trustworthy and honesty of the managers and the managers who fail to gain the trust of their team members, surely lose their trust with the passage of time (Lorenzi Riley, 2013). During the interview process, all the participants agreed to the fact that delivering quality care to the patient is a critical issue and trust is required in healthcare organizations between the team members and the managers. In the absence of trust, a negative effect becomes predominant in the administrative reforms which lead to lower performance of the healthcare personnel and ultimately bring on the disaster of the healthcare organization. The last theme of the first research question was continuation of the professional and personal development of the leader and in response to this, all the participants agreed to the fact that the mangers should and must participate in the process of personal development and continuing education in the healthcare administration. This will increase the knowledge and expertise of the mangers to meet the new challenges in the healthcare policies of the updated medical practices, health insurance issues and financial budgets. The managers are constantly being judged by their abilities to face challenges and are benchmarked against their peers. In an organization, the goalposts for the organization keeps moving and this is because of changing legislation, custo mer demand, recent technologies and chief executives with different visions (Abdelhak, Grostick Hanken, 2014). These changes have an impact on the managers and consecutively on the team members and therefore, there is a need for continuous professional and personal development of the managers and leaders of healthcare organizations. Along with the external challenges, the internal challenges also make up the change initiatives difficult for the managers and some of the common internal challenges include conflicts among the team members, decreasing medical errors and sorting the misuse of the medical services. Therefore, the managers must have adequate knowledge and personal integrity to address these issues and this is only possible through continual professional development and acquiring of soft skills. Soft skills are equally important as they aid to improve the ability to handle conflicts and emotions in the organization through superior communication skills (Hayes, 2014). Peopl e management skills are essential to bring about changes in the healthcare organization and therefore, learning opportunities have to be developed for the managers and team members to effectively bringing about the change. The second research question inquired about the perception of the healthcare managers regarding the impact of the successful initiatives of change within their respective organizations. Out of the five themes supporting the research question, the first theme was about the high performing teams and in response to that, all the participants agreed to the fact that a successful change initiative requires the strengthening of their team performance. The teams should have mutual trust to be effective and sustain their high performance in the environment of dramatic changes in healthcare organizations. The teams built on mutual respect and trust thrives during the change processes if they have shared goals and vision and shared accountability and leadership (Fitzgerald Dufour, 2013). If the managers fail to incorporate these in their teams, their performance decrease, their productivity undermines, the team members might feel defensive and finally crumble. If the success is made apparent in the process of a change initiative, this increases the morale of the team members which ultimately increase the quality of services due to increased personal satisfaction. With clear direction from the managers, the team members tend to focus on making the things better without periodic intervention by the managers for the change initiatives. The second theme talked about improved customer service and in response to this, all the participants expressed an awareness regarding the complaints of the patients about the healthcare services delivery. One of the participants presented statistical figures about the present financial crisis in the hospitals of US that needs an immediate change. It is evident that appropriate change initiatives can result in better service delivery to the patients in a healthcare organization. The success of healthcare business is linked strongly with sustaining and establishing a superior customer experience and change initiatives based on a proven framew ork can promote a patient-centered approach to service delivery. Introduction of this approach at an appropriate stage of the process of change initiative can be crucial for its adoption by the healthcare organization (Watts et al., 2015). Since changes are continuous in healthcare organizations along with the associated modifications, it is important for the managers to focus and record the emerging problems associated with customer service due to change. This will help to avoid the customer service related problems in future and manage the change in the best possible manner. It was agreed upon by all the participants that it is becoming increasingly difficult for the hospitals to generate revenue and therefore it is hitting the customer service inversely. The third theme stated about the lower error margin in service delivery and in response to this, all the participants agreed to the fact that the impact of successful change initiative was clearly evident from the reduction in medical errors in their respective organizations. Implementation of the service delivery principles as a part of the change initiatives can improve the patient services by reducing the errors. Regular consultation with the patients, increased service access and setting higher standards of service can few of the principles that can be implemented to reduce the errors like surgical errors, diagnostic inaccuracies and system failure in a healthcare organization. Apart from medication errors, these are the errors that need attention and can be reduced with effective changes in the organization. Unsuccessful attempts of strategic