People and teams matter in organizational change: professionals' and managers' experiences of changing governance and incentives in primary care

Objectives: To explore the experiences of governance and incentives during organizational change for managers and clinical staff.

Study setting: Three primary care settings in England in 2006-2008.

Study design: Data collection involved three group interviews with 32 service users, individual interviews with 32 managers, and 56 frontline professionals in three sites. The Realistic Evaluation framework was used in analysis to examine the effects of new policies and their implementation.

Principal findings: Integrating new interprofessional teams to work effectively is a slow process, especially if structures in place do not acknowledge the painful feelings involved in change and do not support staff during periods of uncertainty.

Conclusions: Eliciting multiple perspectives, often dependent on individual occupational positioning or place in new team configurations, illuminates the need to incorporate the emotional as well as technocratic and system factors when implementing change. Some suggestions are made for facilitating change in health care systems. These are discussed in the context of similar health care reform initiatives in the United States.