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Purpose – To identify the key success factors in a change process and to demonstrate how adherence to the phases of large-scale change contributed to the successful reform of the Irish cancer services and is critical to the sustainability of this large-scale change.

Design – In-depth retrospective analytical case study drawing from face- to-face semi-structured interviews with key stakeholders and players.

Findings – The Irish health care reform had been continually thwarted by local politics. The Irish government confronted this trend by bringing in an outside expert to head the cancer services reform project who, with government support, managed both clinician and public resistance and, based on the evidence of international best practice, led the reform. Sustainable change was achieved by attention to how large-scale change works. The leadership of the project is an important element in overcoming the path dependency that is dogged in most health care reforms.

Value – This chapter provides evidence that the four key phases of large system change: understanding the need for change, framing the change, undertaking the change and sustaining the change, coupled with key success factors in relation to timing, financial viability, political will and leadership, public support, well-managed process, and technical infrastructure and capacity are critical to the implementation and sustainability of large-scale change.

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.

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.

Recent research in cognitive and social psychology finds that individual change is more emotional than rational. Further evidence suggests that the contagious power of emotions explains how groups may overcome obstacles and behave in unified ways. We offer a neuropsychological model of emotion-driven change in organizations that explains these findings and predicts conditions in which contagion effects will be successful in facilitating rapid change. Our model posits that emotive precursors to conscious action enable goal alignment and overcome cognitive resource limitations necessary to sustain organizational change over time. Our model adapts the findings from social and cognitive neuroscience to bring new insights into the mental mechanisms underlying the change process. The chapter concludes with tentative suggestions for developing new methods for research and practice that improve our predictive capability for creating rapid large-scale organizational change.

This article aims to explore how learning from social movement theory might be applied to large‐scale rapid organizational change.

Drawing on a recent evaluation by the Institute for Employment Studies (IES), this article considers a methodology designed by Janice Stevens and Ginny Edwards based on mobilizing principles, which has been trialled in six NHS (the UK's National Health Service) Trusts to introduce evidence‐based high impact actions (HIAs) in specific aspects of patient care. It starts by considering the underpinning social movement theory, goes on to describe the rapid spread methodology and then illustrates its application through one of the case studies.

The outcomes from the six pilot sites are extremely positive in terms of the metrics used to evaluate change in service improvement, patient satisfaction and cost reduction and also the behavioral legacy of increased staff confidence and pride in delivering nurse‐led change.

The theory behind social movement suggests that tapping into emotions is powerful but needs to be channeled carefully through meticulous organization, empowering leadership and attention to sustainable outcomes.

The chapter redefines the focus of the changes required to create sustainable healthcare away from fixing healthcare organizations and toward reconfiguring the constituent elements of the healthcare ecosystem and redefining how they interrelate to yield value more sustainably.

Based on a review of recent literature on healthcare reform, we argue that unlike other sectors, healthcare organizations cannot change themselves without changing their connections to the rest of the healthcare ecosystem, including other healthcare organizations, patients, governments, research institutions, vendors, and the citizenry at large. This is because these are not only stakeholders but also integral parts of healthcare processes.

Interventions intended to create more sustainable healthcare must bring together knowledge and perspectives from across the ecosystem, and must converge different sources of information and analysis to generate novel ways of connecting across the ecosystem. Change within a healthcare system cannot achieve the magnitude of transformation needed to become sustainable.

If the healthcare ecosystem evolves in the manner described in this chapter, the healthcare ecosystem will no longer center around particular institutions and doctors’ offices but rather be defined by flexible and variable interactions between co-acting elements of the ecosystem.

The chapter treats the context as the focus of change in order to change the healthcare system. It proposes three kinds of flows: knowledge, clinical, and resource that are already beginning to change and that will eventually result in fundamentally different approaches to healthcare.

This study aims to construct an integrated social entrepreneur system in the rural area of Hengshan, Taiwan, that could benefit four stakeholders, namely, tourists, business, community and government. Two social entrepreneur cases demonstrate a mutually beneficial situation of lowering the structural unemployment rate, returning young human capital to villages and innovating rural tourism through the activism of service science.