change initiatives can be equally disastrous as it can invite several damages to the organization with poor quality services delivered to the patients (Battilana Casciaro, 2012). The next theme was about larger capacity for service delivery to which the participants stated that the service delivery capacity of the healthcare organizations is decreasing because of the financial cutbacks due to dwindling budgets and health-insurance policies. Therefore, the initiatives of change management should aim for increasing the healthcare delivery capacity throughout the organization (Peirson et al., 2012). A strategic change initiative is comprised of a successful implementation phase wherein the activities and processes are executed appropriately to actualize the change. It is a big challenge for the healthcare professionals and the policymakers of the creation of a culture that allows the professionals to deliver the patients with the high quality services and increase the capacity for service delivery. Change implementation is likely to be unsuccessful without effective coordination and communication across every aspect of the healthcare organization and therefore, adopting a population health approach can improve and make the overall health system efficient to provide high quality services to the patients (Swanson et al., 2012). In response to this theme, all the participants had the common aspect that they are all working on increasing the capacity for service delivery in their respective organizations through effective change initiatives. The last theme associated with the second research question is credibility of leadership with the team members and the participants responded by stating that the managers are always looked upon with a suspicious eye by the team members. This is because of the conflict between the medical professionals and the manager due to their varying mindsets of social work and business respectively. It is important for the managers to remain aware of the fact that change initiatives are both psychological and situational and therefore, organizational changes impact the indivi dual identities who are involved in the process of change (Kongstvedt, 2012). Ignoring these change aspects will doom the manager of getting caught in the process of constant spin cycle where change is implemented without any realization of the results. With the growth of the urgency and suspicion among the team members, the managers should focus their attention towards the development of a guiding team that will consequently improve their leadership credibility with respect to the team members (Greene, Reid Larson, 2012). Changes are happening globally that are driving the individual healthcare organizations to bring about the change and proceed. With the changes, problems have been inevitable and solutions are required to solve these emerging problems (Ayre Callway, 2013). For keeping the organizations functioning, there has to be periodic upgradation of the skills and knowledge of the employees and managers with the provision of the required training on the appropriate technologies (Anderson, 2013). Changes in healthcare organizations are essential for improving the safety and quality of care and make them affordable by designing change frameworks for a better future. The rate of change in the field of healthcare is growing and the forces responsible for the transformation of healthcare can result in the generation of immense economic potentials with appropriate change plans. For accomplishing this, the organizations and its managers must harness these transforming forces and use them to their impr ovement (Bao, Casalino Pincus, 2013). Along with this, the managers should also be aware of managing change for moving forward with success. Introduction of an appropriate change management approach to an organization according to its situation and requirements can further facilitate the change. Changes in the healthcare organizations involve incremental improvement on the existing capabilities of the organization, continuous support and increased empowerment to the change managers. Conclusion Based on the research aim and objectives of this study it has been demonstrated that any change initiatives may lead to the positive outcome if the leader has a sense of "self-confidence, security, and flexibility" to adopt innovative ways. The negative impact of the changes is due to the lack of adaptability to latest health care policies. The use of effective communication strategy when implementing changes in the health care setting helps minimize confusion and issues. Any new strategic change without clarification among the employees leads to failure in delivering improved quality of health care services. The change management in the hospital requires effective coordination between all the team members. The results demonstrate that the health organizations must overcome its transparency and integrity issues. Transparency adds to the trustworthy and honesty of the managers and the managers who fail to gain the trust of their team members, surely lose their trust with the passage o f time. During the interview process, all the participants agreed to the fact that delivering quality care to the patient is a critical issue and trust is required in healthcare organizations between the team members and the managers. In the absence of confidence, a negative effect becomes predominant in the administrative reforms which lead to the lower performance of the healthcare personnel and ultimately bring on the disaster of the healthcare organization. Therefore, consistent implementation of quality measurement needs elimination of the gaps in coordination. Health care administration must provide continuous education facilities for the professional development of the managers. For keeping the organizations functioning, there has to be periodic upgradation of the skills and knowledge of the employees and managers with the provision of the required training on the appropriate technologies. The managers perception revealed that the change initiative brings negative impact on the team when the goals, roles and the expectation from the team are not clearly