Managing Change and Role Enactment in the Professionalized Organization

The Aims of this research are to examine how clinical directors and service managers from non-clinical backgrounds interpret and enact their roles and use them to implement effective service change. We recognise that the assessment of ‘effective’ change will require assessment on multiple criteria. As a secondary research question, we therefore seek to identify what additional factors account for individual or organisational differences in the effectiveness of change implementation. The approach, which we propose is a qualitative, inductive one, comparing and contrasting case studies of ten sites which have been purposefully selected. This design will facilitate the construction of a large-scale database with both internal and external validity. The ten sites consist of four primary care sites and six acute sector sites in London and the W.Midlands. In each site, the case focuses on a selected area of care and our design includes three clinical areas of care, namely, cancer care; maternity care and diabetes care (in primary care). These care groups have been chosen in relation to the priorities set out in the National Plan. Case study sites have been purposefully selected using a two stage process, to assess case contexts as of ‘higher’ and ‘lower’ complexity. The rationale for this selection is to enable the researchers to examine the extent to which complex, contextual pressures affect the interpretation and enactment of roles and relationships. Case studies will be constructed by gathering data on the context; the roles; the interpretation of the roles and the activities undertaken. Data collection methods will include archival data; interviews and observations of meetings, but with interviews as a prime data source. Interviews will be semi-structured and approximately 200 interviews are targeted. All interviews will be recorded and transcribed. Analysis will be an iterative process and will occur in stages. Initially, there will be a first scan of the transcripts, based on a pre-formulated analytic frame built on the interview questions. As a preliminary validation, pairs of transcripts will be exchanged between Researchers who will work in pairs and code ‘blind’ against the pre-formulated framework, to improve rater reliability. Two further analytic stages will include iterative cycles of comparisons between cases in care groups and across care groups. The final stages of the methods consist of local/regional workshops, run collaboratively with professional organisations and user/advocacy organisations, to debate and action plan on the basis of the findings. The research will lead to specific improvements in the way change is implemented in various settings. We anticipate that the recommendations will cover staff selection; training and development; roles and organisation structures and the processes of performance management.