The role of the organizational champion in achieving health system change
Highlights
▸ We use ethnographic longitudinal case studies to study the role of the champion in implementing organizational change. ▸ We show that champions are highly effective in the first phase of adoption but less effective in later stages. ▸ Champions highly identified with their work and were threatened when asked to share their work with other stakeholders. ▸ Our findings caution against allowing change to become positioned within the remit of a few individuals. ▸ Whilst champions may initially be beneficial they can be detrimental to progress, in the later stages of implementation.
Introduction
Attempts to produce transformational change across health systems to meet the challenges of rising demand and limited resources demonstrate the difficulties of introducing of new ways of working in healthcare (Ferlie et al., 2003, Hendy et al., 2007, McNulty and Ferlie, 2002. It is increasingly acknowledged that integrating complex process innovations into existing health systems is hard, in that they are often only workable in highly context-specific ways (Pettigrew et al., 1992, Plsek and Greenhalgh, 2007, Robert et al., 2009). In part, this stems from the different values, cultures, beliefs and identities of the various professional groups involved (Currie et al., 2008, Ferlie et al., 2005).
Alongside this awareness of the complex and context-dependent nature of change, is a renewed focus on ‘social influence’ theories of organizational change. This theme runs through work on innovation adoption, where product champions act entrepreneurially to engage themselves and others with the innovation (e.g. Rogers, 1995). In health management, the essential role of the champion and opinion leader is also acknowledged (Dobson et al., 2010, Greenhalgh et al., 2004, Locock et al., 2001, Soo et al., 2009), alongside evidence for their effectiveness (Backer and Rogers, 1998, Markham, 1998, Schon, 1963). The research suggests that champions enable formal hierarchies and professional divisions to be circumvented. Yet, as Greenhalgh, Robert, Macfarlane, Bate, and Kyriakidou (2004) note, little direct empirical evidence exists on how to harness the benefits and energy of champions. Questions remain about what factors determine their success.
The idea of the organizational champion as a vehicle for social influence is not new (Beath, 1991, Meyer and Goes, 1998, Schon, 1963. In defining a champion, we use Howell and Higgins (1990) definition. The champion, at least initially, emerges spontaneously and informally within an organization (cf. Schon, 1963) and actively and enthusiastically promotes innovation and change to others for the good of the organization (Howell and Shea, 2001, Mantere, 2005). In Schon’s words (1963 p. 84) champions “identify with the idea as their own, and with its promotion as a cause, to a degree that goes far beyond the requirements of their job”. This definition is useful in reflecting a personal commitment to the role, as opposed to emphasizing expertise or seniority (Locock et al., 2001).
A major aspect of the champions’ role is to influence and facilitate change in others. Champions do this by demonstrating commitment, promoting innovation with passion and persistence, pulling together diverse groups of professionals, team-building, and developing informal networks to support them (Maidique, 1980, Pettigrew et al., 1992, Schon, 1963).Importantly, they communicate meanings attached to the innovation to organizational members, and involve and motivate others to do the same, acting as boundary spanners between top management and other members (Carlile, 2002).
Howell and Higgins (1990) report that champions are distinguishable by their ability to communicate a clear vision of the innovation. This process is described in organizational literature as sensegiving, the ability to create understandings in others that accommodate new organizational goals (Gioia and Chittipeddi, 1991, Maitlis and Lawrence, 2007). Information for sensegiving is gathered and used in many forms; conversations, documents, storytelling, behaviors and actions (Balogun & Johnson, 2004). On an emotional level sensegiving can help establish identification, an intertwined understanding, with new elements of the organization becoming embedded in employees’ self-concept (Pratt, Rockman & Kaufman 2006).
With sensegiving comes sensemaking (Gioia and Chittipeddi, 1991, Gioia et al., 1994, Maitlis and Lawrence, 2007). Sensemaking is a narrative process through which a mental model of the world is created, shared and maintained (Mohammed & Dumville, 2001). Research on the development of sensemaking and shared mental models suggests that the development of team goals, and identification with work roles is usually positive – particularly so in healthcare organizations, where good team work is an essential component of effectiveness (Baker, Day, & Salas, 2006).
Ease in sensegiving and the development of shared understandings is connected with homogeneity. Because sensegiving is a social process, it is often enhanced when the sensegiver and recipient share educational, professional, and cultural backgrounds (Fennell and Warnecke, 1988, Fitzgerald et al., 2002). Work on shared mental models has shown that this unity, although useful, may over time become problematic (Mohammed, Ferzandi, & Hamilton, 2010). Group members need to agree and disagree, simultaneously, in order to maintain needed balance and flexibility. A very closely shared group schema can become a liability, with the group jointly refusing to abandon consensually validated, but organizationally ineffective, views of the world (Klimoski & Mohammed, 1994).