defined. The results indicate that change initiative method is successful with role-model supportive methods rather than coercive ones. Implementation success highly depends on the clarity of organizational vision, communication, and leadership. Aligning the stakeholders around the global view is important. They must be throughout engaged in the process. These enhance the confidence of managers in controlling the crowd. The results reflect that perceived qualitative and quantitative quality program contribute to employee commitment. The health managers recognize that the initiatives or changes implemented fail to meet the objective until and unless without explicitly considering the multi-level approach to change. The multi-level change framework provides a base for assessing the progress along the journey. Also, the framework helps the health managers to have a practical understanding of the factors affecting the outcome of the strategic initiatives. These includes organization, individual, group/team, and larger environmental or system level. It is necessary that the practitioners realize as to when the change is to be imposed. There should be more focus to resolve issues of team development, leadership, and culture and information development at all levels. The motivation and satisfaction of the employees are influenced by the quality of the leadership and management. The efforts taken to improve the delivery of health facilities are affected by various contingency factors. Health Manager believes that these factors must balance the number of tradeoffs between centralization and decentralization in the quest to sustain the impetus for quality improvement. Usually, the employees have a suspicious eye towards the management. Therefore, the leadership must be able to persuade the employees to work towards the common goals. The environment should be conducive to change. According to the health mangers perspectives, implanting significant change gives them the credibility. The loss of the credibility of leadership will impede the health care managers to move forward the change initiatives. With the growth of th e urgency and suspicion among the team members, the managers should focus their attention towards the development of a guiding team that will consequently improve their leadership credibility on the team members. The more the managers spent in the implementation of the change the more is its impact on the clinical outcome. The health managers perceive that the negative consequences of the change initiatives are because that the leaders mainly pay attention to the processes instead of the challenges associated with the people. The time spent by the managers also influence their process and quality performance. There are several positive outcomes of the change initiatives related to anything when the problems are addressed with out of box solutions. The study highlights that a successfully implemented change initiative positively affects the employee performance and empowers the team. Consequently, the customer service and the delivery of care are improved. It is the organizational changes like layoffs can lead to disastrous consequences like insecurities, anger, confusion and paranoia among the employees under the change auspices. Effective collaboration in the team and at the management level empowers the members at all levels in an organization. The case study results showed that most of the managers are aware of the negative impact of the change initiative and the services delivered to the employees. The feedback from the participants revealed that the significant effect of the positive change initiatives is the strengthening the performance of the teams they supervise." The negative response to the initiated change occurs when something new is not implemented rightly in an organization. The response from the participants hi ghlighted that changes are helpful in decreasing the medical errors that impede the organizations long-term sustainability. It further leads to disastrous against health facilities. Successful implementation of the changes in the hospital setting decreases the financial cost of errors. This concluded that dwindling budgets and health insurance policies had caused the financial cutbacks. As a result, the capacity to deliver services has gradually diminished. High quality service delivery is apparent with careful collaboration ensuring financial sustainability. These results imply that there is need of alignment of health care financing system and the aims of the clinicians for actual improvement of care. The strategies invented are not addressing the challenges of generating revenue and declining patient volumes. Such unsuccessful strategic changes have increased the margin of error. Thus there is a need of strategies such that health care can deal with the law, government regulation s, and latest health care policies. There is an increased effort for improving capacity for service delivery, and it is still the long way to get because the rationale for rapid change is not clear to those in the organization. There is a need of culture focused on meeting employees needs constantly. The change initiative about the recruitment of potential employees has the positive impact. However, the challenge to this initiative is due to the recruiters who tend to recruit only in the areas, they are familiar, and thus the larger demographic is not reached. Consequently, the staff does not receive the change in a positive manner. The strategies fail to evoke clients trust in medical doctors, which increase the uncertainty. The strategic change initiatives fail to improve the care services when there is a lack of resources. Therefore, the patient concern could not be taken into consideration here. It concludes that to improve the care services by successfully implementing the change initiatives; it is necessary that the change must occur in the number of aspects of the health care system to ensure high quality services. Further the results reveal that there must be an effective allocation of resources and prepare the employees to sustain the innovation. The implementation of th e concepts and systems without wasting