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The results of a study designed to investigate issues in large‐scale change efforts are presented. The sample for this study consisted of 398 individuals with expertise in the area of planned change. Individuals were asked to indicate the types of issues they perceived as having a positive or negative impact on large‐scale change programs in general. Respondents also provided data on 312 specific change efforts. Results indicate that several variables, including high industry competition, a high percentage of employee participation and the participation of employees from many organizational levels, may have a significant positive impact on the success of large‐scale change programs.

The study identifies the variation of change strategies used in a complex large scale change program in health and social services in Sweden, aimed at changing professionals' health promoting practices. The purpose is to investigate the change strategies used over time and describe the potential variation in key change agent views, using a framework inspired by De Caluwé and Vermaak's multi paradigm change typology.

The first six years of the regional multi-sector program are examined. Results are based on content analyses of interviews with key change actors, and archival data describing program activities. Respondents belonged to either the strategic or the operational program management team, representing different sectors of health and social services in a region.

Multiple strategy paradigms showed varying influence over the program's different phases, partly due to program progress, change agent influence and/or varying contextual demands. Respondents' views on strategies and program focus varied depending on their program roles. Respondents expressed insights about the varying conditions for change and on the conflicting expectations within and between program management teams.

This study introduces the application of a new framework on a large scale, complex change program. The framework sheds light on a number of basic assumptions and change strategies that can be further compared with content and context factors, barriers, facilitators, outcomes, and in turn with other programs.

Reports results from an extensive survey of major American change programmes which revealed a set of clusters of interventions. Most typically, the change programmes involved combinations of intervention techniques. Team‐building, strategic planning, skill building and restructuring were the most common interventions. Success, however, appeared to depend on complex interactions amongst individual, organizational and change process variables.

The purpose of this paper is to reflect on the experience of the Advancing Quality Alliance's (AQuA) regional Integrated Care Discovery Community created to translate integrated care theory into practice at scale and to test ways to address the system enablers of integrated care.

Principles of flexibility, agility, credibility and scale influenced Community design. The theoretical framework drew on relevant complexity, learning community and change management theories. Co-designed with stakeholders, the discovery-based Community model incorporated emergent learning from change in complex adaptive environments and focused bespoke support on leadership capability building.

In total, 19 health and social care economies participated. Kotter's eight-step change model proved flexible in conjunction with large-scale change theories. The tension between programme management, learning communities and the emergent nature of change in complex adaptive systems can be harnessed to inject pace and urgency. Mental models and simple rules were helpful in managing participant's desire for a directive approach in the context of a discovery programme.

This is a viewpoint from a regional improvement organisation in North West England.

The Discovery Community was a useful construct through which to rapidly develop multiple integrated health and social care economies. Flexible design and bespoke delivery is crucial in a complex adaptive environment. Capability building needs to be agile enough to meet the emergent needs of a changing workforce. Collaborative leadership has emerged as an area requiring particular attention.

Learning from AQuA's approach may assist others in structuring large-scale integrated care or complex change initiatives.

The purpose of this paper is to understand the process of large-scale organizational change in a community-based enterprise in Myanmar.

A qualitative case study methodology was selected to understand the phenomenon of change in a community-based enterprise in Myanmar. Data were collected over a four-week period of fieldwork through individual interviews, focus groups, observations and document collection. Data were analyzed via a modified inductive analytic strategy using constant comparative analysis.

Findings revealed the processes used in this large-scale organizational change as impacted by the national cultural dimensions of Myanmar and the social learning experienced by the participants. Learning about organization development and change and sharing that learning in the organization by its members who participated in a certificate program in organizational development designed by Payap University (Thailand) and the International Rescue Committee had a major role in the change processes. Myanmar’s high power distance and collectivist culture facilitated social learning by highlighting authority figures as role models and providing high interaction environments conducive to learning.

This study illuminates the change process in a community-based organization in the emerging economy of Myanmar where no roadmaps for change in these types of organizations exist. The findings of this study are transferrable to community-based organizations in emerging economies with similar national cultural characteristics and call for future case studies to understand the complexities of change in these unique organizations and environments.

This study explores the efficacy of social movements thinking for mobilizing resources toward sustainable change in large-scale systems such as health and social services.

The study proceeds from a critical realist perspective employing a qualitative multi-case study approach. Drawing on the tenets of grounded theory (i.e. constant comparative analysis and theoretical sampling), data from semi-structured interviews and field notes were analyzed to facilitate theoretical integration and elaboration.

