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Success Factors for Strategic Change Initiatives: A Qualitative Study of Healthcare Administrators’ Perspectives Bita Arbab Kash, PhD, FACHE, assistant professor, Texas A&M University Health Science Center, College Station; Aaron Spaulding, PhD, assistant professor, Brooks College of Health, University of North Florida, Jacksonville; Christopher F. Johnson, PhD, director. Graduate Program in Health Services Administration, School of Public Health, University of Washington, Seattle; and Larry Gamm, PhD, director. Center for Health Organization Transformation, Texas A&M University Health Science Center

E X E C U T I V E S U M M A R Y Success factors related to the implementation of change initiatives are well docu- mented and discussed in the management literature, but they are seldom studied in healthcare organizations engaged in multiple strategic change initiatives. The pur- pose of this study was to identify key success factors related to implementation of change initiatives based on rich qualitative data gathered from health leader inter- views at two large health systems implementing multiple change initiatives.

In-depth personal interviews with 61 healthcare leaders in the two large systems were conducted and inductive qualitative analysis was employed to identify success factors associated with 13 change initiatives. Results firom this analysis were compared to success factors identified in the literature, and generalizations were drawn that add significantly to the management literature, especially to that in the healthcare sector.

Ten specific success factors were identified for the implementation of change initiatives. The top three success factors were (1) culture and values, (2) business processes, and (3) people and engagement. Two of the identified success factors are unique to the healthcare sector and not found in the literature on change models: service quality and client satisfaction (ranked fourth of 10) and access to information (ranked ninth).

Results demonstrate the importance of human resource functions, alignment of culture and values with change, and business processes that facilitate effective commu- nication and access to information to achieve many change initiatives. The responses also suggest opportunities for leaders of healthcare organizations to more formally recognize the degree to which various change initiatives are dependent on one another.

For more information about the concepts in this article, contact Dr. Kash at bakash@srph.tamhsc.edu.

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JOURNAL OF HEALTHGARE MANAGEMENT 59:1 JANUARY/FEBRUARY 2014

I N T R O O U C T I O N Strategic change capabilities have become a primary focus as hospitals and healthcare systems attempt to perpetu- ally improve and position themselves in a competitive market characterized by continuous regulatory changes and opportunities for reorganization and grov r̂th. Yet few empirical studies focus- ing on success factors for effective orga- nizational change have been conducted in hospitals or healthcare settings (Rosacker, Zuckweiler, & Buelow, 2010).

The present study draws on man- agement literature and examples of the successful implementation of strate- gic change initiatives in healthcare to further improve our understanding of how to plan for and implement such an initiative. The purpose of this study was to explore and identify specific change initiative success factors as depicted by healthcare leaders’ assessments of change efforts in their health systems. Success factors available in the manage- ment literature are identifted and con- trasted to responses gathered ftom more than 60 administrators at two large healthcare systems engaged in multiple change initiatives.

Prior research attempted to evalu- ate how strategic change initiatives are implemented (Edmondson, Böhmer, & Pisano, 2001), how leaders promote organizational successes (Bass & Rig- gio, 2006), and how culture affects organizational performance (Pfeffer & Veiga, 1999). Many of these strategies have even been categorized and sum- marized according to the organizational change theories applied (Van de Ven & Poole, 1995). However, variation ftequently occurs within and across

systems in innovative program suc- cess (Armutlu, Foley, Surette, Belzile, & McCusker, 2008; Hosier & Nadle, 2000; Manzo et al., 2005; Silow-Carroll, Alteras, & Meyer, 2007), and it may be that variations in success are related to an organization’s ability to acquire and use new knowledge to ensure successful initiatives (Kash, Spaulding, Gamm, & Johnson, 2013).