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The article describes the results and the experience gained in using a participatory approach to design a strategic development plan (SDP) in a veterinary public health institute. The bottom-up approach utilised was co-designed between the units of "Research and Innovation" and "Training". It included a survey administered to the institute staff (570 people) to collect inputs on three relevant areas: i) innovative research topics; ii) innovation needed to improve services; iii) new tools to carry out activities. After the survey, the following criteria were used to prioritise the research topics: appropriateness, relevance, capacity, impact and innovativeness. Based on the priority topics identified, small working groups were set up on a voluntary basis. The working groups, following the EuropeAid method, co-designed a SDP, set over a three-year period, with indications on aims, objectives, outputs, activities, SMART indicators, means of verification and targets. The method proved useful in continuing the process of institutional innovation, especially by stimulating the participation and commitment of younger innovative staff at the bottom of the hierarchical pyramid. The integration of the described method into regular management procedures would be desirable, to achieve more effective results.

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BACKGROUND: Constant organizational change is the norm in many companies today. At present, evidence on the impact of organizational change on psychosocial risks at work and employee mental health is limited. We investigate organizational change and its association with psychosocial risks and mental health in three consecutive surveys covering 12 years. METHODS: The study was based on data from three cross-sectional waves (2006, 2012, 2018) of the German BIBB/BAuA Employment Survey, comprising 53,295 employees. Four change indicators (i.e., introduction of new software, changes in goods and services produced/provided, downsizing and restructuring), five indicators of psychosocial risks (i.e., time pressure, interruptions, multitasking, working to the limits of capability, and working very quickly) and four mental health indicators (i.e., sleep disturbances, nervousness, tiredness and depressive symptoms) were investigated. We applied Poisson regression analysis to examine associations between organizational change, psychosocial risks, and mental health. RESULTS: According to the pooled analysis of all three waves, the majority of employees reported having experienced at least one organizational change, such as downsizing or restructuring, between 2006 and 2018. Organizational change was negatively associated with psychosocial risks (e.g., working to the limits of one's capability, PR: 1.66; 95% CI: 1.48-1.86) and with employee mental health (PR: 1.82; 95% CI: 1.61-2.04). CONCLUSIONS: Organizational change is omnipresent in the modern economy. Our research suggests that transformation processes in organizations can bear risks to employees' health as psychosocial risks increase. Therefore, companies planning organizational change should accompany such processes with occupational health and safety measures.

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BACKGROUND: Organizational adoption is a key but understudied step in translating evidence-based interventions into practice. The purpose of this study was to report recruitment strategies and factors associated with church enrollment and intervention adoption in a national implementation study of the Faith, Activity, and Nutrition (FAN) program. METHODS: We worked with partners using multiple strategies to disseminate intervention availability. Interested churches completed an online form. To enroll, the church coordinator (FAN coordinator) and pastor completed baseline surveys and then received intervention online training access. We compared enrolled vs. non-enrolled churches on how they heard about the study and church characteristics. We compared intervention-adopting vs. non-adopting churches on Consolidated Framework for Implementation Research (CFIR) constructs using Fisher's exact tests, χ2, or independent sample t-tests and reported differences where p < 0.10, d≥|0.35|, or the difference in percentage points was ≥ 10. RESULTS: We received 226 interest forms; 107 churches enrolled, and 85 churches adopted the intervention. Faith-based sources were the most, and paid media the least, effective in reaching churches, which were largely from the southeast with a Methodist or Baptist tradition (no differences by enrollment status). Enrolled churches were less likely to have 500 + worshipers and more likely to have attended a study information session than non-enrolled churches. Church (CFIR inner setting) and FAN coordinator characteristics, but not intervention characteristics, were related to intervention adoption. CONCLUSION: Partnerships, relationships, and "face time" are important for enrolling churches in evidence-based interventions. Church and church coordinator characteristics are related to intervention adoption. Further work on adoption conceptualization and operationalization is needed.

