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Organizational change is a key mechanism to ensure the sustainability of healthcare systems. However, healthcare organizations are persistently difficult to change, and literature is riddled with examples of failed change endeavors. In this chapter, we attempt to unravel the underlying causes for failed organizational change. We distinguish three types of change with different levels of depth that require different change approaches. Transformations are the deepest forms of change where beliefs and principles need to be modified to successfully influence routines. Renewals are deep forms of change where principles need to be modified to successfully influence routines. Improvements are shallow forms of change where only modifications at the level of routines are needed. Using deoxyribonucleic acid (DNA) as our metaphor, we propose a theory of “organizational DNA” to understand organizations and these three types of organizational changes. We posit that organizations are made up of a double helix consisting of a so-called “social string,” which contains the “soft” interaction or communication among the organization's members, and a so-called “technical string,” which contains “hard” organizational aspects such as structure and technology. Ladders of organizational nucleotides (i.e., Routines, Principles, and Beliefs) connect this double helix in various combinations. Together, the double helix and accompanying nucleotides make up the DNA of an organization. Without knowledge of the architecture of organizational DNA and whether a change addresses beliefs, principles, and/or routines, we believe that organizational change is constrained and based on luck rather than change management expertise. Following this metaphor, we show that organizational change fails when it attempts to change one part of the DNA (e.g., routines) in a way that renders it incompatible with the connecting components (e.g., principles and beliefs). We discuss how the theory can be applied in practice using an exemplar case.

In Morocco, as in many developing countries, environmental responsibility is not well integrated into corporate management at the operational, tactical, and strategic levels. While the management literature offers a rich body of knowledge on Corporate Social Responsibility (CSR) strategies and practices, less attention has been paid to exploring the complexity of environmental responsibility through the lens of corporate culture. This research aims to address this gap by examining the influence of cultural factors on the deployment of environmental responsibility using Johnson's (2000) model of corporate culture. This model identifies seven components of corporate culture: stories or myths, symbols, power structures, organizational structures, control systems, rituals and routines, and paradigms. Through a Moroccan industrial group case study, this chapter presents the successful deployment of environmental responsibility and describes how managing cultural factors facilitated this transition. This chapter also identifies the unique aspects of the group's culture that allowed redesigning the company's management systems. These insights offer valuable implications for managers and policymakers seeking to improve the environmental performance of large enterprises in developing countries.

At the beginning of the 21st century, multiple and diverse social entities, including the public (consumers), private and nonprofit healthcare institutions, government (public health) and other industry sectors, began to recognize the limitations of the current fragmented healthcare system paradigm. Primary stakeholders, including employers, insurance companies, and healthcare professional organizations, also voiced dissatisfaction with unacceptable health outcomes and rising costs. Grand challenges and wicked problems threatened the viability of the health sector. American health systems responded with innovations and advances in healthcare delivery frameworks that encouraged shifts from intra- and inter-sector arrangements to multi-sector, lasting relationships that emphasized patient centrality along with long-term commitments to sustainability and accountability. This pathway, leading to a population health approach, also generated the need for transformative business models. The coproduction of health framework, with its emphasis on cross-sector alignments, nontraditional partner relationships, sustainable missions, and accountability capable of yielding return on investments, has emerged as a unique strategy for facing disruptive threats and challenges from nonhealth sector corporations. This chapter presents a coproduction of health framework, goals and criteria, examples of boundary spanning network alliance models, and operational (integrator, convener, aggregator) strategies. A comparison of important organizational science theories, including institutional theory, network/network analysis theory, and resource dependency theory, provides suggestions for future research directions necessary to validate the utility of the coproduction of health framework as a precursor for paradigm change.

High-quality nursing home (NH) care has long been a challenge within the United States. For decades, policymakers at the state and federal levels have adopted and implemented regulations to target critical components of NH care outcomes. Simultaneously, our delivery system continues to change the role of NHs in patient care. For example, more acute patients are cared for in NHs, and the Center for Medicare and Medicaid Services (CMS) has implemented value payment programs targeting NH settings. As a part of these growing pressures from the broader healthcare delivery system, the culture-change movement has emerged among NHs over the past two decades, prompting NHs to embody more person-centered care as well as promote settings which resemble someone's home, as opposed to institutionalized healthcare settings.

