Showing papers on "Culture change published in 2013"
TL;DR: In this article, the authors present the findings of a longitudinal study of coerced implementation of a practice in the face of a low degree of fit between the practice and an organization's culture, and they portray the implementation of culturally dissonant practices as an ongoing process involving the mutual adaptation of organizational practices and culture.
Abstract: In this article, we present the findings of a longitudinal study of coerced implementation of a practice in the face of a low degree of fit between the practice and an organization's culture. Contrary to current predictions stating that a lack of cultural fit will eventually be resolved through adaptation of new practices, our findings portray the implementation of culturally dissonant practices as an ongoing process involving the mutual adaptation of organizational practices and culture. Our emerging model describes the cultural changes induced by the coercive implementation of new practices as involving a partial change in shared beliefs and behavioral patterns and a more general enrichment of the cultural repertoire of organization members. [ABSTRACT FROM AUTHOR]
147 citations
TL;DR: During early integration efforts, challenges related to workflow and access, leadership and culture change, and tracking and using data to evaluate patient- and practice-level improvement emerged for ACT innovators.
Abstract: Background: More than 20 years ago the Institute of Medicine advocated for integration of physical and behavioral health care. Today, practices are integrating care in response to recent policy initiatives. However, few studies describe how integration is accomplished in real-world practices without the financial or research support available for most randomized controlled trials. Methods: To study how practices integrate care, we are conducting a cross-case comparative, mixed-methods study of 11 practices participating in Advancing Care Together (ACT). Using a grounded theory approach, we analyzed multiple sources of data (eg, documents, practice surveys, field notes from observation visits, semistructured interviews, online diaries) collected from each ACT innovator. Results: Integration requires making changes in organization and interpersonal relationships. During early integration efforts, challenges related to workflow and access, leadership and culture change, and tracking and using data to evaluate patient- and practice-level improvement emerged for ACT innovators. We describe the strategies innovators are developing to address these challenges. Conclusion: Integrating care is a fundamental and difficult change for practices and health care professionals. Research identifying common challenges that manifest in early efforts can help others attempting integration and inform state, local, and federal policies aimed at achieving wide-spread implementation.
98 citations
TL;DR: In this article, the authors propose a theoretical model linking human resource development (HRD), corporate social responsibility (CSR), corporate sustainability (CS), and business ethics, which suggests that CSR, CS, and ethics are parts of the same organizational subsystem, shaped by a complex interaction between human capital, individual moral development, habitus, organizational practices and culture, and external situational factors.
Abstract: This article proposes a theoretical model linking human resource development (HRD), corporate social responsibility (CSR), corporate sustainability (CS), and business ethics. The model development was informed by Pierre Bourdieu’s relational theory of power and practice, and by Norbert Elias’ and Michel Foucault’s theories of power and knowledge. The model suggests that CSR, CS, and ethics are parts of the same organizational subsystem, shaped by a complex interaction between human capital, individual moral development, habitus (mindsets, dispositions), organizational practices and culture, and external situational factors. The generative mechanism, or motor, driving the development and change of organizational culture, consists of power relationships that are shaped by specific figurations of various types of human capital (social, cultural, economic, and symbolic). HRD can influence this system by engaging in culture change efforts, ethics and CS-/CSR-related education and training on all levels of the ...
77 citations
TL;DR: Reform of health professions education is needed in the following six critical areas: interprofessional education, new models for clinical Education, new content to complement the biological sciences, new educational models based on competency, neweducational technologies, and faculty development for teaching and educational innovation.
Abstract: The size, composition, distribution, and skills of the health care workforce will determine the success of health care reform in the United States. Whatever the size of the workforce that will be r...
75 citations
TL;DR: In this article, the authors explore the idea of using Kotter's eight-step model for change leadership to create a culture of assessment that is embedded in the organizational culture of an academic library.