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Lack of access, system inequities, and inefficiencies plague our current healthcare system. With a challenge this complex, no one intervention is sufficient; all will be necessary. The primary care system needs a strong health workforce prepared in bold new ways. Students represent an important voice, given their role as future leaders of health education and healthcare. For students to lead, educators must leverage education paradigms that position current students as leaders of transformation. Yet, in current health education systems, students are often seen as passive recipients of knowledge and skill. Transformative education seeks to foster critical reflection (an ongoing process of questioning unhelpful assumptions and power relations) and informed action in students to enable them to challenge and change norms and change practices, structures, and society. This article highlights the value of transformative education in cultivating thoughtful change agents and provides one tangible example of a new education/practice model that puts this paradigm into action.

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The five-year rule must die. Despite an extensive literature search, the origins of the five-year rule remain unknown. In an era when the nursing profession is so focused on evidence-based practice, any approach that arbitrarily limits literature searches to articles published in the previous five years lacks scientific basis. We explore some reasons for the pervasiveness of the practice and suggest that librarians need to engage with nursing faculty, who are well-positioned to be change agents in this practice.

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BACKGROUND: Primary care is often described as slow to change. But conceptualized through complexity theory, primary care is continually changing in unpredictable, non-linear ways through self-organization processes. Self-organization has proven hard to study directly. We aimed to develop a methodology to study self-organization and describe how a primary care clinic self-organizes over time. METHODOLOGY: We completed a virtual case study of an urban primary care clinic from May-Nov 2021, applying methodological insights from actor-network theory to examine the complexity theory concept of self-organization. We chose to focus our attention on self-organization activities that alter organizational routines. Data included fieldnotes of observed team meetings, document collection, interviews with clinic members, and notes from brief weekly discussions to detect actions to change clinical and administrative routines. Adapting schema analysis, we described changes to different organizational routines chronologically, then explored intersecting changes. We sought feedback on results from the participating clinic. FINDINGS: Re-establishing equilibrium remained challenging well into the COVID-19 pandemic. The primary care clinic continued to self-organize in response to changing health policies, unintended consequences of earlier adaptations, staff changes, and clinical care initiatives. Physical space, technologies, external and internal policies, guidelines, and clinic members all influenced self-organization. Changing one created ripple effects, sometimes generating new, unanticipated problems. Member checking confirmed we captured most of the changes to organizational routines during the case study period. CONCLUSIONS: Through insights from actor-network theory, applied to studying actions taken that alter organizational routines, it is possible to operationalize the theoretical construct of self-organization. Our methodology illuminates the primary care clinic as a continually changing entity with co-existing and intersecting processes of self-organization in response to varied change pressures.

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BACKGROUND: While healthcare organizations in several countries are embracing Value-Based Health Care (VBHC), there are limited insights into how to achieve this paradigm shift. This study examines the decade-long (2012-2023) change towards VBHC in a pioneering Dutch university hospital. METHOD: Through retrospective, complexity-informed process research, we study how a Dutch university hospital's strategy to implement VBHC evolved, how implementation outcomes unfolded, and the underlying logic behind these developments. Data include the hospital's internal documents (n = 10,536), implementation outcome indicators (n = 4), a survey among clinicians (n = 47), and interviews with individuals contributing to VBHC at the hospital level (n = 20). RESULTS: The change towards VBHC is characterized by three sequential strategies. Initially, the focus was on deep change through local, tailored implementation of multiple VBHC elements. The strategy then transitioned to a hospital-wide program aimed at evolutionary change on a large scale, emphasizing the integration of VBHC into mainstream IT and policies. Recognizing the advantages and limitations of both strategies, the hospital currently adopts a "hybrid" strategy. This strategy delicately combines deep and broad change efforts. The strategy evolved based on accumulated insights, contextual developments and shifts in decision-makers. The complexity of change was downplayed in plans and stakeholder communication. By the end of 2023, 68 (sub)departments engaged in VBHC, enabled to discuss patients' responses to Patient Reported Outcomes Measures (PROMs) during outpatient care. However, clinicians' use of PROMs data showed limitations. While pioneers delved deeper into VBHC, laggards have yet to initiate it. CONCLUSIONS: VBHC does not lend itself to linear planning and is not easily scalable. While there appears to be no golden standard for implementation, blending local and larger-scale actions appears advantageous. Local, deep yet harmonized and system-integrated changes culminate in large scale transformation. Embracing complexity and focusing on the ultimate aims of (re)institutionalization and (re)professionalization are crucial.