the resources and opportunities will be the challenge as the pitfalls of managing change was ignored earlier. Overall, the health care managers perceive both the positive and the negative impact of the change initiatives depending on the factor that it was implemented in a right manner. Changes in the healthcare organizations involve incremental improvement on the existing capabilities of the organization, continuous support and increased empowerment to the change managers. Conclusively, the case study highlighted the actions and conditions conducive to deliver high quality health services. The perceptions of the managers from this multiple case study highlight their and the leadership roles in quality and safety management. The failures are traced to missing of alignment in thinking, appropriate guidance and tactics for maintaining long-term results. The results imply that there is a need of adopting management system which will clearly link projects and performance with overall change strategies. Limitations This investigation has been challenging and the research findings are conclusive to the research questions. However, there are various limitation associated with every practical suggestions which may or may not be under the control of researcher. One of the major limitations of the study is the restriction of the samples only to the managers of a healthcare facilities located in the Mid-Atlantic region of the United States. The data obtained from multiple case studies using various health organizations is the weakness of the study. Therefore, the results obtained could not be applied to other organizations. The study should have involved the employees and other non-mangers to know the strategic change initiatives taken by their managers and their impact. This would have provided a balanced review of the health managers. It would have better explained the work of the health managers and their contribution to the quality. The study is limited due to the over-reliance on the perceptions of the managers in this study. Consequently, the validity of the conclusions obtained from the research findings is reduced. As the case study is based on, the single aspect there remains an issue of generalisability. According to Anderson, (2013 ), the quality assessment scores are subjective and does not consider the factors beyond the quality assessment scale used. The respondents are the stakeholders in US health care organization. Therefore, the results of the study cannot be generalized to the health sector in other countries. It may happen that the respondents wanting to be successful in their management positions may not give true accounting of the events. It may happen that the managers perceive this study to be a comparative analysis of competition between their organizations. Hence, they might not consider this study as a fact-finding method used for identifying attributes for deploying successful change initiatives and its advantage in bringing future changes. However, the results of the study cannot be replicated in the future but can be used as the template for future studies. The limitations of this study offer an opportunity for further research and discovery. Delimitations The primary delimitation in this qualitative study is the limitation of the samples to mainly healthcare managers, and no other staff of health organizations is involved in this study. Therefore, it limited the generalisability to a total number of the working managers of healthcare. Further, the scope of the study adds to the delimitation which is because the main focus is laid on the health sector managers that limits the generalizability across different employee levels and industries. Recommendations This section represents implications for practice as well as recommendations for further investigation in the area of change management initiatives. The detailed capture of the opinions, attitudes and beliefs and the recommendations expressed by the health managers suggests for revision of existing change management strategies and the method of implementation. Future studies must consider the limitations identified in this study. Further research is required to take into consideration the perception of the non-mangers. There is the need to study to determine the task involvement of the senior managers outside the boardroom. There is a need to lay greater focus on the contextual issues surrounding the managerial activities (MacLean et al., 2012). To strengthen the evidence, the research needs to use robust methodologies with objective outcome measures (Hancock Algozzine, 2015). There is a need to address the issues related to attainment of qualitative and quantitative data to meet th e research objectives. Greater depth of information from the respondents can be obtained by site visits for observation of more contextual issues. The organization must be more conducive and accustomed with the objective of surveys, focus groups and interviews (Kash et al., 2013). To increase the generalizability of the results to the health sector in other countries the research must explore the perceptions of the managers in the different health care systems. Given the current body of knowledge, it is vital to explore the aim of this study across different industries in other regions of America. Further investigation can be carried on the managers' perceptions regarding the effect of the economic conditions and how that affects their job satisfaction and turnover intentions (Saji, 2012). Also, the needs of the managers and policy makers can be investigated as they are not addressed with the same interest as that of the clinicians. The understanding of how policymakers perceive that making feasible changes in health care payments benefits and supports health organization is essential for positive change initiative (Goetsch Davis, 2014). Further, a comparative study can be conducted on the change initiatives and its impact in America as well other nation (Samson Bevington, 2012). There is a literature gap in reference to ways determining the successful change initiative methods and the contributing attributes. Future research should target this aspect to guide the organization