Many organizations are considering reconfiguring their workspaces to optimize them. While studies (Brunia et al., 2016; Dunford et al., 2013; Hoendenvanger et al., 2016) on open and flexible spaces tend to show mixed results, it is important to consider experimenting and transitioning to these new spaces so that they best meet the needs of the change recipients and the organization. A pilot project was built for recipients to experiment with new spaces. A support team followed 15 cohorts of about 15 people for two to three months each, over three years. Exploratory action research in a university setting made it possible to collect qualitative data from weekly follow-up meetings, a survey, and videotaped statements. Concept maps created (Davies, 2011) from 260 verbatim excerpts illustrate the hierarchical relationships between critical factors and their psychosocial effects. The results show three critical factors. The diversity and flexibility of the layouts facilitated adaptation and created a sense of increased performance by meeting the needs for focus, privacy, and teamwork. Physical proximity contributed to increased social interaction and accessibility to colleagues and managers, leading to collaboration and a sense of well-being. Change management fostered the perception of organizational support and spatial appropriation. Change management practitioners and leaders might consider a transition period of a few months for learning and monitoring of recipient groups before final decisions are made. The results obtained need to be contextualized and could vary by type of position. The effects of these spaces in the long term and consideration of tasks performed during the days spent in the office would be interesting leads for future studies.

Purpose This study aims to investigate innovation intensity by exploring the roles of internally focused and externally focused information technology (IT) use intensity and innovation culture on innovation intensity and organizational performance. Design/methodology/approach A model exploring the effects of internally and externally focused IT use, plus two key dimensions of innovation culture – collaborative and entrepreneurial – on innovation intensity and organizational performance is tested via a structural equation model using partial least squares with data collected from 395 top executives. Findings The results indicate that intense use of internally and externally focused IT and the collaborative dimension of culture positively affect innovation intensity, which, in turn, increases operational and financial performance. Practical implications Innovation is an important driver of performance, for both internal efficiency and competitiveness. The role of IT in the innovation process is key: it allows information, knowledge and idea sharing. Top managers should make a wide array of IT tools available to increase internal and external information exchanges. They should also develop an organizational context that stimulates innovativeness and promotes collaboration. Originality/value IT helps employees acquire and use the knowledge needed to innovate within and outside organizational boundaries. To be innovative, employees need to work in an organization with a strong innovation culture, a primary determinant of innovation intensity. This study is one of the first to examine the effects of an organization’s innovation culture and its use of IT on innovation intensity and organizational performance. In addition, constructs of innovation intensity and internally and externally focused IT use are developed and tested.

Pour faciliter la réussite d’un projet de transformation organisationnelle ou de changement stratégique, il est de plus en plus courant d’avoir recours à des équipes d’accompagnement du changement. En quoi consistent-elles, comment sont-elles gérées et à quoi servent-elles vraiment ? Voici quelques réponses pour mieux comprendre le contexte particulier et la dynamique de ces équipes.

Despite the increasing use of medical records to measure quality of care, studies have shown that their validity is suboptimal. The objective of this study is to assess the concordance of cardiovascular care processes evaluated through medical record review and patient self-administered questionnaires (SAQs) using ten quality indicators (TRANSIT indicators). These indicators were developed as part of a participatory research program (TRANSIT study) dedicated to TRANSforming InTerprofessional clinical practices to improve cardiovascular disease (CVD) prevention in primary care. For every patient participating in the TRANSIT study, the compliance to each indicator (individual scores) as well as the mean compliance to all indicators of a category (subscale scores) and to the complete set of ten indicators (overall scale score) were established. Concordance between results obtained using medical records and patient SAQs was assessed by prevalence-adjusted bias-adjusted kappa (PABAK) coefficients as well as intraclass correlation coefficients (ICCs) and 95% confidence intervals (95% CI). Generalized linear mixed models (GLMM) were used to identify patients’ sociodemographic and clinical characteristics associated with agreement between the two data sources. The TRANSIT study was conducted in a primary care setting among patients (n = 759) with multimorbidity, at moderate (16%) and high risk (83%) of cardiovascular diseases. Quality of care, as measured by the TRANSIT indicators, varied substantially between medical records and patient SAQ. Concordance between the two data sources, as measured by ICCs (95% CI), was poor for the subscale (0.18 [0.08–0.27] to 0.46 [0.40–0.52]) and overall (0.46 [0.40–0.53]) compliance scale scores. GLMM showed that agreement was not affected by patients’ characteristics. In quality improvement strategies, researchers must acknowledge that care processes may not be consistently recorded in medical records. They must also be aware that the evaluation of the quality of care may vary depending on the source of information, the clinician responsible of documenting the interventions, and the domain of care.