Abstract: Purpose – The purpose of this paper is to explore the idea of using Kotter's eight‐step model for change leadership to create a culture of assessment that is embedded in the organizational culture of an academic library.Design/methodology/approach – This is a conceptual paper that examines the potential application of a business change model to an academic library change context. Each step of Kotter's model is described within the context of building a culture of assessment, supported by examples and suggestions from the literature of libraries, higher education, organizational behavior and change leadership.Findings – While building a culture of assessment is critical for libraries in the current environment, it is a difficult and complex process that requires grassroots initiative, top‐down support and strong leadership. Kotter's model for change management provides a pragmatic structure for culture change through behavioral change and change leadership regardless of positional authority.Practical impli...
68 citations
TL;DR: In this paper, a multilevel study of 2163 immigrants and locals residing in Canada was conducted to investigate the relationship between acculturation of visible elements of culture, such as language proficiency or cuisine and music tastes.
Abstract: The effects of culture in the workplace have been well documented. Because cultures vary across countries, business practices that are effective in some regions may not be effective in others. While cross-country cultural differences have been explored in depth, little is known about cultural variations and dynamics in the context of immigration. On the basis of a multilevel study of 2163 immigrants and locals residing in Canada, we investigate (1) patterns of immigrant acculturation; (2) the relationship between acculturation of visible elements of culture, such as language proficiency or cuisine and music tastes, and acculturation of tacit cultural values and (3) individual- and group-level predictors and moderators of acculturation. The results are discussed with a focus on implications for practitioner managers and immigration policy makers.
62 citations
01 Mar 2013-Studies in History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences
TL;DR: The way in which few of the empirical findings accumulated by sociologists of science about research science seem to apply to forensic science is explored, which suggests forensic science seems to have developed a distinct culture for which a sociological analysis will require new explanatory tools.
57 citations
TL;DR: In this article, the authors explore the role played by some managers who accelerated the cultural change process through utilising formal and informal agencies of change in their management roles, and adapts Gidden's Structuration Theory to provide a model of manager action during the change process.
Abstract: Purpose – The purpose of this paper is to explore the merger of two large State departments and the cultural change program orchestrated by the Human Resources (HR) department. This study reveals the instrumental role played by some managers who accelerated the cultural change process through utilising formal and informal agencies of change in their management roles.Design/methodology/approach – The paper explores a two‐year investigation of a major State organisation trying to reshape the culture and values of the organisation after a politically determined merger. This paper reviews the context for this change process, the associated concepts from the literature, and adapts Gidden's Structuration Theory to provide a model of manager action during the change process that may also be used to explore subsequent change practices.Findings – The findings from the sequenced phases of data collection provide new evidence from a strategic HR perspective of the multiple ways managers act to embed a culture change...
56 citations
TL;DR: In this article, a case study was conducted to examine the key mechanisms and processes of a successful culture change programme at English Rugby Union's Leeds Carnegie, where semi-structured interviews were conducted with team management, one specialist coach, six players, and the CEO.
Abstract: Although high performing cultures are crucial for the enduring success of professional sport performance teams, theoretical and practical understanding of how they are established and sustained is lacking. To develop knowledge in this area, a case study was undertaken to examine the key mechanisms and processes of a successful culture change programme at English Rugby Union's Leeds Carnegie. Exploring the change process from a 360 degree perspective, semi-structured interviews were conducted with team management, one specialist coach, six players, and the CEO. Analysed and explained through decentred theory, results revealed that culture change was effectively facilitated by team management: a) subtly and covertly shaping the physical, structural, and psychosocial context in which support staff and players made performance-impacting choices, and b) regulating the ‘to and fro’ of power which characterises professional sport performance teams. Decentred theory is also supported as an effective framework for...
50 citations
TL;DR: The Group Health Demonstration Project yielded five key lessons for successful implementation, including the synergy between efforts to reduce practice variation and increase shared decision making; the need to support modifications in practice with changes in physician training and culture; and the value of identifying best implementation methods through constant evaluation and iterative improvement.
