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The purpose of this paper is to demonstrate that, if teams in healthcare focus on the patient using the framework of a care pathway, change can occur without the overt need to “manage” it directly.

In this paper the relevant literature is reviewed and it is demonstrated that if this approach is used it also provides a means for addressing difficult professional and organisational issues that are often unresolved in broader projects of organisational change. This is not presented as a panacea or the solution to all change projects, rather the contention here is that it is one means among many that can be used to bring about important changes in practice.

The paper finds that care pathways represent a useful tool, which teams can use to work through the contextual and practical issues involved in changing practice.

The paper describes the development of integrated care pathways, which can be regarded as a fortunate fusion of managerial and professional concerns.

The purpose of this paper is to systematically apply theory of organisational routines to standardised care pathways. The explanatory power of routines is used to address open questions in the care pathway literature about their coordinating and organising role, the way they change and can be replicated, the way they are influenced by the organisation and the way they influence health care professionals.

Theory of routines is systematically applied to care pathways in order to develop theoretically derived propositions.

Care pathways mirror routines by being recurrent, collective and embedded and specific to an organisation. In particular, care pathways resemble standard operating procedures that can give rise to recurrent collective action patterns. In all, 11 propositions related to five categories are proposed by building on these insights: care pathways and coordination, change, replication, the organisation and health care professionals.

The paper is conceptual and uses care pathways as illustrative instances of hospital routines. The propositions provide a starting point for empirical research.

The analysis highlights implications that health care professionals and managers have to consider in relation to coordination, change, replication, the way the organisation influences care pathways and the way care pathways influence health care professionals.

Theory on organisational routines offers fundamental, yet unexplored, insights into hospital processes, including in particular care coordination.

The aim of this paper is to understand how systemic change agents influence the twin digital and green transitions. The authors build on agency-based theories to argue that transition pathways are influenced by a combination of place-based characteristics, the mobilisation and preferences of systemic change agents (such as local clusters), and the institutional and economic context. The conceptual framework defines the different steps of the twin transition, and it identifies how systemic change agents and geographic characteristics determine the direction and speed of the transition pathway.

This paper starts with a literature review to identify the different schools of thoughts on transition pathways and the twin transition, before developing a conceptual framework and deriving policy implications.

First, this paper argues that each transition involves three steps: framing, piloting and scaling. Each of these steps is driven by systemic change agents who engage local actors in trust-based collaboration, pool resources, create network effects and exchange information to source solutions for industry-level challenges. Second, the combination of place-based characteristics and the actions of local systemic change agents define the path of the transition and the new (post-transition) equilibrium. Finally, this paper sets out implications for policymakers who are interested in using systemic change agents to shape transition pathways in their local area.

Further research is needed to provide robust empirical evidence from a range of territorial realities for the hypotheses in this paper. Specifically, the role of systemic change agents, such as trade associations, regional organisations, clusters or research groupings, needs to be investigated more closely. These agents can play a key role in progressing the transition because they already focus on sourcing solutions to joint challenges and opportunities by exchanging information, engaging local actors in trust-based collaboration, pooling resources and fostering network effects and critical mass. Future research should investigate how policymakers can best leverage on these crucial actors to progress or steer transitions and how this varies depending on place-based characteristics. This could include, for instance, training activities, networking and collaboration (e.g. through the European Cluster Collaboration Platform) or clearer sign-posting the key next steps required for the transition.

This paper identifies specific ways in which local actors can influence the direction and speed of transitions at each stage of the transition: at the framing stage, political entrepreneurship can be fostered through collaboration and smooth information flows between different levels of governance, at the piloting stage, commercial and social entrepreneurship require effective knowledge sharing and a wide and open search for solutions which, in turn, may require capacity building at the local level and coordination across stakeholder groups and levels of governance and effective scaling up can be fostered through network effects, joint commitment from a broad range of stakeholders and pooling of resources to achieve economies of scale.

An important implication of the framework is that, if several places are undergoing a parallel or joint transition, the result may not be convergence between these places. Instead, different places may choose different end points and they may proceed at different speeds. For instance, in the context of the European Union’s green and digital transitions, it is unlikely that every region will transition to a similar level of digitisation or make steps in the same direction when it comes to sustainability.

