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This chapter describes the change efforts and action research projects at a Dutch multinational which, over a period of 25 years, produced in one of its businesses a zigzag path toward collaborative leadership dynamics at the horizontal and vertical interfaces. The chapter also identifies the learning mechanisms that helped achieve this transformation. Changing the patterns at the vertical interfaces proved to be a most tricky, complex, and confusing operation. The data show that organizations need hierarchical interfaces between levels, but are hindered by the hierarchical leadership dynamics at these interfaces. The data furthermore show that competitive performance requires more than redesigning horizontal interfaces. A business can only respond with speed and flexibility to threats and opportunities in the external environment when the leadership dynamics at agility-critical vertical interfaces are also changed.

An issue of managing a business (unit) as a whole successfully is perceived to belong to the fundamental issues within strategic management. This paper proposes that a business unit can be managed successfully in short and longer term in its focal contexts as a set of three recursive, competence-based, and process-based systems. Many elements of Stafford Beer's (1985) viable system model along the key competence-based theoretical bases are applied to this system design task. The outcome is an ideal, recursive template for advancing competence-based business management (CBBM) and its conceptual modeling. It is assumed that it is possible to design a business unit as a viable system that is capable of sustaining a separate existence at only three levels of hierarchy, as part of single or multi-business firms. Business-process models and their redesign processes are chosen as the 2nd-order, focal system which produces a business unit's competitiveness and solves longitudinal CBBM problems. One level of recursion down includes a unit's value creating, capturing, releveraging, and respective processes that enable to solve cross-sectional problems. One level of recursion up includes a unit's existential foresights and their crafting processes that solve existential problems. Recursivity is designed inside each system in terms of three kinds of subsystems for (a) primary value releveraging, process-model redesign, and business-foresight crafting, (b) the management of varieties in releveraging, modeling, and foreseeing, and (c) the monitoring and probing of all three systems. Systemic competences are incorporated inside respective systems. Such competences possess three flexibilities of absorption, attenuation, and amplification. At each level of recursion, a competence-based process is a unit of conceptual modeling of CBBM. A business unit is defined as a set of its purposeful processes. No thing or one is left outside them. Viability is ensured by real-time interaction and the 1st-, 2nd-, and 3rd-order feedback loops between three systems. Overall, the suggested, recursive, 3-system template is intended to serve future, compatible modeling efforts among interested, pioneering firms, professional CBBM modelers, scholars, and alike. Its novelty is produced by choosing and designing the CBBM modeling as the 2nd-order system-in-focus with its two recursions, by designing and using systemic, competence-based processes as the units of conceptualization, and by choosing and drawing the figures to illustrate the 3-system template in the ways that allow also business managers comprehend and apply the suggested template in practice.

In this chapter, we identify three distinct transformational performance improvement (TPI) approaches commonly used to redesign work processes in health care organizations. We describe the unique components or tools that each approach uses to improve the delivery of health services. We also summarize what is empirically known about the effectiveness of each TPI approach according to systematic reviews and recent studies published in the peer-reviewed literature. Based on examination of this research, we discuss what knowledge is still needed to strengthen the evidence for whole system transformation. This involves the use of conceptual frameworks to assess and guide implementation efforts, and facilitators and barriers to change as revealed in a recent evaluation of one major initiative, the Lean Enterprise Transformation (LET) at the Veterans Health Administration. The analysis suggests ways in which TPI facilitators can be developed and barriers reduced to improve the effectiveness and sustainability of quality initiatives. Finally, we discuss appropriate study designs to evaluate TPI interventions that may strengthen the evidence for their effectiveness in real world practice settings.

Developing structures and processes that support learning and knowledge creation has become an area of extensive study. This paper describes dimensions of knowledge that were needed in integrating theory and practice for an applied research project. The project involved team members from university, business and consulting organizations. The knowledge created through this team structure was inherently multi-dimensional, with theoretical, practicable, educable and evidentiary components. The paper concludes with considerations for how the essence of this project team structure might be replicated for organizational knowledge creation in American industry.