Researchers have linked culture change to high-quality outcomes and the ability to adapt and respond to the ever-changing pressures brought on by changes in our regulatory and delivery system. Making enduring culture change within organizations has long been a challenge and focus in NHs. Despite research suggesting that culture-change initiatives that promote greater resident-centered care are associated with several desirable patient outcomes, their adoption and implementation by NHs are resource intensive, and research has shown that NHs with high percentages of low-income residents are especially challenged to adopt these initiatives.

This chapter takes a novel approach to examine factors that impact the adoption of culture-change initiatives by assessing knowledge management and the role of knowledge management activities in promoting the adoption of innovative care delivery models among under-resourced NHs throughout the United States. Using primary data from a survey of NH administrators, we conducted logistic regression models to assess the relationship between knowledge management and the adoption of a culture-change initiative as well as whether these relationships were moderated by leadership and staffing stability. Our study found that NHs were more likely to adopt a culture-change initiative when they had more robust knowledge management activities. Moreover, knowledge management activities were particularly effective at promoting adoption in NHs that struggle with leadership and nursing staff instability. Our findings support the notion that knowledge management activities can help NHs acquire and mobilize informational resources to support the adoption of care delivery innovations, thus highlighting opportunities to more effectively target efforts to stimulate the adoption and spread of these initiatives.

How can large international financial firms go green in authentic ways? What enhances ‘Net Zero action’? Changes in global banks, fund managers, and insurance firms are at the heart of green finance. External change pressures – combined with problematic firm predispositions – exacerbate barriers to change and promote scepticism about authentic Net Zero change. Field research reveals main elements, connections, and interactions of this question by considering financial firms as complex socio-technical systems (Mitleton-Kelly, 2003). An interdisciplinary/holistic narrative approach (De Bakker et al., 2019) is adopted to design a conceptual framework that can support a green ‘behavioural theory of the financial firm’ (green BTFF). The BTFF presents an international version (Peng, 2001) of the resource-based view (RBV) of the firm (Barney, 1991; Hart, 1995; Teece et al., 1997).

The approach of this chapter is aimed at closing knowledge gaps and realign values in financial markets and society. By raising awareness about organised hypocrisy and facades (Brunsson, 1993; Cho et al., 2015; Schoeneborn et al., 2020) in financial firms the chapter aims at overcoming the gap between ‘talking’ and ‘walking’ in the financial sector. The chapter defines testable firm-level hypotheses for ‘Green Finance’ (Poterba, 2021) as well as – by implication – tests for ‘greenwashing’.

Designing and developing safe systems has been a persistent challenge in health care, and in surgical settings in particular. In efforts to promote safety, safety culture, i.e., shared values regarding safety management, is considered a key driver of high-quality, safe healthcare delivery. However, changing organizational culture so that it emphasizes and promotes safety is often an elusive goal. The Safe Surgery Checklist is an innovative tool for improving safety culture and surgical care safety, but evidence about Safe Surgery Checklist effectiveness is mixed. We examined the relationship between changes in management practices and changes in perceived safety culture during implementation of safe surgery checklists. Using a pre-posttest design and survey methods, we evaluated Safe Surgery Checklist implementation in a national sample of 42 general acute care hospitals in a leading hospital network. We measured perceived management practices among managers (n = 99) using the World Management Survey. We measured perceived preoperative safety and safety culture among clinical operating room personnel (N = 2,380 (2016); N = 1,433 (2017)) using the Safe Surgical Practice Survey. We collected data in two consecutive years. Multivariable linear regression analysis demonstrated a significant relationship between changes in management practices and overall safety culture and perceived teamwork following Safe Surgery Checklist implementation.

A quick search of the headlines of major newspapers reveals a treasure trove of technology procurement gone wrong. While the private sector seems to adopt and implement new technology seamlessly and quickly to deliver for customers, the government struggles to accomplish technology purchases and integrations with the same ease. As governments in the United States are looking to retain their current workforce and attract the next generation of workers, the technological capabilities and ethos of governments will be paramount. With nearly every industry being transformed by technology and Generation T being the first generation to have an ingrained “technology first” mindset, the ability of governments to attract these workers depends, in large part, on the ability to transform their government technology culture, policies, and practices.

In this chapter, the authors examine the administrative branch and observe two key components at the root of most technology failures: poor organizational structure in the bureaucracy and the lack of an empowered Chief Information/Technology Officer. Building upon case studies from Massachusetts and California, this chapter looks at the factors related to failure or success to understand the technology procurement culture. The chapter concludes by presenting four key “best practice” principles of public policy and administration that can be implemented by almost any governmental entity to improve their acquisition and implementation of technology.