Abstract: In 2007 Washington State became the first state to enact legislation encouraging the use of shared decision making and decision aids to address deficiencies in the informed-consent process. Group Health volunteered to fulfill a legislated mandate to study the costs and benefits of integrating these shared decision-making processes into clinical practice across a range of conditions for which multiple treatment options are available. The Group Health Demonstration Project, conducted during 2009–11, yielded five key lessons for successful implementation, including the synergy between efforts to reduce practice variation and increase shared decision making; the need to support modifications in practice with changes in physician training and culture; and the value of identifying best implementation methods through constant evaluation and iterative improvement. These lessons, and the legislated provisions that supported successful implementation, can guide other states and health care institutions moving towar...
44 citations
TL;DR: Changes to hand hygiene auditing and response processes demonstrate ability to improve and sustain adherence rates within a clinical microsystem.
Abstract: Hand hygiene occurs at the intersection of habit and culture. Psychological and social principles, including operant conditioning and peer pressure of conforming social norms, facilitate behavior change. Participatory leadership and level hierarchies are needed for sustainable patient safety culture. Application of these principles progressively and significantly improved hand hygiene compared with the hospital aggregate control. Changes to hand hygiene auditing and response processes demonstrate ability to improve and sustain adherence rates within a clinical microsystem.
TL;DR: The idiosyncratic nature and influence of warrior culture and subculture is examined and recommendations to promote culture change are offered and Faith-based spirituality and prayer are examined as adjunct modalities for stress management and emotional healing.
Abstract: Research has shown an increase in suicides by military veterans and law enforcement officers in the United States. Etiologic research elucidates warrior culture and subculture as contributing factors of this pathology. This paper examines the idiosyncratic nature and influence of warrior culture and subculture and offers recommendations to promote culture change. Faith-based spirituality and prayer are examined as adjunct modalities for stress management and emotional healing. Further research is recommended to assess the associated hidden cost factors and long-term financial impact of warrior culture on society.
TL;DR: The LAN was developed to create the experience of a culture that would prepare participants to facilitate a culture in academic medicine that would be more collaborative, inclusive, relational, and that supports the humanity and vitality of faculty.
Abstract: Introduction
Research suggests an ongoing need for change in the culture of academic medicine. This article describes the structure, activities and evaluation of a culture change project: the C - Change Learning Action Network (LAN) and its impact on participants. The LAN was developed to create the experience of a culture that would prepare participants to facilitate a culture in academic medicine that would be more collaborative, inclusive, relational, and that supports the humanity and vitality of faculty.
Methods
Purposefully diverse faculty, leaders, and deans from 5 US medical schools convened in 2 1/2-day meetings biannually over 4 years. LAN meetings employed experiential, cognitive, and affective learning modes; innovative dialogue strategies; and reflective practice aimed at facilitating deep dialogue, relationship formation, collaboration, authenticity, and transformative learning to help members experience the desired culture. Robust aggregated qualitative and quantitative data collected from the 5 schools were used to inform and stimulate culture-change plans.
Results
Quantitative and qualitative evaluation methods were used. Participants indicated that a safe, supportive, inclusive, collaborative culture was established in LAN and highly valued. LAN members reported a deepened understanding of organizational change, new and valued interpersonal connections, increased motivation and resilience, new skills and approaches, increased self-awareness and personal growth, emotional connection to the issues of diversity and inclusion, and application of new learnings in their work.
Discussion
A carefully designed multi-institutional learning community can transform the way participants experience and view institutional culture. It can motivate and prepare them to be change agents in their own institutions.
TL;DR: The purpose of this article is to present the application of patient-centered care and clinical ethics into nutrition practice, illustrate the process in a case study, and promote change in the current healthcare clinical ethics model.
