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The purpose of this paper is to examine how external change agents (ECAs) engaged to disseminate a national quality register (NQR) called Senior alert nationwide in the Swedish health care and elderly care sectors interpret their work. To study this, sensemaking theories are used.

This is a qualitative inductive interview study including eight ECAs. To analyze the data, a thematic analysis is carried out.

Well-disseminated NQRs support health care organizations’ possibility to work with quality improvement and to improve care for patient groups. NQRs function as artifacts that can influence how health care professionals make sense of their work. In this paper, a typology depicting how the ECAs make sense of their dissemination work has been developed. The ECAs are engaged in prospective sensemaking. They describe their work as being about creating future good results, both for patients and affiliated organizations, and they can balance different quality aspects.

The number of NQRs increased markedly in Sweden and elsewhere, but there are few reports on how health care professionals working with the registers interpret their work. The use of ECAs to disseminate NQRs is a novel approach. This paper describes how the ECAs are engaged in prospective sensemaking – an under-researched perspective of the sensemaking theory.

The purpose of this study is to examine and establish how sensemaking develops among a group of external change agents (ECAs) engaged to disseminate a national quality register nationwide in Swedish health care and elderly care. To study the emergent sensemaking, the theoretical concept of cognitive shift has been used.

The data collection method included individual semi-structured interviews, and two sets of interviews (initial sensemaking and renewed sensemaking) have been conducted. Based on a typology describing how ECAs interpret their work, structural analyses and comparisons of initial and renewed sensemaking are made and illuminated in spider diagrams. The data are then analyzed to search for cognitive shifts.

The ECAs’ sensemaking develops. Three cognitive shifts are identified, and a new kind of issue-related cognitive shift, the outcome-related cognitive shift, is suggested. For the ECAs to customize their work, they need to be aware of how they interpret their own work and how these interpretations develop over time.

The study takes a novel view of the interrelated concepts of sensemaking and sensegivers and points out the cognitive shifts as a helpful theoretical concept to study how sensemaking develops.

The purpose of this paper is to address how adult development (AD) theories can contribute to quality improvement (QI).

A theoretical analysis and discussion on how personal development empirical findings can relate to QI and Deming’s four improvement knowledge domains.

AD research shows that professionals have qualitatively diverse ways of meaning-making and ways to approach possibilities in improvement efforts. Therefore, professionals with more complex meaning-making capacities are needed to create successful transformational changes and learning, with the recognition that system knowledge is a developmental capacity.

In QI and improvement science there is an assumption that professionals have the skills and competence needed for improvement efforts, but AD theories show that this is not always the case, which suggests a need for facilitating improvement initiatives, so that everyone can contribute based on their capacity.

This study illustrates that some competences in QI efforts are a developmental challenge to professionals, and should be considered in practice and research.

The study of successful transformational change processes in organizations has been limited. The purpose of this paper is to understand a change process and the type of change that occurred in a pharmaceutical company in Sweden 2005–2014.

An interactive research design was used, and semi-structured interviews were conducted with 19 individuals, asking about their views on the change journey. Meetings and dialogue with leaders from the organization also took place. Observations from feedback meetings with leaders were included in the analysis. The results were analysed using a time-ordered display identifying key events, interpreted by a theoretical lens determining the type of change over a period of 10 years.

This was a transformational change caused by external pressure, supported by visionary and transparent leadership, collaborative methods aiming at broad involvement and systemic understanding. The results indicated a 40 per cent increase in productivity and altered organizational design and culture. Sense-making activities, persistent adoption of quality improvement tools, dispersed power and sequential change activities underpinned the success.

The results provide insight into the processes of transformational change. Change leaders were provided with knowledge, inspiration and insight when facing transformations.

Increased prevalence of transformational change calls for new organizational competencies and altered roles for leaders and employees. There is a need for new ways of developing competence and new recruitment policies for leaders.

This case presents unique empirical evidence of a successful cultural transformation led by a leader using post-conventional principles.

The purpose of this paper is to examine people’s experience of a change process and if and how post-conventional leadership principles are expressed in the change process.

The study used a retrospective exploratory qualitative design. In total, 19 semi-structured interviews and 4 workshops were conducted and analyzed in accordance with a thematic qualitative analysis.

The post-conventional leadership appears to have facilitated an organizational transformation where explorative work methods aimed at innovation and improvement as well as holistic understanding was used. Dispersed power and mandate to employees, within set frames and with clear goals, created new ways of organizing and working. The leader showed personal consideration, acknowledged the importance of the emotionally demanding aspects of change and admitted the leader’s own vulnerability. Balance between challenge and support created courage to take on new roles and responsibilities. Most employees thrived and grew with the possibilities given, but some felt lack of support and clear directions.

Inspiration from this case on work methods and involvement of employees can be used on other change efforts.

This study provides knowledge on leadership capabilities needed for facilitation of transformational change.

Few transformational change processes by post-conventional leaders are thoroughly described, and this study provides in-depth descriptions of post-conventional leadership in transformational change.