Successful large system change: at what cost?

Abstract

This paper analyses a case study of the re-organization of a regional orthopaedic service. The purpose of the research was to demonstrate the utility of a model of large system change through a retrospective analysis of how the re-organization was planned, managed and implemented. The theoretical framework for the retrospective analysis of the case was the Coghlan and McAuliffe (2003) model of large system change. Documentary analysis allowed an understanding of the steps taken in the change process. Semi-structured interviews were retrospectively conducted with key stakeholders to gain a deeper understanding of the impacts of the change process. The Coghlan and McAuliffe model of large system change provided a very good structure for this retrospective analysis of the re-organization of orthopaedic services. It facilitated the exploration of a change that from an external perspective was considered successful. Through this exploration a number of important lessons have been highlighted. The analysis highlights the importance of a systems perspective. Interviewee responses demonstrate how failure to take adequate account of the system's future needs is likely to impact negatively on continuing progress in the orthopaedic services and on future change initiatives within the organization. This paper, through the retrospective analysis of a case study, uses empirical data to demonstrate the utility of a model of large system change. The findings highlight the weaknesses in change models that fail to pay attention to the consolidation and sustainability of change by neglecting the impact of the change on the wider system.