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The purpose of this paper is to describe an inventory of the strategic responses of institutional providers of mental handicapped care to the strengthening of consumer choice through a personal care budget (PCB)

Semi structured interviews were conducted among 26 providers covering 52 per cent of the total market volume of about 100,000 clients annually.

A representative number of providers was included; on average a percentage below the national average of PCB users was found to be served. Of the 26 providers, 16 indicated adaption to their strategy in response to expected consumer empowerment. The actual deployment of this response in the organisations seemed not to be very thorough or explicit. Surprisingly, as a growing part of PCB‐clients choose alternative providers, no concerns were raised concerning the possible emergence of new service providers.

Although the market share of PCB users is growing fast and existing providers do not seem to absorb this accordingly, a lack of market analysis and strategic behaviour of the traditional providers in response to this development was found. Based on this research growth of market shares of disruptive service providers can very well be anticipated.

Barriers to adequate healthcare in rural areas remain a grand challenge for local healthcare systems. In addition to patients' travel burdens, lack of health insurance, and lower health literacy, rural healthcare systems also experience significant resource shortages, as well as issues with recruitment and retention of healthcare providers, particularly specialists. These factors combined result in complex change management-focused challenges for rural healthcare systems. Change management initiatives are often resource intensive, and in rural health organizations already strapped for resources, it may be particularly risky to embark on change initiatives. One way to address these change management concerns is by leveraging socio-technical simulation models to estimate techno-economic feasibility (e.g., is it technologically feasible, and is it economical?) as well as socio-utility feasibility (e.g., how will the changes be utilized?). We present a framework for how healthcare systems can integrate modeling and simulation techniques from systems engineering into a change management process. Modeling and simulation are particularly useful for investigating the amount of uncertainty about potential outcomes, guiding decision-making that considers different scenarios, and validating theories to determine if they accurately reflect real-life processes. The results of these simulations can be integrated into critical change management recommendations related to developing readiness for change and addressing resistance to change. As part of our integration, we present a case study showcasing how simulation modeling has been used to determine feasibility and potential resistance to change considerations for implementing a mobile radiation oncology unit. Recommendations and implications are discussed.

The purpose of this paper is to gain a better understanding of the difficulties encountered in the hybrid roles of physician−managers (P−Ms), examine the impact of organizational constraints on the role conflicts experienced by P−Ms and explore the different ways their two roles are integrated.

A qualitative approach was adopted, using six focus groups made up of clinical co-managers, medical directors and P−Ms. In all, 43 different people were interviewed to obtain their perceptions of the day-to-day realities of the role of the P−M. The data collected were subsequently validated.

Although the expectations of the different groups involved regarding the role of P−Ms are well understood and shared, there are significant organizational constraints affecting what P−Ms are able to do in their day-to-day activities, and these constraints can result in role conflicts for the people involved. Such constraints also affect the ways P−Ms integrate the two roles. The authors identify three role hybridization profiles.

The results afford a better understanding of how organizational constraints might be used as levers of organizational change to achieve a better hybridization of the dual roles of P−Ms.

This paper seeks to reach beyond a simple identification of constraints affecting the dual roles of P−Ms by analyzing how such constraints impact on these professionals’ day-to-day activities. Results also enable us to further refine Katz and Kahn’s (1966) role model, in addition to identifying hybridization profiles.