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Nobody in charge: Distributed change agency in healthcare

Cranfield University School of Management, david.buchanan{at}cranfield.ac.uk

Rachael Addicott

Health and Public Sector Management at the School of Management, Royal Holloway University of London

Louise Fitzgerald

department of human resource management at De Montfort University, Leicester, lfitzgerald{at}dmu.ac.uk

Ewan Ferlie

School of Management, Royal Holloway, University of London, ewan.ferlie{at}rhul.ac.uk

Juan I. Baeza

Health Policy at Imperial College London's Tanaka Business School, j.baeza{at}imperial.ac.uk

This article illustrates how distributed change agency can implement complex organizational changes in the absence of formal management plans, roles, and structures. Distributed change agency typically involves small teams and senior groups. In this qualitative study of service improvements in the treatment of prostate cancer at an acute hospital, Grange, change roles were distributed more widely, with responsibilities `migrating' among a large informal cast supporting four central characters. This distribution appears to have been triggered by the change goals and substance, and by the network organization through which services were delivered. Cross-case comparisons with other hospitals, Henley and Norwood, suggest that a combination of factors contributed to the development of a distributed approach. Analytical generalization invites speculation concerning the transferability of this model, with `nobody in charge', to other settings. One policy implication concerns the provision of development in change agency competencies to staff other than those in senior positions.

Key Words: change agency • change management • distributed leadership • healthcare • organizational change

Human Relations, Vol. 60, No. 7, 1065-1090 (2007)
DOI: 10.1177/0018726707081158


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