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Management and leadership in health care are described as complex and challenging, and the span of control is known to be a key component in the manager’s job demands. The implementation of change can be a challenge in health care, and managers often have roles as implementation leaders. Little attention has been given to how managers perceive the process of implementation. Thus, this study aims to explore second-line managers’ perceptions of, prerequisites for and experiences from the implementation of changes in their manager’s work conditions.

A grounded theory–based qualitative design was used. Data were collected from a purposive sample of nine second-line managers by individual semi-structured interviews. The three stages of initial coding, focus codes and axial coding were used in data analysis.

Three thematic areas were identified: engagement, facilitation and achievement. The second-line managers’ descriptions suggest that the change work entails a complex challenge with an unclear result. Involvement, consideration for the context and facilitation are needed to be able to conduct a cohesive implementation process.

This study findings outline that to succeed when implementing change in complex organizations, it is crucial that managers at different levels are involved in the entire process, and that there are prerequisites established for the facilitation and achievement of goals during the planning, implementation and follow-up.

The purpose of this study is to discover the learning mechanisms and temporal dynamics of implementing systems (Six Sigma) as it unfolds over time.

The data come from a European engineering company that was implementing a Six Sigma-based quality management system (QMS) over a seven-year period. The analysis is based on an event-sequence reconstruction of the implementation process as it unfolded over time and discovers four different learning mechanisms that emerged: programmatic, persistent, adaptive and dialectical learning mechanisms. The research follows a process design study, where the authors study how the process unfolds over time.

Much of the literature on implementing management systems suggests that implementation follows a prescribed sequence of “turn-key” steps. However, the findings show that only 40% of all events were driven by prescribed “turn-key” generic practices, while 56% of events required constructing new practices via adaptive and dialectical learning. Moreover, the implementation process did not proceed in a linear programmatic fashion, but instead followed a punctuated equilibrium pattern, which alternated between periods of incremental change and major organizational change. The study also found that implementation required changing many complementary organizational structures and practices that were interdependent with the management system (i.e. Six Sigma). By understanding the implementation process, managers can better assess the time and effort involved, better adapt the system to their situated context and predict critical junctures where implementation could break down.

This research complements the few studies that have examined the process of implementing management systems. Most studies examine factors or conditions that result in implementation success (the what of implementing systems), but few examine the process of implementation and the learning that takes place during implementation (the how of implementing systems), which is a complex nonlinear process that involves different modes of learning.

Facilitation activities support implementation of evidence-based interventions within healthcare organizations. Few studies have attempted to understand how facilitation activities are performed to promote the uptake of evidence-based interventions in hospitals from resource-poor countries during crises such as pandemics. This paper aims to explore facilitation activities by infection prevention and control (IPC) professionals in 16 hospitals from 9 states in Brazil during the COVID-19 pandemic.

Primary and secondary data were collected between March and December 2020. Semi-structured interviews were conducted with 21 IPC professionals in Brazilian hospitals during the COVID-19 pandemic. Public and internal documents were used for data triangulation. The data were analyzed through thematic analysis technique.

Building on the change response theory, this study explores the facilitation activities from the cognitive, behavioral and affective aspects. The facilitation activities are grouped in three overarching dimensions: (1) creating and sustaining legitimacy to continuous and rapid changes, (2) fostering capabilities for continuous changes and (3) accelerating individual commitment.

During crises such as pandemics, facilitation activities by IPC professionals need to embrace all the cognitive, behavioral and affective aspects to stimulate positive attitudes of frontline workers toward continuous and urgent changes.

This study provides unique and timely empirical evidence on the facilitation activities that support the implementation of evidence-based interventions by IPC professionals during crises in hospitals in a resource-poor country.

Implementing change in healthcare is difficult to accomplish due to the unpredictability associated with challenging the status quo. Adapting the intervention/practice/program being implemented to better fit the complex context is an important aspect of implementation success. Despite the acknowledged influence of context, the concept continues to receive insufficient attention at the team-level within implementation research. Using two heterogeneous multidisciplinary healthcare teams as implementation case studies, this study evaluates the interplay between context and implementation and highlights the ways in which context influences the introduction of a collective leadership intervention in routine practice.

The multiple case study design adopted, employed a triangulation of qualitative research methods which involved observation (Case A = 16 h, Case B = 15 h) and interview data (Case A = 13 participants, Case B = 12 participants). Using an inductive approach, an in-depth thematic analysis of the data outlined the relationship between team-level contextual factors and implementation success.

Themes are presented under the headings: (1) adapting to the everyday realities, a key determinant for implementation success and (2) implementation stimulating change in context. The findings demonstrate a dynamic relationship between context and implementation. The challenges of engaging busy healthcare professionals emphasised that mapping the contextual complexity of a site and adapting implementation accordingly is essential to enhance the likelihood of successful implementation. However, implementation also altered the surrounding context, stimulating changes within both teams.

By exposing the reciprocal relationship between team-level contextual factors and implementation, this research supports the improved design of implementation strategies through better understanding the interplay and mutual evolution of evidence-based healthcare interventions within different contexts.

Taking the dialogic organizational development perspective, this study aims to investigate the framing processes when engaging in dialogue for strategy implementation and how these enable the evolution of implementation opportunities.

Through a qualitative exploratory study conducted in a large multinational, the authors analyse the dialogue and interactions among 25 dyads when identifying opportunities to contribute to strategy implementation. The data analysis relies on a process-coding approach and linkography, a valuable protocol analysis for identifying recursive interaction schemas in conversations.

The authors identify four main framing processes – shaping, unveiling, scattering and shifting – and provide a framework of how these processes affect individuals’ mental models through increasing the tangibility of opportunities or elevating them to new value hierarchies.