The problematic nature of homogeneity is further highlighted in the work of Ferlie et al. (2005). The study shows that adoption is easier when the innovation or change is contained within small homogenous groups. Knowledge diffuses within the group, but will fail to diffuse across boundaries and get stuck, when values are not shared. Ferlie et al. (2005 p. 129), explains that “the presence of strong professional roles and identities makes it even less likely that knowledge will flow across social boundaries”. This raises an interesting question; if a champion highly identifies with an innovation, and shares this sensemaking with the team, how does this consensus impact on the team’s ability to spread the innovation outwards. Unfortunately, the authors do not pursue the answer. For elaboration we need the work of sensemaking and identity theorists.
To varying degrees people derive a sense of who they are from the organizations and work groups to which they belong (Hogg & Terry, 2000). People need to situate themselves with reference to others, but in large organizations there may be a multiplicity of available groups nested or embedded within each other (e.g. workgroup, professional group, division and the wider organization) (Ashforth & Johnson, 2001). By internalizing the group or organization as part of oneself, the individual member gains a sense of meaningfulness and connection to others and a coherent sense of who they are. Strong organizational identification or “perceived oneness with a group” (Ashforth & Mael, 1989, p. 35; Elsbach, 1999) is more likely within more exclusive, concrete and proximal groups. Thus, in a large company identification with your specific work group is more salient than identification with the wider organization.
Gioia and Chittipeddi, 1991, Pratt et al., 2006 and Fiol (2002) explain that organizational change, such as the introduction of an innovative model of healthcare delivery, can trigger changes that disrupt the basis of organizational identification. The organization may need to evolve, and change its internalized structure, in terms of what it stands for and where it intends to go. These changes require associated shifts in organizationally shared values and attitudes (Ashforth & Mael, 1989), with aspects of member identification becoming redundant or destroyed (Fiol, 2002). For example, if a specific work practice is invalidated by changes in organizational policy, members need to re-establish themselves in-line with the new work practice (Pratt et al., 2006; Ravasi & Schultz 2006).
So, in effectively implementing organizational change, champions need to make sense of the change by re-identifying with the new context, before sharing the change via their sensegiving with others. Our first research question is how do champions re identify? Can identification be re-established, through sensemaking, to fit with changes brought about by an innovation? Our second question is how do champions establish re-identification in others? Do champions, through their sensegiving abilities, allow other members to embrace change, so enabling innovation adoption? To answer these questions we need to consider the changing nature of organizational identification and the type of identity work (sensemaking and sensegiving) that needs to be done, over a period of substantial organizational change.
Section snippets
Research context and design
An area where the work of champions is particularly prominent is in the development of remote care, commonly called ‘telecare’. Telecare systems are used to monitor patients with chronic conditions, such as diabetes, or in the case of a frail elderly person, act as motion sensors, so an incidence such as fall in the home is relayed remotely to a call center. These systems have been around for over a decade, but have been slow to spread (Barlow, Bayer, & Curry, 2006). The systems are politically
Results
For reasons of confidentiality we have omitted the real names of our three study sites, instead we identify them within the paper as C, N, and S respectively. Examination of previous remote care progress at each site demonstrated that levels of penetration were similar at the start of the research (see Table 2). This suggests that the organizational champions were similarly effective in the first phase of adoption. When the sites attempted to reposition remote care as a routine part of the
Discussion
Organizations must adapt to environmental change, with champions viewed as part of an armory of strategies to ensure the organization’s vision and identity are effectively managed alongside this change (Howell & Higgins, 1990). By the nature of their role, champions should sell, promote and encourage alignment with an innovation. Underlying these arguments are several assumptions. Firstly, that changes in manager identification occur, secondly that managers go on to induce such modification in
Conclusions
There is a long held wisdom that organizational champions have a necessary and positive impact on organizational change (Locock et al., 2001). Our findings question these assumptions. Our work suggests that the champion’s ability to identify with changes in context is not a given. For the champions in our study, their own identification was so entwined with their current role that they worked to maintain this role, clinging to the existing schema for self-enhancement purposes and continuity,
Acknowledgments
We are extremely grateful to the participating case study organizations for their help, and to individual interviewees for their time and interest in the study. They are not named to preserve anonymity. We are also grateful to members of the remote care community for their continuing support. We also thank Steffen Bayer, Richard Curry, Theti Chrysanthaki and Bora Trimcev for their support and input.
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