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Organizational change is a complex process that often faces high failure rates due to challenges in managing transition issues. The role of emotional intelligence in fostering readiness for organizational change among nurses remains understudied, especially in the context of Jordan. The study aimed to investigate the relationship between emotional intelligence and readiness for organizational change among Jordanian nurses working in governmental hospitals. A descriptive cross sectional correlational design was used. A convenient sampling method was used to enroll Jordanian nurses from different governmental hospitals, with a resulting final sample of 250 nurses. Self-reported questionnaires were used to collect data. Data analysis was run using descriptive and inferential analysis. The findings revealed that the participants had moderate levels of emotional intelligence with a mean score of (M = 87.96, SD = 26.59). The participants demonstrated strengths in understanding their own emotions, perceiving others' emotions, and setting goals. They also showed good control of their emotions and a positive self-perception. Regarding readiness for organizational change, the mean score was (M = 39.58, SD = 11.16), suggesting a moderate level of readiness. The participants exhibited commitment, motivation, and confidence in handling challenges associated with change. A strong positive relationship between emotional intelligence and readiness for change commitment (r = .942, P < .01), change efficacy (r = .935, P < .01), and total readiness for change (r = .951, P < .01) were exist. Moreover, age and years of experience were negatively correlated with readiness for change. There was a strong and significant positive relationship between emotional intelligence and readiness for change. This emphasizes the importance of developing emotional intelligence abilities among nurses to facilitate successful change processes in healthcare organizations.

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Change is a noticeable feature of civic, personal, and organizational life. Progress, Goal achievement, and avoidance of contingence were frequently involved in the implementation of planned changes. Workers might completely recognize the motives for the alteration or the ladders needed to implement it through strong and constant communication. Outstanding communication could help decrease confrontation, rally a complex of alteration provision, and deliver evidence essential for individuals to adjust efficiently. Organizational change is essential for corporations to thrive and raise. It permits workers to comprehend and obligate change and effort successfully. The goal of this study is to determine the effect of conflicts and organizational changes on the communication process in the IT sector. Gathered data has been achieved by survey with help of surveys and then the collected data is analyzed using the SPSS software, SEM model and confirmatory factor analysis. The primary data collected are nearly 126 from employees working in various departments in the IT sector. This study analyzes the effects of conflicts and organizational changes on the communication process in the IT sector. The study also recommends that the IT sector improve strategies for tackling the issues faced because of organizational change.

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BACKGROUND: Although clinical substance use disorder (SUD) care is multidisciplinary there are few opportunities to collaborate for quality improvement or systems change. In Oregon, the Project ECHO (Extension for Community Healthcare Outcomes) model was adapted to create a novel multidisciplinary SUD Leadership ECHO. The objective of this study was to understand the unique effects of the adapted ECHO model, determine if the SUD Leadership ECHO could promote systems change, and identify elements that enabled participant-leaders to make changes. METHODS: Four focus groups were conducted between August and September of 2022 with a purposive sample of participants from the second cohort of the Oregon ECHO Network's SUD Leadership ECHO that ran January to June 2022. Focus group domains addressed the benefits of the adapted ECHO model, whether and why participants were able to make systems change following participation in the ECHO, and recommendations for improvement. Thematic analysis developed emergent themes. RESULTS: 16 of the 53 ECHO participants participated in the focus groups. We found that the SUD Leadership ECHO built a multi-disciplinary community of practice among leaders and reduced isolation and burnout. Three participants reported making organizational changes following participation in the ECHO. Those who successfully made changes heard best practices and how other organizations approached problems. Barriers to initiating practice and policy changes included lack of formal leadership authority, time constraints, and higher-level systemic issues. Participants desired for future iterations of the ECHO more focused presentations on a singular topic, and asked for a greater focus on solutions, advocacy, and next steps. CONCLUSIONS: The adapted ECHO model was well received by focus group participants, with mixed reports on whether participation equipped them to initiate organizational or policy changes. Our findings suggest that the SUD Leadership ECHO model, with fine-tuning, is a promising avenue to support SUD leaders in promoting systems change and reducing isolation among SUD leaders.