Qualitative approach was applied to data obtained from 12 research projects spanning three years. Service experience engineering (SEE) methods were used to conduct a service design for social entrepreneurs in an integrated service system. The service system aimed to innovate rural tourism through the activism of service science.

SEE methods explain a series of service design processes that helped our research team start up two social entrepreneur projects as service prototypes to offer service innovation based on cultural creativity to innovate rural tourism. These two social entrepreneurs in rural tourism offer job opportunities to young people and senior citizens alike. In addition, an integrated service system of interdisciplinary knowledge, multi-stakeholders and local resources fulfills various requirements of stakeholders to promote sustainable rural tourism.

Real action studies are limited in the research on social entrepreneurs. This case study provides research insights into service science and calls for action in practice to change the future of a local village. The results provide the philosophy and knowledge of service science that social entrepreneurs of rural tourism can use in the village. Designing service innovation for rural tourism has shaped its vision toward a sustainable tourism system.

Few studies have shown that social entrepreneurs could innovate rural tourism. The present study presents an action case through the activism of service science.

The purpose of this paper is to examine the application of intentional change theory (ICT) at the organizational level through the lens of a case study.

This paper is a case study of Roadway Express, a leading transportation provider of industrial and commercial goods throughout North America, which embarked on a journey of cultural transformation in 1999, using a popular change process known as appreciative inquiry (AI). The Roadway case study illustrates both the theory of intentional change and the method of AI in use and provides a platform upon which to observe change at the organizational level.

Roadway Express serves as a solid benchmark for organizations considering how to succeed in cultural transformation. The implementation of the philosophy and methodology of appreciative inquiry, played a key role in that success. Analysis shows the link between ICT and AI. From this observation, ICT emerges as a stand‐along theory upon which to interpret the success of Roadway's organizational change efforts.

Drawing insight from the Roadway case study, ICT provides us with a comprehensive model for understanding how to approach and sustain change at the organizational level.

For the past three decades, most of the work using intentional change theory has focused on individual change. This paper presents a different view of the same theory, this time at the organizational level. This insight may be of interest to leaders, managers and change agents.

Social entrepreneurs are leaders who aspire to build more just societies through the mechanisms of the market. The concept of social enterprise has grown increasingly popular, but it continues to be a nebulous notion. This chapter explores the meaning of social enterprise and the attributes and characteristics of social entrepreneurial leaders whose enterprises have become the vehicles of social, economic, and even political transformations. The transformative potential of social entrepreneurial leaders is illustrated with brief, but prominent, examples that are aimed to inspire further research. It is shown that social entrepreneurship is not confined to an exclusive arena, but actually flourishes in diverse sectors. It is also posited that educational institutions and organizations can promote greater interest and investment in social entrepreneurship as a progressive model for a positive social change.

This study aims to develop an empirically validated taxonomy. Typologies of social entrepreneurship are primarily based on conceptual considerations and case studies. There is a need for quantitative approaches and empirical testing of this emerging organizational form and its characteristics.

First, an item scale was developed that emerged from frequently mentioned elements in social entrepreneurship literature. Next, social entrepreneurs rated these items. Finally, the authors conducted a cluster analysis to derive a taxonomy with three distinguishable types of social enterprises.

Based on a cluster analysis (N = 70), an empirically validated taxonomy is provided with three social enterprise types: social service providers, social change makers and social philanthropists.

Although this research has an exploratory character, it makes a clear contribution by complementing existing typologies, which tend to be conceptual in nature, with a taxonomy that is empirically grounded. This study defogs the blurry understanding and limited knowledge about different social enterprise forms and provides insight into meaningfully similar groups across the sector as a whole.

This article fills a void of empirically grounded taxonomies by analyzing which definitional aspects of social entrepreneurship literature correspond to the perceptions of social entrepreneurs regarding the nature of their organizations.