From a theoretical perspective, this study contributes to the strategy implementation and organizational development literature, providing a micro-perspective of how dialogue allows early knowledge structures to emerge and shape the development of opportunities for strategy implementation.

From a managerial perspective, the authors offer insights to trigger action and change in individuals to contribute to strategy when moving from formulation to implementation.

Rather than focusing on the structural control view of strategy implementation and the role of the top management team, this study considers strategy implementation as a practice and what it takes for organizational actors who do not take part in strategy formulation to enact and shape opportunities for strategy implementation through constructive dialogue.

The purpose of this paper is to explore what happens when changes to clinical practice are proposed and introduced in healthcare organisations. The authors use the implementation of Treatment Escalation Plans to explore the dynamics shaping the translational journey of a complex intervention from research into the everyday context of real-world healthcare settings.

A qualitative instrumental collective case study design was used. Data were gathered using qualitative interviews (n = 36) and observations (n = 46) in three English acute hospital trusts. Normalisation process theory provided the theoretical lens and informed data collection and analysis.

While each organisation faced the same translational problem, there was variation between settings regarding adoption and implementation. Successful change was dependent on participants' ability to manage and shape contexts and the work this involved was reliant on individual capacity to create a new, receptive context for change. Managing contexts to facilitate the move from research into clinical practice was a complex interactive and iterative process.

The paper advocates a move away from contextual factors influencing change and adoption, to contextual patterns and processes that accommodate different elements of whole systems and the work required to manage and shape them.

The paper addresses important and timely issues of change in healthcare, particularly for new regulatory and service-oriented processes and practices. Insights and explanations of variations in implementation are revealed which could contribute to conceptual generalisation of context and implementation.

Adaptation to the requirements of digital economy is especially difficult for older workers, which is a challenge for today’s organizations due to workforce shrinking and ageing. Therefore, the purpose of this paper is to investigate how it is possible to develop older employees’ potential in technology use in the business environment.

The authors examined how employees at various age perceive barriers during enterprise system (ES) adoption and use. This exploratory study is based on grounded theory and draws from the opinions of 187 Polish ES practitioners.

With age, emphasis on employees’ perception of mandatory ICT implementation projects is shifting from technology to people-related considerations. For older employees, job security and workload appear the most critical issues in such projects. Age-diverse collaboration appears necessary to address the problems posed by technology-related and demographic changes.

The findings imply that incorporating multiple stakeholder perspectives and age-related considerations into research on ICT adoption appears essential.

ICT adoption in the business environment can be successfully supported by age-balanced team building, cooperation between younger and older employees, and age-adjusted change management initiatives.

Supporting older employees during the implementation of mandatory business software should embrace reducing their negative attitudes to ICT-induced change by minimizing their perception of job insecurity.

Unlike many prior studies, the current research places age in the central role and discusses not only how it is possible to support older employees, but also how to leverage their potential in the process of ICT adoption and use in a mandatory setting.

The purpose of this paper is to identify factors influencing implementation of control charts on key performance indicators (KPIs).

Factors driving organizational change described in literature are analyzed inspired by the affinity-interrelationship method. A holistic multiple-case design is used to conduct six workshops to affect the usage of control charts on KPIs at a global company in the automotive industry. The theoretical factors are compared with the result from the case study.

The important factors for implementation success differ to some extent between the theoretical and empirical studies. High-level commitment and a clear definition of the goal of change could be most important when creating a motivation for change. Thereafter, having a dedicated change agent, choosing an important KPI and being able to describe the gain in financial terms becomes more important.

By using control charts on KPIs, the organization in the case study has become more proactive, addressing the right issues upstream in the process, in the right way, cross-functionally.

Factors affecting the implementation of already available solutions in the industry are highlighted. This potentially provides a basis for improved decision making, which has a significant value.

Process facilitation as part of a complex intervention for changing or improving practices within workplaces is becoming a common work method. The aim of this study was to investigate what characterizes the process-facilitating role in a complex intervention.

The present study focuses on a complex work environment intervention targeting eight organizational units (workplaces) in the Swedish healthcare sector. The study applies a mixed-method approach and has been carried out in two steps. First, a qualitative process evaluation was performed. Secondly, an evaluation was conducted to see to what extent these identified conditions and mechanisms affected the quantitative intervention effect in term of sickness absence.

The analysis shows that the facilitating role consisted of three overlapping and partially iterative phases. These phases involved different activities for the facilitating role. Depending on how the facilitating role and the intervention were designed, various supporting conditions were found to significantly affect the outcome of the intervention measured as the total sickness absence.

It is concluded that the facilitation is not static or fixed during the change process. Instead, the facilitation role develops and emerges through the process of support during the different implementation phases.

The facilitative role of performing support is based on a combination of support role activities and expert role activities. The support role focuses on support activities, while the expert role includes capacity building through knowledge- and legitimacy-oriented activities.

This study contributes to earlier research by developing a methodological approach for carrying out process facilitation in complex interventions.

The main factor that leads organizations to implement Building Information Modeling (BIM) is customer demand. While this is a frequent topic in the BIM literature, few studies address BIM organizational readiness. Due to this gap in BIM implementation literature, this paper aims to understand what affects organizational BIM readiness and how the BIM readiness process occurs.

The present paper adopts design science research as a methodological approach. A literature review examined 69 journal articles. The analysis focused on multiple theories, such as organizational readiness for change, adoption and diffusion of innovations and project management.

By investigating BIM organizational readiness, this study presents a construct and a conceptual model for driving BIM readiness.

This study can benefit researchers and organizations. The results presented may drive further research and discussions on the topic. But it is important to state that these results must be tested on real situations.