Abstract: The purpose of this article is to present the application of patient-centered care and clinical ethics into nutrition practice, illustrate the process in a case study, and promote change in the current healthcare clinical ethics model. Nutrition support clinicians have an opportunity to add another dimension to their practice with the incorporation of patient-centered care and clinical ethics. This represents a culture change for healthcare professionals, including nutrition support clinicians, patients and their family. All of these individuals are stakeholders in the process and have the ability to modify the current healthcare system to improve communication and facilitate a change by humanizing nutrition support practice. Nutrition support is a medical, life-sustaining treatment, and the use of this therapy requires knowledge by the nutrition support clinician of patient-centered care concepts, preventive clinical ethics, religion/spirituality and cultural diversity, palliative care team role, and advance care planning. Integrating these into the practice of nutrition support is an innovative approach and results in new knowledge that requires a change in the culture of care and engagement and empowerment of the patient and their family in the process. This is more than a healthcare issue; it involves a social/family conversation movement that will be enhanced by the nutrition support clinician’s participation.(Nutr Clin Pract. 2013;28:543-555)
TL;DR: The results counter the argument that culture change facilities have a stronger internal employee focus than facilities more generally but do show that culture changes facilities report stronger developmental cultures than non-culture change facilities, which indicates a potential to be innovative in their strategies.
Abstract: Background: Culture change initiatives propose to improve care by addressing the lack of managerial supports and prevalent stressful work environments in the industry; however, little is known about how culture change facilities differ from facilities in the industry that have not chosen to affiliate with the resident-centered care movements.
Purpose: The aim of this study was to evaluate representation of organizational culture values within a random sample of U.S. nursing home facilities using the competing values framework and to determine whether organizational values are related to membership in resident-centered culture change initiatives.
Design and Methods: We collected reports of cultural values using a well-established competing values framework instrument in a random survey of facility administrators and directors of nursing within all states. We received responses from 57% of the facilities that were mailed the survey. Directors of nursing and administrators did not differ significantly in their reports of culture and facility measures combined their responses.
Findings: Nursing facilities favored market-focused cultural values on average, and developmental values, key to innovation, were the least common across all nursing homes. Approximately 17% of the facilities reported that all cultural values were strong within their facilities. Only high developmental cultural values were linked to participation in culture change initiatives. Culture change facilities were not different from non-culture change facilities in the promotion of employee focus as organizational culture, as emphasized in group culture values. Likewise, culture change facilities were also not more likely to have hierarchical or market foci than non-culture change facilities.
Practice Implications: Our results counter the argument that culture change facilities have a stronger internal employee focus than facilities more generally but do show that culture change facilities report stronger developmental cultures than non-culture change facilities, which indicates a potential to be innovative in their strategies. Facilities are culturally ready to become resident centered and may face other barriers to adopting these practices.
TL;DR: The authors describe a multifaceted approach—informed by a working model of organizational research productivity—by which the University of Minnesota Department of Family Medicine and Community Health successfully increased its collective research productivity during a 10-year period (1997–2007) and maintained these increases over time.
Abstract: Efforts to foster the growth of a department’s or school’s research mission can be informed by known correlates of research productivity, but the specific strategies to be adopted will be highly context-dependent, influenced by local, national, and discipline-specific needs and resources. The authors describe a multifaceted approach—informed by a working model of organizational research productivity—by which the University of Minnesota Department of Family Medicine and Community Health (Twin Cities campus) successfully increased its collective research productivity during a 10-year period (1997–2007) and maintained these increases over time. Facing barriers to recruitment of faculty investigators, the department focused instead on nurturing high-potential investigators among their current faculty via a new, centrally coordinated research program, with provision of training, protected time, technical resources, mentoring, and a scholarly culture to support faculty research productivity. Success of these initiatives is documented by the following: substantial increases in the department’s external research funding, rise to a sustained top-five ranking based on National Institutes of Health funding to U.S. family medicine departments, later-stage growth in the faculty’s publishing record, increased research capacity among the faculty, and a definitive maturation of the department’s research mission. The authors offer their perspectives on three apparent drivers of success with broad applicability—namely, effective leadership, systemic culture change, and the self-awareness to adapt to changes in the local, institutional, and national research environment.