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PURPOSE: The purpose of this research is to examine the relationship between high- performance work systems (HPWS) and organisational innovation in hospital settings, examining the role of employee engagement as a mediator in this relationship. Additionally, the study aims to investigate the moderating role of perspective-taking between HPWS and employee engagement as well as the moderating effect of trust in leader on the connection between employee engagement and organisational innovation. DESIGN/METHODOLOGY/APPROACH: A quantitative-deductive causal method, along with a cross-sectional approach, was utilized. Structural equation modelling was applied to analyse data from a sample of 530 doctors employed in hospitals, practicing human resources management in the public and private sectors of Sindh province, Pakistan. FINDINGS: The findings show positive effects of HPWS on employee engagement and organisational innovation. Additionally, employee's engagement partially mediates the relationship between HPWS and organisational innovation, while the moderating role of perspective-taking significantly influences the link between HPWS and employee engagement. ORIGINALITY/VALUE: While HPWS are recognized for enhancing organisational innovation, this study confirms their positive effects on individual and organisational outcomes, particularly within the healthcare sector in Pakistan. This study suggests that when HPWS are effectively perceived and implemented, these integrated practices can be beneficial for both employees and organizations, even in challenging situations.

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Employee driven innovation (EDI) is essential in transforming hospitals and other providers, but the challenge is also to have impact on health systems as a whole. Usually a mix from top down measures and bottom up initiatives leads to an innovative culture. An important aspect is the innate difference between types of providers related to initiating, facilitating and rewarding innovation. Second the rewarding system within organisations but also in science and scientific journals. Especially nursing and other non-medical professions can be emancipated in this regard. Further there is a growing interdependence with digitalisation in all its forms and awareness of the related team effort is needed to actually realise innovative projects within a standing organisation. Lastly change the paradigm related to the spread of innovations from "not invented here" to "proudly copied from," create trust and organize collaboration between providers and spend sufficient attention to credible evidence on the effectiveness.

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BACKGROUND: Sierra Leone has one of the world's highest maternal and infant mortality rates and suffers from a shortage of well-trained health professionals, including midwives. Prior to engaging in systematic interventions, it is critical to measure organizational readiness to gauge members' psychological and behavioral preparedness to implement change. We aimed to measure the organizational readiness for implementing change and compare results among midwives and administrative leaders at two schools of midwifery in Sierra Leone prior to the rollout of a midwifery preceptor program. METHODS: The Organizational Readiness for Implementing Change (ORIC) survey is a validated 12-item questionnaire designed to assess two domains of organizational readiness for change: change commitment (motivation) and change efficacy (capacity). All survey items begin with the same prompt and a five-item Likert scale response, with seven questions about change commitment and five about change efficacy. Data collection occurred in two schools of midwifery in Sierra Leone during two day-long meetings with stakeholders. Statistical analysis was conducted using descriptive statistics and Wilcoxon rank-sum test to compare independent samples: School 1 versus School 2 (site), midwife versus other roles (role). RESULTS: Participants included 42 respondents (mean age 41 years, 95% female). Surveys were distributed evenly between the two sites. Occupations included midwifery faculty (n = 8), administrators (n = 5), clinicians (n = 25), and clinical educators (n = 4). Domain 1 (change commitment) had a mean score of 4.72 (SD 0.47) while Domain 2 (change efficacy) had a mean score of 4.53 (SD 0.54) out of a total potential score of five. There were no statistically significant differences between site responses for Domain 1 (p = 0.5479) and Domain 2 (p = 0.1026) nor role responses for Domain 1 (p = 0.0627) and Domain 2 (p = 0.2520). CONCLUSION: Stakeholders had very high overall readiness for change across all ORIC questions for both change commitment and change efficacy. Mean scores for change commitment were slightly higher which is not surprising given the low-resourced settings stakeholders work in while training students. High mean scores across sites and roles is encouraging as this novel preceptor program is currently being rolled out.

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The Department of Veterans Affairs (VA) has committed to becoming a High Reliability Organization (HRO). The Truman VA Medical Center (VAMC) successfully implemented and sustained foundational HRO elements over a period with several changes in facility executive leadership. We interviewed current and past leaders at Truman to understand how they retained fidelity to the HRO transformation. We conducted 16 interviews with 14 leaders involved in the HRO transformation and identified three themes related to the Truman HRO transformation: (1) Leadership visibly drove culture change through intentional communication and modeling HRO principles; (2) Leadership deferred to frontline expertise and empowered staff to make changes and to fail; (3) Hiring the right team members for the organizational culture and investing in training can support HRO principles and values. Our findings highlight key actions for leaders in the context of HROs: regularly communicate the significance of HRO, demonstrate behavior consistent with what they hope to see from staff, celebrate failure, allocate time and resources to the creation of hiring frameworks that identify employee skillsets conducive to HRO principles, and substantial and recurring investments in employee development. Importantly, successive executive leaders at Truman VAMC modeled these skills to promote and sustain the HRO transformation.