One case study explores the emergence of social movements thinking in mobilizing a community to engage in sustainable system change. Data analysis revealed a three-stage conceptual framework whereby building momentum for change requires a fundamental shift in culture through openness and engagement to challenge the status quo by acknowledging not only the apparent problems to be addressed but also the residual apathy and cynicism holding the system captive to entrenched ideas and behaviors. By challenging the status quo, energy shifts and momentum builds as the community discovers shared values and goals. Achieving a culture shift of this magnitude requires leadership that is embedded within the community, with a personal commitment to that community and with the deep listening skills necessary to understand and engage the community and the wider system in moving forward into change. This emergent conceptual framework is then used to compare and discuss more intentional applications of social movements thinking for mobilizing resources for large-scale system change.

This study offers a three-stage conceptual framework for mobilizing community/system resources toward sustainable large-scale system change. The comparative application of this framework to more intentional applications of social movements thinking to planned change initiatives offers insights and lessons to be learned when large-scale systems attempt to apply such principles in redesigning health and social service systems.

Tim is the current managing director of Bridge. Bridge is an international consultancy specializing in leadership and organization development, and supporting large scale change programmes.

This briefing is prepared by an independent interviewer.

In this interview, Tim Littlehales discusses the types of leadership development programmes offered by Bridge, how to “future proof” organizations, and his experiences of working on large scale change programmes.

Provides strategic insights and practical thinking that have influenced some of the world's leading organizations.

Tim Littlehales provides some interesting and useful insights into leadership development, drawing on his experiences at Bridge, and his professional background, which centered around Accountancy and Business Consulting.

The purpose of this paper is to investigate the contributing factors that lead to resistance to change, and to ascertain the relationship between organizational culture and employee resistance in organizational change programmes, such as lean.

The methodology for this research is in three main parts. Firstly, a systematic review of the literature pertaining to resistance to change is, secondly, followed by a case study involving an anonymous survey and semi-structured interviews to test the assumptions drawn from the literature. Finally, the literature research and case study results are drawn together to present a new model of resistance.

The finding of the literature, along with the finding of the case study confirm that lack of communication and participant involvement during change are highlighted as significant contributing factors to resistance and that these are related to organizational culture.

Whilst the secondary sources of information provide a significant weight of evidence to support the results from the case study, the results of the research are based on a single case study; therefore, caution should be applied before making generalizations from the data.

The findings can provide organizations, and change practitioners, with an insight into a number of the issues that should be considered in relation to an organizations culture before attempting large-scale change programmes.

The research findings provide a new model, the “resistance model” that identifies the interconnected issues that affect employees’ attitude to, and thus acceptance of, organizational change.

The purpose of this paper is to investigate program management teams' views on issues and challenges in managing a large, multi-sectoral child health promotion program in Sweden.

In total, 17 participants representing two autonomous program management teams, one strategic and one operational, were interviewed. Analysis of interview data was complemented with reviews of program documents.

Program management teams identified important issues concerning the program's formal structure, goals, role distribution, and change and dissemination processes, but lacked a shared mental model of the situation. Inter and intra group communication, long- and short-term strategic planning were further areas in need of improvement. While issues and challenges might seem to be agreed upon by the program's change agents, closer inspection reveals variation in key characteristics as well as in perspectives on solutions.

Health promotion programs are challenging. Researchers trying to understand program success have focused on particular interventions, contextual factors and program recipients. Less research has focused on the internal processes of teams tasked with wide-ranging change mandates and the effects such processes can have on program outcomes. This study contributes to a deeper understanding on internal processes and mental models of change agent teams.

When organizations implement continuous quality improvement (CQI) programs, managers and employees are faced with massive change, often requiring a renegotiation of the psychological contract between employer and employee. This paper discusses generational differences in reactions to major change initiatives as well as change management issues in public and nonprofit organizations. Its specific focus is an organizational unit in the nonprofit sector whose CQI program, which required more employee involvement, was met with varied reactions among older veterans of its small workforce. Observations of the unit and its employees are used to develop a typology of reactions to major change among long‐time, older workers. Strategies are provided to managers who must develop methods to deal with adverse reactions to major organizational changes such as CQI. The typology may be useful to management development specialists who are attempting to transform organizations with significant age diversity.