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Purpose – To identify the key success factors in a change process and to demonstrate how adherence to the phases of large-scale change contributed to the successful reform of the Irish cancer services and is critical to the sustainability of this large-scale change.

Design – In-depth retrospective analytical case study drawing from face- to-face semi-structured interviews with key stakeholders and players.

Findings – The Irish health care reform had been continually thwarted by local politics. The Irish government confronted this trend by bringing in an outside expert to head the cancer services reform project who, with government support, managed both clinician and public resistance and, based on the evidence of international best practice, led the reform. Sustainable change was achieved by attention to how large-scale change works. The leadership of the project is an important element in overcoming the path dependency that is dogged in most health care reforms.

Value – This chapter provides evidence that the four key phases of large system change: understanding the need for change, framing the change, undertaking the change and sustaining the change, coupled with key success factors in relation to timing, financial viability, political will and leadership, public support, well-managed process, and technical infrastructure and capacity are critical to the implementation and sustainability of large-scale change.

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This chapter considers viable and nonviable methods for corruption and ethics reform. Among the different types of methods considered are: vision and values based methods; win-win incentive and ethics networking methods; power-based top-down compliance and bottom-up whistle-blowing methods; alternative institution building methods; and, social movement methods. The chapter analyzes how the different types of methods can be more and less viable depending upon the specific multilevel situational factors related to micro individual, meso organizational, and macro institutional level, political-economic, and cultural obstacles to corruption and ethics reform.

Purpose – This chapter frames the topic of organizing for sustainable health care in terms of the environmental trends that have rendered current health care approaches unsustainable, the embeddedness of health care in society's triple bottom line, and the need to build adaptive capability within the complex health care ecosystem.

Design/methodology/approach – We synthesize documented trends and empirical findings regarding the viability of current approaches to health care, and provide a theoretically framed treatment of the adaptation process in the complex health care system that can lead to the emergence of sustainable approaches.

Findings – There is a misfit between current approaches to delivering health care and the requirements and trends in contemporary society. Fundamental transformation is required that entails a broadening of purpose, a future orientation, and a rethinking of how health care adds value and how it is embedded in society.

Originality/value – By reconceptualizing health care reform as intricately related to societal sustainability and the triple bottom line, we open the possibility of transcending a narrow focus on reengineering to create more efficient organizations and work processes that consume fewer resources and deliver greater value. We invite health care practitioners and scholars to rethink all the connections in the health care ecosystem, and the need to build in self-organizing capabilities and adaptive capacity. The cases in this book provide knowledge from systems engaged in fundamental transformation, analyzed through the lenses of theoretical frameworks that help us better understand essential dynamics involved in creating sustainable health care systems.

This chapter will establish the two main strands of the study's theoretical framework. These strands represent the internal and external resources in the GSE case. The resource mobilisation (RM) strand refers to the internal resources of GSE, while the political opportunity structure (POS) refers to external resources. By referring to the literature on social movements particularly that which dwells on RM and the exploitation of political opportunities, the study will provide an understanding of collective action. This study investigates the campaign of an environmental movement that challenged the waste policy of the state, on the issue of incineration. As the state changed waste policy, the Galway campaign mobilised internal resources and exploited external political opportunities. The shifting nature of this opportunity structure may affect the patterns of internal mobilisation, utilisation of resources and types of networks a movement implements. Government responses to such challenges may also influence the patterns of collective action, as movements attempt to exploit the opportunities of the wider political environment.