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INTRODUCTION: Healthcare organisations face multiple challenges, often conceptualised as appropriate care. It requires change on different levels: healthcare systems (macro), healthcare organisations (meso), and healthcare professionals (micro). This study focuses on bottom-up changes initiated by healthcare professionals. The aim is to investigate hindering and stimulating factors healthcare professionals experience. MATERIALS AND METHODS: The study used a qualitative design with purposive sampling of eight Dutch healthcare professionals who initiated changes. We conducted online interviews and used Atlas TI with a combination of open, axial, and selective coding for data analysis. RESULTS: The results indicate that professionals are often mission-driven when they initiate change, support from clients and peers may help them overcome barriers. Conversely, peers who feel threatened in their autonomy hinder initiatives of professionals, especially when their changes have financial consequences for their organization. CONCLUSION: Aligning and integrating macro- and micro-level initiatives is crucial to advancing the movement towards appropriate care and stimulating bottom-up initiatives of healthcare professionals. More research remained needed, in particular studies on the hindering or stimulating role of employers and healthcare professionals' representatives, and the adoption of the concept of appropriate care by patients.

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BACKGROUND: In an era marked by rapid technological advancements, changing demographics, and evolving healthcare needs, the landscape of health services has been undergoing a profound transformation. Innovation has emerged as a central force driving change in the healthcare sector, as stakeholders across the globe strive to enhance the quality, accessibility, and efficiency of healthcare services. OBJECTIVE: Within this dynamic context, this systematic literature review explored the barriers and driving forces behind successful health service innovation. METHODS: A comprehensive systematic literature review was conducted using the Griffith University Library search engine and databases that included PubMed, ProQuest, Web of Science, Scopus, and CINHAL. To achieve the study goal, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the associated PRISMA checklist guided the review and reporting method. RESULTS: Findings from this review identified a need for a universal definition of health innovation that encompasses the unique complexities and challenges within this context. In our comprehensive analysis of healthcare innovation, we have uncovered pivotal findings that underscore the indispensable nature of a well-structured framework. CONCLUSIONS: To succeed in fostering innovation within the health and social care sectors, it is imperative to establish an overarching organisational culture that meticulously addresses the following key components: team challenges; communication and collaboration; governance goals and authentic leadership, environmental engagement; and innovation endurance. Through systematic analysis of existing literature, this review offers a definition of health innovation, covering its conceptual foundations, determinants, and barriers, and provides a framework for creating an innovative culture.

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To provide insight on how ambulatory care practices can reduce emergency department (ED) visits, we studied changes in Medicare ED visits for primary and specialty care practices in the Transforming Clinical Practice Initiative. We compared practices that transformed more vs less during the 6-year period ending in 2021 (3,773 practices). Using data from a practice transformation assessment tool completed at multiple intervals, we found improvement in the transformation score was associated with reduced ED visits by 6% and 4% for primary and specialty care practices, respectively, 3 to 4 years after first assessment. Transformation in 5 of 8 domains contributed to reduced ED visits.

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Digital technologies can bring about fundamental changes in corporate processes, which may result in a shift from process innovation to digital process innovation. However, owing to resource constraints and various stakeholders, digital process implementation is extremely challenging for firms. Based on stakeholder theory, this study explores whether and how stakeholder pressure for digitalization can facilitate corporate digital process innovation and unravels the mediating effect of routine reconfiguration and the moderating effect of strategic flexibility. The findings from a survey of 351 firms prove that stakeholder pressure for digitalization can facilitate corporate digital process innovation via routine reconfiguration. Moreover, this study finds that increased strategic flexibility can strengthen the positive mediating effect of routine reconfiguration. The findings contribute to the deep understanding of digital process innovation and offer a boundary condition for the effectiveness of stakeholder pressure.

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