towards success. Summary This qualitative study was carried out for exploring the perceptions of the healthcare managers on their initiatives of strategic change in the facilities of healthcare located in the Middle Atlantic region of the United States. The results obtained from five different themes in the first question conclude that traditional methods are not functional for successful implementation of change initiatives, and healthcare managers must be appraised of the recent policies. Further, leader's credibility and involvement of team is essential in effective decision-making. Establishment of a clear vision regarding the direction of the process of change is a crucial element for the assurance of successful change. The purpose of this multiple case study is to explore the perceptions of the health care managers on the nature of the strategic change initiatives. It can be concluded from the second research questions and five themes strengthening of the team performance, effective coordination and co mmunication, morale among team members and superior customer experience ensures the success of healthcare business. Further, it was recognized from the results that the strategic initiatives could reduce medical errors. Overall, changes in the healthcare organizations involve incremental improvement on the existing capabilities of the organization, continuous support and increased empowerment to the change managers. The study is limited due to the over-reliance on the perceptions of the managers in this study. Consequently, the validity of the conclusions derived from the research findings is reduced. As the case study is based on the single aspect, there remains an issue of generalisability. The respondents are the stakeholders in US health care organization. Therefore, the results of the study cannot be generalized to the health sector in other countries. To strengthen the evidence the research needs to use robust methodologies with objective outcome measures. Further research is required to take into consideration the perception of the non-mangers. References Abdelhak, M., Grostick, S., Hanken, M. A. (2014).Health information: management of a strategic resource. Elsevier Health Sciences. Anderson, D. L. (2013).Organization development: The process of leading organizational change. Sage Publications. Ayre, G., Callway, R. (2013).Governance for sustainable development: A foundation for the future. Earthscan. Bao, Y., Casalino, L. P., Pincus, H. A. (2013). Behavioral health and health care reform models: patient-centered medical home, health home, and accountable care organization.The journal of behavioral health services research,40(1), 121-132. Battilana, J., Casciaro, T. (2012). Change agents, networks, and institutions: A contingency theory of organizational change.Academy of Management Journal,55(2), 381-398. Corrigan, J., McNeill, D. (2009). Building organizational capacity: a cornerstone of health system reform.Health Affairs,28(2), 205215 Cummings, T. G., Worley, C. G. (2014).Organization development and change. Cengage learning. Fitzgerald, L., Dufour, Y. (2013). Clinical management as boundary management.Journal of Management in Medicine. Goetsch, D. L., Davis, S. B. (2014).Quality management for organizational excellence. pearson. Greene, S. M., Reid, R. J., Larson, E. B. (2012). Implementing the learning health system: from concept to action.Annals of internal medicine,157(3), 207-210. Grol, R., Wensing, M., Eccles, M., Davis, D. (Eds.). (2013).Improving patient care: the implementation of change in health care. John Wiley Sons. Hancock, D. R., Algozzine, B. (2015).Doing case study research: A practical guide for beginning researchers. Teachers College Press. Hayes, J. (2014).The theory and practice of change management. Palgrave Macmillan. Kash, B. A., Spaulding, A., Gamm, L., Johnson, C. E. (2013). Health care administrators' perspectives on the role of absorptive capacity for strategic change initiatives: A qualitative study.Health care management review,38(4), 339-348. Kongstvedt, P. R. (2012).Essentials of managed health care. Jones Bartlett Publishers. Kuipers, B. S., Higgs, M., Kickert, W., Tummers, L., Grandia, J., Van der Voet, J. (2014). The management of change in public organizations: A literature review.Public Administration,92(1), 1-20. Longest Jr, B. B., Darr, K. J. (2014).Managing Health Services Organizations and Systems,(MHSOS). Health Professions Press, Inc.. Lorenzi, N. M., Riley, R. T. (2013).Organizational aspects of health informatics: managing technological change. Springer Science Business Media. MacLean, D. MacIntosh, R. (2012). Strategic change as creative action.International Journal of Strategic Change Management, 4(1), p.80 Mintzberg, H. (2012). Managing the myths of health care.World Hospitals and Health Services,48(3), 05. Ottersen, O. P., Dasgupta, J., Blouin, C., Buss, P., Chongsuvivatwong, V., Frenk, J., ... Leaning, J. (2014). The political origins of health inequity: prospects for change.The Lancet,383(9917), 630-667. Peirson, L., Ciliska, D., Dobbins, M., Mowat, D. (2012). Building capacity for evidence informed decision making in public health: a case study of organizational change.BMC Public Health,12(1), 1. Saji, B. (2012). Strategic change initiatives in reward management in a merger case study. International Journal of Strategic Change Management, 4(2), p.139. Samson, D. Bevington, T. (2012).Implementing strategic change. London: Kogan Page. Stake, R. E. (2013).Multiple case study analysis. Guilford Press. Swanson, R. C., Cattaneo, A., Bradley, E., Chunharas, S., Atun, R., Abbas, K. M., ... Best, A. (2012). Rethinking health systems strengthening: key systems thinking tools and strategies for transformational change.Health Policy and Planning,27(suppl 4), iv54-iv61. Swayne, L. E., Duncan, W. J., Ginter, P. M. (2012).Strategic management of health care organizations. John Wiley Sons. Watts, N., Adger, W. N., Agnolucci, P., Blackstock, J., Byass, P., Cai, W., ... Cox, P. M. (2015). Health and climate change: policy responses to protect public health.The Lancet,386(10006), 1861-1914. Yin, R. K. (2014).Case study research: Design and methods. Sage Publications.