Hospital and Health System Change and Transformation Typology
Background: Change and Transformation are terms that are frequently found in much of the healthcare management and change literature. However, over time the meanings of these terms have been diluted as multiple theories, concepts, and models use the same terms to describe different phenomenon. Objective: The purpose of this study is to provide a deeper understanding of the dynamics of the change process so that we can better and more clearly define the mechanisms of change and provide both researchers and practitioners with a greater understanding of the phenomena. Research Design: This study utilizes a systematic narrative literature review and cluster analysis to examine the hospital transformation and organizational change literature from 1970- 2010 through the lens of organizational dimensions. Measures: 16 different organizational theories were reviewed within the hospital and health system change and transformation literature to determine their relative focus on leadership, culture, external environment, and organizational technologies (administrative, clinical, social, and information). A cluster analysis was conducted based on these results to determine if the theories naturally grouped into change foci based on their emphasis of one or more of the organizational dimensions. Results: Four distinct change foci clusters were identified and labeled: Systems, Managerial/Social, Managerial/Admin, and External Forces. MANOVA and pairwise statistics indicated significance difference among the four clusters as well as along the seven dimensions in the study. Conclusions: This study indicates that organizational dimensions are a viable means of grouping and understanding the underlying change foci in theoretical models. Furthermore, the differences within each cluster promote the ability for researchers and practitioners to better understand change and apply the most relevant theory based on the intent or desired outcomes of the change initiative.