TL;DR: In this paper, a case study in the financial sector was used to explore 12 employees' narrated accounts of living through a culture change initiative and three themes emerged: respondents' investment of self, accepting the culture change initiatives and its values, employees' epistemic analyses of the embedded value promises including experiencing a critical incident that interrupted managers' enactment of values; employees' resulting "received practice" whic...
Abstract: Purpose – The purpose of this paper is to present adaptive culture structuration, a new approach for theorizing and analyzing culture change and for creating an “adaptive cultural structurated learning environment”. Design/methodology/approach – Incorporating a case study in the financial sector the paper explores 12 employees' narrated accounts of living through a culture change initiative. A constructivist, interpretive, qualitative research study followed grounded theory principles. Organizational documentation provided secondary data. Semi structured interview data were analyzed using content analysis, constant comparison and theoretical sensitivity and were managed by ATLAS.ti software. Findings – Three themes emerged: respondents' investment of self, accepting the culture change initiative and its values; employees' epistemic analyses of the embedded value promises including experiencing a critical incident that interrupted managers' enactment of values; employees' resulting “received practice” whic...
TL;DR: A new, comprehensive model of nursing home culture change is described, the Nursing Home Integrated Model for Producing and Assessing Cultural Transformation (Nursing Home IMPACT), which includes detailed, triangulated assessment methods capturing various stakeholder perspectives for each of the model's domains.
TL;DR: In this article, the authors examine how the country's recent public sector reform initiatives have largely failed to bring about expected results, pointing out that the success and failure of policy change occurs in several ways, manifesting multiple challenges including a lack of well-prepared implementation framework and culture change.
Abstract: For many years, public management reform has been an evolving concept. New Public Management (NPM) and Good Governance have been the two ground–breaking ideas, generating colossal discourse over the past three decades. Inspired by NPM-led policy changes in the developed world, many developing countries have lately joined the reform bandwagon but achieved limited success. Policy analysts observe that the policy planners in the developing world seem to have spent more resources in policymaking than addressing the policy implementation challenges. Also, the policy transfer effort ignored the issue of administrative culture. Focusing on Fiji, this article examines how the country's recent public sector reform initiatives have largely failed to bring about expected results. Based on the case studies of two organizations, it explains that the success and failure of policy change occurs in several ways, manifesting multiple challenges including a lack of well-prepared implementation framework and culture change.
Abstract: INTRODUCTION Cruickshank et al. provide an interesting account of elite sporting culture, having chosen professional rugby union club Leeds Carnegie as the site for their investigation. In their article, they promote a perspective on cultural change that is very different from the majority of top-down processes described in sport management and sport psychology domains. Theirs is a more textured analysis of cultural change in a professional sport environment that, in a number of ways, serves to advance the empirical research base in this area.
TL;DR: In this paper, the authors argue that the authors took the decision to elide these literatures which are foundational to a really nuanced, developed understanding of the phenomena explored in this study.
Abstract: INTRODUCTION My commentary is situated within my own field of expertise which lies within management and organization studies. This location leads me to be somewhat critical of Cruickshank et al.’s article because the authors took the decision to elide these literatures which I argue are foundational to a really nuanced, developed understanding of the phenomena explored in this study. My comments are restricted to three key areas: i) the issue of professional sports organizations being businesses and the implications of this for culture; ii) the exclusion of theory from management and organization studies literatures; and iii) a critique of methods.
TL;DR: The study found that staff-reported culture change correlated with occupancy rate and organizational commitment, and provided a persuasive argument that policies and/or programs to support culture change in nursing homes should be enhanced.
Abstract: Purpose: This study aims to examine culture change in nursing homes in South Korea and to identify the outcomes of culture change implementa tion. Design and Methods : Data were taken from survey responses from 223 top- or mid-level staff among nursing homes in South Korea that were selected through a proportionate random-stratified sampling method from four regions nationwide. Culture change in nursing homes was operationalized by five person-directed care (PDC) constructs and three organizational environment constructs, and outcome quality was indicated by changes to occupancy rate and organizational commitment. Results: After controlling for facility characteristics, the effect of staff-repor ted culture change on occupancy rate and organizational commitment was analyzed through the multiple-regression method. Consistent with previous research, this study revealed positive effects of culture change for nursing homes in South Korea. The study found that staff-reported culture change correlated with occupancy rate and organizational commitment. Implications: Given that culture change variables were significantly related to occu pancy rate and organizational commitment, the findings of the study provide a persuasive argument that policies and/or programs to support culture change in nursing homes should be enhanced. Management-level workers in these facilities should have the skills and knowledge to foster more PDC and a more person-directed environment.