The high-risk/high-stress nature of hospital emergency departments has made handoffs (i.e. patient transfers across organizational units) an area of significant safety consequence, as evidenced by numerous studies and 2006 Comprehensive Accreditation Manual for Hospitals: The Official Handbook (CAMH). Joint Commission Resources, Inc.: Author; 2005. This same high-risk/high-stress environment is known for generating resistance to traditional deficit-based, external expert driven approaches to improvement. The authors describe how one hospital overcame this resistance by using an Appreciative Inquiry approach to the redesign of the information flow and organizational roles within a mission-critical area of the hospital. Rather than designing to ameliorate the root causes of ineffective handoffs, this positive lens approach (Appreciative Inquiry) was used to engage staff in identifying and expanding upon their most effective handoff experiences. Implications for shifting from problem-based design to a positive lens approach in the creation of micro-information systems and new organizational processes are discussed.

Organizations that adopt new practices employ managers to make decisions about how to materialize these practices. I examine how these managers move between the meanings and resources found in extra-local and local realms. I find that managers’ practices shift over time from adapting BPR practices to inhabiting BPR as an idea. Managers’ approaches are shaped by each organization’s history of efforts to introduce extra-local ideas. Rather than adapting BPR practices, managers draw on change tools, techniques, and methods that have worked in the organization and integrate BPR work into ongoing interactions, activities, and language in the local context.

This chapter integrates organization design and sustainability concepts to describe an accelerated transformational change at the Fairview Medical Group (United States).

A case study of the transformation at Fairview Medical Group’s primary care clinics was developed from interviews and first-person accounts of the change. Objective data regarding outcomes was used to evaluate the effectiveness of the redesign process.

The Fairview Medical Group developed an innovation and change capability to transform 35 primary care clinics in six months. All of the clinics were certified by the state of Minnesota as complying with their healthcare standards. Clinical outcomes, costs, and employee and physician engagement also increased. All of the improved measures are sustained.

Healthcare reform in the United States struggles because the organization design challenges are great and the change difficulties even greater. Fairview’s experience provides important evidence and lessons that can help advance our understanding of effective healthcare and create more sustainable healthcare systems. This chapter provides healthcare system administrators evidence and alternatives in the pursuit of implementation.

The digital transformation calls for new thinking about sociotechnical systems design (STSD) because it has enabled new kinds of work systems to proliferate. We identify a new class of sociotechnical system, called the Platform-STS (P-STS), which complements the existing Industrial- and Knowledge-STSs. The P-STS has distinctive characteristics compared to the other classes because it reaches directly into ecosystems and is, therefore, “distributed,” and because it is governed through market mechanisms rather than hierarchy or clan mechanisms. We introduce a new design principle, redundancy of connectivity, to ground design thinking about the P-STS. We demonstrate why fundamental STSD principles need to be reconfigured, suggest how they might do so, and conclude that socioecological designs and interventions may need to supplant sociotechnical ones.

This chapter analyzes the success factors, outcomes, and future viability of large-group methods. We have used an exploratory action research approach focusing on eight variously purposed large-group methods (AmericaSpeaks, Appreciative Inquiry, Conference Model®, Decision Accelerator, Future Search, Participative Design, Strategic Change Accelerator/ACT (IBM), and Whole-Scale™ Change). We interviewed nine leading practitioners and creators for each method, as well as six clients who had played key roles in most of these methods' execution at their organizations, asking them to reflect on the current practices and outcomes and the future of each respective large-group method, as well as the methods as a group of interventions. Based on our findings derived through theme and content analysis of interviews, we purport that both the Art (excellence in method execution) and the Artist (the right facilitator) are necessary for achieving desired outcomes of the large-group methods. We stipulate that critical elements of the Art include these five common elements (or five “I”s): having the right Individuals in the room; aiming the method at resolving the right Issue; having Intentional process (including pre-work, intra-method process, and follow-up); having the right Information in the meeting; and using the right Infrastructure (such as appropriate physical space, technology, etc.). We suggest that while these elements of Art are important, the simultaneous requisite role of the Artist is to manage the tension between the rigidity of the Art (the 5 “I”s) and the emerging human dynamics occurring between the large-group method process and the associated evolving client objectives. That is, to achieve desired outcomes, the execution of large-group method needs to be both highly premeditated and ingenious. We supplement our findings with client case descriptions and quotes from the practitioners and conclude that these large-group methods are particularly appropriate for resolving a variety of issues facing today's organizations operating under the conditions of high technology saturation, interdependence, globalization, economic downturn, and others – and that this, with some exceptions, will likely remain the case in the future. However, the future use of these methods will be challenged by the availability of Artists who can execute the methods so they lead to desired outcomes. We close with discussion of open questions and directions for future research.