This paper plugs a gap in understanding how systemic transitions unfold and how their speed and direction are influenced by different stakeholder groups. This paper develops a conceptual framework to define twin transition pathways and it analyses prominent place-based factors affecting these pathways.

The purpose of this paper is to investigate to what extent the implementation of internal environmental management and voluntary environmental information is related to organisational change.

Organisational change literature provided a framework for the analysis of the materials which were collected through a mixed method. Data on internal environmental management were collected through a survey, while a quality disclosure index was used to assess the quality of the environmental voluntary disclosure. Interviews were used to enhance the quantitative results interpreted according to the four pathways proposed by Tilt (2006) and characterised by several levels of internal environmental management and voluntary disclosure.

The results indicated that companies implement more internal activities than external disclosure. Environmental planning and operational practices were the most important changes carried out. When environmental management accounting and environmental disclosure were also implemented, environmental aspects were more integrated within companies, thus revealing that a more structured integration of sustainability aspects within organisational values had taken place. The results underline the importance of primarily establishing a set of internal changes, driven by environmental planning, to promote organisational change.

The study presents a larger empirical analysis of the organisational change pathways followed by companies, showing similarities and differences among the four pathways. The results underline the importance of both dimensions for studying organisational changes. The framework of Tilt has been enriched, considering a more precise explanation of the internal aspects and adding the concept of the quality of disclosure as proxy to assess organisational change.

Organisational change is investigated through an extensive analysis of internal and external aspects and collecting quantitative and qualitative evidence. The analysis complements previous sustainability accounting literature focussed on the analysis of internal environmental management and external disclosure.

HealthPathways is an online decision support portal, primarily aimed at General Practitioners (GPs), that provides easy to access and up to date clinical, referral and resource pathways. It is free to access, with the intent of providing the right care, at the right place, at the right time. This case study focuses on the experience and learnings of a HealthPathways program in metropolitan Sydney during the COVID-19 pandemic. It reviews the team's program management responses and looks at key factors that have facilitated the spread and scale of HealthPathways.

Available data and experiences of two HealthPathways program managers were used to recount events and aspects influencing spread and scale.

The key factors for successful spread and scale are a coordinated response, the maturity of the HealthPathways program, having a single source of truth, high level governance, leadership, collaboration, flexible funding and ability to make local changes where required.

There are limited published articles on HealthPathways. The focus of spread and scale of HealthPathways during COVID-19 is unique.

COVID-19 has forced Big 4 firms to challenge existing management control arrangements and adapt their ways of working. Yet, we know little about how management control might be enacted in the future of the sustainable workplace. The objective of the study is to examine the patterns of management control change in the Big 4 accounting firms during the COVID-19 pandemic.

Adopting an exploratory qualitative research design, the authors draw on 42 interviews with directors and associates in the Big 4 professional services firms.

The findings reveal two pathways of management control change including alignment and displacement. The authors found that relatively minor adaptions to action and result controls were relied upon to respond to substantial cultural and personnel control changes.

The contributions are threefold: the authors take a temporal perspective to (1) unpack the changes to management control arrangements; (2) theorise the findings by developing a three-dimensional taxonomy of change pathways encompassing pace, scope and longevity of management control change and (3) contextualise management control arrangements in a hybrid work setting.

1. COVID-19 has forced Big 4 firms to challenge existing management control arrangements.

2. Literature has focused on traditional, onsite work settings and largely ignored change pathways.

3. The authors take a temporal perspective to unpack changes to management control arrangements.

4. Big 4 firms adapted to hybrid work with substantial changes to personnel and cultural controls.

5. The authors theorise the findings by developing a three-dimensional taxonomy of change pathways.

COVID-19 has forced Big 4 firms to challenge existing management control arrangements.

Literature has focused on traditional, onsite work settings and largely ignored change pathways.

The authors take a temporal perspective to unpack changes to management control arrangements.

Big 4 firms adapted to hybrid work with substantial changes to personnel and cultural controls.

The authors theorise the findings by developing a three-dimensional taxonomy of change pathways.

The purpose of this paper is to describe and explain a clinician‐led improvement of a hip fracture care process in a university hospital, and to assess the results and factors helping and hindering change implementation.

The paper has a mixed methods case study design. Data collection was guided by a framework directing attention to the content and process of the change, its context and outcomes.