TL;DR: This article addresses and responds to the provider liability and regulatory apprehensions that impede the progress of culture change in nursing homes, using proposed new dietary services standards as an example.
Abstract: There continue to be serious deficiencies in the quality of life available to many nursing home residents in the United States. One significant response to this undesirable situation is the nursing home "Culture Change" movement, which attempts to improve the nursing home environment-and consequently residents' quality of life-by making facilities less institutional and more homelike. One of the impediments often interfering with the adoption and implementation of culture change in specific facilities is apprehension by staff, administrators, and governing boards about potential legal liability and regulatory exposure if residents suffer injuries that might arguably be attributed to facility conditions or policies that were inspired and encouraged by the culture change movement. This article addresses and responds to the provider liability and regulatory apprehensions that impede the progress of culture change in nursing homes, using proposed new dietary services standards as an example.
TL;DR: The article by Cruikshank et al. as mentioned in this paper adds much needed attention to a contemporary topic in the coaching psychology literature and the intimate access obtained by the authors and the resulting multiple stakeholder perspective provide necessary steps forward in assessing and understanding team culture.
Abstract: INTRODUCTION ‘Changing the culture’ has certainly entered the coaching lexicon at all competitive levels of sport. Yet a significant body of literature on team culture—how it is built, changed, embodied or integrated—has yet to develop. The article by Cruikshank et al. adds much needed attention to a contemporary topic in the coaching psychology literature. The intimate access obtained by the authors and the resulting multiple stakeholder perspective provide necessary steps forward in assessing and understanding team culture. However, without a clear characterization of team culture, the degree of culture change evident is less clear. This highlights the need for the development of a comprehensive conceptualization of team culture.
DOI•
01 Jan 2013TL;DR: This dissertation focuses on the development of concepts of Personhood and PCC—Conceptual Issues to Date and the role of personhood in person-Centred care.
Abstract: ............................................................................................................................. ii" PREFACE................................................................................................................................ iv" TABLE OF CONTENTS.......................................................................................................... v" ACKNOWLEDGEMENTS...................................................................................................... x" CHAPTER 1: INTRODUCTION: BACKGROUND AND SIGNIFICANCE ....................... 1" Research Problem ................................................................................................................. 6" Study Implications............................................................................................................. 9" Study Purpose and Objectives .......................................................................................... 9" Dissertation Overview .................................................................................................... 10" CHAPTER 2: REVIEW OF SELECTED LITERATURE.................................................... 12" Problematizing Traditional Care......................................................................................... 13" Transforming LTRC ........................................................................................................... 16" The Role of Personhood .................................................................................................. 16" The Role of Person-Centred Care................................................................................... 19" Culture Change Models .................................................................................................. 21" Applying Theory in Practice............................................................................................... 23" Communication Skills Training in Person-Centred Dementia Care .............................. 25" Resident Biography ......................................................................................................... 27" Challenges to Culture Change in LTRC............................................................................. 31" Staffing Levels and Quality of Care ................................................................................ 31" Defining Quality of Life .................................................................................................. 34" Expanding Concepts of Personhood and PCC—Conceptual Issues to Date ...................... 36" Embodiment .................................................................................................................... 36" The Physical Environment .............................................................................................. 37" Agency ............................................................................................................................. 39" Relationship-Centred Care ............................................................................................. 40" Ethics in Person-Centred Care............................................................................................ 43" I/Thou and I/It Modes of Relating................................................................................... 44" Intentional and Non-Intentional Modes of Relating ....................................................... 45"
Book•
13 May 2013
TL;DR: The evolution of organizational change practices to business change management is discussed in this paper, where the authors discuss the risks and best practices in business change Management, change resistance, and creating and sustaining culture change.
