The impact of implementing a person-centred pain management intervention on resistance to change and organizational culture

Angelini et al. BMC Health Services Research https://doi.org/10.1186/s12913-021-06819-0 (2021) 21:1323 RESEARCH ARTICLE Open Access The impact of implementing a personcentred pain management intervention on resistance to change and organizational culture Eva Angelini1,2,3* , Axel Wolf2, Helle Wijk2,4,5, Helena Brisby1,6 and Adad Baranto1,6 Abstract Background: Resistance to change and organizational culture are essential factors to consider in change management in health care settings. Implementation of structural change remains a challenge. There is a lack of studies providing information on the impact of implementation processes on the organization. The aim of this study was to describe the impact of implementing a systematic change process concerning postoperative personcentred pain management on resistance to change and organizational culture in an orthopaedic spine surgery unit. Methods: The study was set in an orthopaedic spine surgery unit at a university hospital. Person-centred bundles of care for postoperative pain management of spine surgery patients were developed in co-creation by a multiprofessional expert group and implemented throughout the care pathway. The intervention was underpinned by theories on organizational culture and inspired by principles of person-centred care. Quantitative data were collected using the Resistance to Change Scale and the Organizational Culture Assessment Instrument and analysed using descriptive statistics. Results: The findings showed a low resistance to change decreasing during the study. The organizational culture shifted from a result-oriented to a formalized and structured culture after the implementation. The culture preferred by the staff was team-oriented and participation-focused throughout the study. The discrepancy between the current and preferred cultures remained extensive over time. Conclusion: It is challenging to describe the influence of the development and implementation of a postoperative pain management program on organizational culture as well as in terms of resistance to change, in a complex health care setting. In the current study the unit was under organizational strain during the implementation. Albeit, the important discrepancy between the current and preferred organizational culture could imply that structural changes aren’t enough when implementing person-centred pain management structures and needs to be combined with relational aspects of change. Keywords: Resistance to change, Organizational culture, Organization, Person-centred care, Implementation, Spine surgery * Correspondence: 1 Department of Orthopaedics, Institute of Clinical Sciences, at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 2 Institute of Health and Care Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden Full list of author information is available at the end of the article © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. 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BMC Health Services Research (2021) 21:1323 Background In this paper, our focus is on understanding implementation processes by describing the effect of a change process on resistance to change (RTC) and organizational culture (OC) in an orthopaedic surgery setting in a large university hospital. Health care organizations (HCOs) have an obligation to maintain and safeguard high quality through continuous improvement, and so are submitted to constant change to meet demands for improved quality, safety and efficiency. The task of introducing change into overburdened and complex organizations such as in health care is challenging as these settings are large in scale and divided into specialized fields. Moreover, HCOs can develop fatigue with constant changes, leading to resistance to change, and in fact change in health care is often met by resistance [1]. According to Peiperl (2005, p. 348) [2], RTC is “active or passive responses on the part of a person or group that militate against a particular change, a program of changes, or change in general”. RTC is mostly described as resistance on an individual basis, but Curt Lewin who introduced the concept in 1930, followed by Coch and French, considered that RTC does not arise from the unique individual but from the context in which the change takes place [3]. According to Lewin, the individual’s behaviour is a product of a complex system, an organization, forming a force field around the individual [4]. This is of relevance in a study like the present where the survey is completed by individuals in a HCO and then aggregated and analysed as one. An organizational culture can be described as fluid and hard to grasp as it lies under the surface of what is seen and tangible, reflecting the underlying values and shared assumptions within an organization [5]. In health care, the concept has been used for decades [5, 6]. OCs may be contributing factors in poor change implementation. Every organization has its unique culture specific to each lone workplace. The concept of organizational culture originates in the social sciences where the underlying assumption that an organization can be seen as a miniature society and justifies a cultural approach. According to Michie and Williams [7], hospital wards develop their own local OCs. In this study, we were interested in observing a specific ward’s underlying OC during structural change, as Resistance to change and organizational culture may impede organizational development and change in health care [8]. Person-centred care (PCC) is an approach including the patient as an equal partner and stakeholder in health care [9]. It has gained increasing interest as a way to empower patients and improve quality. When operationalizing PCC, deliberate (i.e. planned) strategies are important to consider, as are emergent strategies (i.e. in response to the specific change process) [10]. PCC goes Page 2 of 11 beyond the relationship between patient/ (...truncated)