Using a multiprofessional project team, beneficial changes in the early parts of the care process were achieved, but inability to change surgical staff work practices meant that the original goal of operating patients within 24 hours was not reached. After three years, top management introduced a hospital‐wide process improvement programme, which “took over” the responsibility for improving hip fracture care.

A clear vision why change is needed and what needs to be done, which is well communicated by a respected clinical leader, can motivate personnel, but other influences are also needed to bring about change. Without a plan agreed and supported by top management, changes are likely to be limited to parts of the process and improvements to patient care may be minimal. These and other findings may be applicable to similar situations in other services.

This case study is an illustration of both the strengths and the weaknesses of a “bottom‐up, clinician‐champion‐led improvement initiative” in a complex university hospital.

There has been considerable interest in the theory and practice of organisation change. Similarly there has been a great deal of attention given to the processes that lead to and result from accounting change within organisations. There has also been a more limited interest in the interaction and interrelationship between these two literatures. In this paper we explore these different literatures and provide a perspective on this extensive research. The contents are not intended to be a systematic summary of this voluminous literature but rather a recounting of our own views on how we have engaged with this material, as a precursor to thoughts on a future research agenda for these important issues. The paper starts by posing four questions related to organisational and accounting change, the answers to which circumscribe how these themes can be approached theoretically and empirically. Based on our answers to these questions we then move into perspectives on understanding organisations, understanding organisational change and understanding accounting change within an organisational change context. From this analysis the paper concludes with some suggestions on a possible future research agenda on these important organisational issues.

The purpose of this paper is to explore how change processes are dependent on historical events, geographical conditions, strong stakeholders and social norms developed over long‐time periods. The paper poses the question: what is the role of path dependencies in mergers between hospitals when motives of the mergers are ambiguous and the context of the change initiatives is characterized by conflicting goals?

The primary objective of this study is to describe the experience of three hospitals that were merged into a hospital enterprise, with the focus on a change in activity from 2003 to 2006. This fieldwork allowed a longitudinal study. The empirical data were generated from observations, interviews, document studies and newspaper clippings.

The investigations showed that the merger forced the hospitals to change, but the new organization – the different components of the merged hospital – followed different pathways to handle the externally imposed changes. Parallel processes evolved, and these processes were rooted in the historical and geographical conditions. Further, the paper illuminates the unique strengths of qualitative research methods that allowed a deeper understanding of these change processes.

The paper's findings add to our knowledge on the complex relations between externally imposed organizational change and the nature of internal organizational behaviour when intertwined with strong stakeholders. The paper particularly highlights the possible consequences when there is little interaction between the changes of systems and the practices of the professionals in hospitals when the processes are heavily influenced by path dependencies rooted in historical and geographical traditions.

The purpose of this paper is to examine the early stages of change and the way that stories can open up forms of collaborative dialogue and creative thinking among divergent stakeholders on known but “intractable” problems by enabling multiple voices to be heard in the co-construction of future possibilities for change. The empirical focus is on a project undertaken by two organizations located in Australia. The organizations – AAC, a large aged care provider and Southern Disability Services, a disability support service – collaborated with the researchers in identifying and re-characterizing the nature of the problem in the process of storying new pathways for tackling the transitioning needs of people with intellectual disabilities into aged care services.

An action research approach was used in conducting interviews in the case organizations to ascertain the key dimensions of the presenting problem and to identify change options, this was followed by an ethnographic study of a Pilot Project used to trial the provision of disability day service programmes within an aged care setting.

A key finding of the study centres on the importance of stories at the early stages of change in widening the arena of innovative opportunities, in facilitating collective acceptance of new ideas and in initiating action to resolve problems. The paper demonstrates how stories are used not only in retrospective sensemaking of existing problems but also in giving prospective sense to the possibilities for resolving protracted problems through innovative solutions that in turn facilitates a level of collective acceptance and commitment to opening up new pathways for change.

The paper focuses on problem characterization during the early stages of change and bring to the fore the often hidden notion of time in utilizing concepts from a range of literatures in examining temporality, stories and sensemaking in a context in which future possibilities are made sense of in the present through restorying experiences and events from the past. On a practical and policy front, the paper demonstrates the power of stories to mobilize commitment and action and presents material for rethinking change possibilities in the delivery of aged and disability care.