Abstract: 1. The Evolution of Organizational Change Practices to Business Change Management 2.Change Risks and Best Practices in Business Change Management 3.Change Leadership and Management 4.Change Resistance 5. Creating and Sustaining Culture Change
TL;DR: A dynamic model shaping a process of knowledge management (KM) culture change is suggested aimed at providing effective KM of employees for obtaining desired results in an organization by adjusting the dynamic process of KM culture change.
Abstract: A dynamic
model shaping a process of knowledge management (KM) culture change is
suggested. It is aimed at providing effective KM of employees for obtaining
desired results in an organization. The essential requirements for obtaining KM
culture change are determined. The proposed model realizes these requirements.
Dynamics of the model are expressed by a change of its parameters. It is
adjusted to the dynamic process of KM culture change. Building the model
includes elaboration and integration of interconnected components. The “Result”
is a central component of the model. This component determines a desired
organizational goal and possible directions of its attainment. The “Confront”
component engenders constructive confrontation in an organization. For this
reason, the employees are prompted toward KM culture change with the purpose of
attaining the desired result. The “Assess” component realizes complex
assessments of employee proposals by management and peers. The proposals are
directed towards attaining the desired result in an organization. The “Reward”
component sets the order of assigning rewards to employees based on the assessments
of their proposals.
01 Jan 2013
TL;DR: In this article, the authors highlight five key issues in addressing this challenge: (1) the implementation of strategies like front-line ownership (FLO) in the context of macro-level social forces; (2) the central role of distributed leadership and its strengthening within the organization; (3) the need to attend to developing systems thinking skills at all levels; (4) the very significant challenge of how to scale up the labour-intensive change strategies within FLO, the role of "simple rules" and the potential for systems thinking tools such as concept mapping and dynamic modelling
Abstract: The challenge of culture change in hospitals must address three distinct but interwoven tensions: the need to shift paradigm and understand healthcare as a complex adaptive system; the challenge of knitting together the contributions of both evidence-based medicine and practice-based evidence; and the critical role of distributed, problem-focused leadership.The authors of the lead paper highlight five key issues in addressing this challenge: (1) the implementation of strategies like front-line ownership (FLO) in the context of macro-level social forces; (2) the central role of distributed leadership and its strengthening within the organization; (3) the need to attend to developing systems thinking skills at all levels; (4) the very significant challenge of how to scale up the labour-intensive change strategies within FLO, the role of "simple rules" and the potential for systems thinking tools such as concept mapping and dynamic modelling; and (5) the concurrent orchestration of not one culture change but three tensions in the challenge FLO represents to simpler versus complex adaptive systems, leadership and management and the balance between evidence-based medicine and practice-based evidence, at the clinical, organizational and macro-system levels.
TL;DR: In this article, the authors combine several approaches to explain why the account given of a Mexican town's history changed between 1879 and 1992, and identify and explain what did not change during the period, as well as during the subsequent period of fieldwork itself, 1992-2005.
Abstract: Explaining culture change requires a multi-dimensional approach, and so does explaining cultural continuity. I combine several approaches to explain why the account given of a Mexican town's history changed between 1879 and 1992. I also identify and explain what did not change during the period, as well as during the subsequent period of fieldwork itself, 1992–2005. Rather than treat cultural continuity as the result of inertia, I follow Urban ([2001], Metaculture: How Culture Moves Through the World, University of Minnesota Press, Minneapolis, MN) in looking for what motivates the transmission of culture as well as what pathways it takes, although I prefer to stress human agency in writing of the trajectories along which people propel culture, in this case a town's history. One approach which I draw, for explaining the trajectories of culture, is Malinowski's seminal study of Trobriand myths (1926), but I combine it with the more recent approaches that link versions of history to the interests of social ...