Predictors of Successful Organizational Change: The Alignment of Goals,Logics of Action and Leaders' Roles to Initiate Clinical Pathways

Abstract

The implementation of clinical pathways (CPs) is a quality improvement process that uses a horizontal and multidisciplinary approach far different from the silo approach usually present in hospital structures. Because hospitals are pluralistic organizations characterized by multiple objectives and diffuse power, CP implementation represents a complex intervention. By focusing on the initiation stage, our research aims to understand the key managerial success factors to take into account during this critical period. Using a qualitative approach, we analyse the CP change initiation stage within 11 Belgian hospitals. Based on a double success indicator collected one year and a half after CP project's initiation, we focus on CP failures and successful CP implementations. This research suggests three key factors supporting CP's effective implementation: the importance of alignment between direction's goals and piloting team's expectations (alignment of goals), the piloting team's acceptance of CP choice (alignment of logics of action), and the importance of complementarities between multiple leaders (alignment of leaders' roles). In conclusion, change initiation in a complex organizational environment is a major strategic stake for its managers. The suggested triple organizational alignment is useful for any CP implementation, but also for the initiation stage of any changes in pluralistic organizations.