Background: Cardiovascular disease morbidity and mortality are largely influenced by poor control of hypertension, dyslipidemia, and diabetes. Process indicators are essential to monitor the effectiveness of quality improvement strategies. However, process indicators should be validated by demonstrating their ability to predict desirable outcomes. The objective of this study is to identify an effective method for building prediction models and to assess the predictive validity of the TRANSIT indicators. Methods: On the basis of blood pressure readings and laboratory test results at baseline, the TRANSIT study population was divided into 3 overlapping subpopulations: uncontrolled hypertension, uncontrolled dyslipidemia, and uncontrolled diabetes. A classic statistical method, a sparse machine learning technique, and a hybrid method combining both were used to build prediction models for whether a patient reached therapeutic targets for hypertension, dyslipidemia, and diabetes. The final models’ performance for predicting these intermediate outcomes was established using cross-validated area under the curves (cvAUC). Results: At baseline, 320, 247, and 303 patients were uncontrolled for hypertension, dyslipidemia, and diabetes, respectively. Among the 3 techniques used to predict reaching therapeutic targets, the hybrid method had a better discriminative capacity (cvAUCs=0.73 for hypertension, 0.64 for dyslipidemia, and 0.79 for diabetes) and succeeded in identifying indicators with a better capacity for predicting intermediate outcomes related to cardiovascular disease prevention. Conclusions: Even though this study was conducted in a complex population of patients, a set of 5 process indicators were found to have good predictive validity based on the hybrid method.

Objective To assess a selection of psychometric properties of the TRANSIT indicators. Design Using medical records, indicators were documented retrospectively during the 14 months preceding the end of the TRANSIT study. Setting Primary care in Quebec, Canada. Participants Indicators were documented in a random subsample (n = 123 patients) of the TRANSIT study population (n = 759). Interventions For every patient, the mean compliance to all indicators of a category (subscale score) and to the complete set of indicators (overall scale score) were established. To evaluate test-retest and inter-rater reliabilities, indicators were applied twice, two months apart, by the same evaluator and independently by different evaluators, respectively. To evaluate convergent validity, correlations between TRANSIT indicators, Burge et al. indicators and Institut national d'excellence en santé et en services sociaux (INESSS) indicators were examined. Main Outcome Measures Test-retest reliability, inter-rater reliability, and convergent validity. Results Test-retest reliability, as measured by intraclass correlation coefficients (ICCs) was equal to 0.99 (0.99-0.99) for the overall scale score while inter-rater reliability was equal to 0.95 (0.93-0.97) for the overall scale score. Convergent validity, as measured by Pearson's correlation coefficients, was equal to 0.77 (P < 0.001) for the overall scale score when the TRANSIT indicators were compared to Burge et al. indicators and to 0.82 (P < 0.001) for the overall scale score when the TRANSIT indicators were compared to INESSS indicators. Conclusions Reliability was excellent except for eleven indicators while convergent validity was strong except for domains related to the management of CVD risk factors.

L’étude examine le parcours emprunté par dix-neuf directeurs des ressources humaines (DRH) et quatre chercheurs ayant choisi la recherche-action pour accompagner le transfert, le partage et la co-construction de connaissances propices au déploiement du Lean Santé au Québec. Propulsée par le Ministère de la Santé et des Services sociaux, cette démarche donne lieu à des ateliers interactifs sur plusieurs thématiques décidées au fur et à mesure selon les besoins anticipés des DRH. Ils ont pu trouver des solutions pragmatiques entre pairs ainsi qu’avec d’autres acteurs qui se sont joints en cours de route. La recherche-action montre que le déploiement du Lean Santé au Québec ne peut se réaliser sans une contextualisation locale du changement. Le mode agile permet justement d’adapter les stratégies de mise en œuvre à l’environnement sans cesse turbulent.

La résistance au changement est un construit qui a été abondamment discuté et observé surtout chez les employés, lors d’un seul changement organisationnel, et étudié selon une méthodologie souvent transversale. Cependant, très peu de chercheurs se sont attardés à mesurer de façon empirique, l’évolution des réactions des cadres intermédiaires et encore moins, en contexte de plusieurs changements simultanés, selon une méthodologie diachronique. Selon une étude de Prosci (2012), la résistance des cadres intermédiaires serait le quatrième plus important obstacle d’une transformation et plus de la moitié de cette résistance pourrait être évitée si elle était gérée pro-activement. Décoder les préoccupations inhérentes aux changements concomitants qui sont à la source de la résistance (selon le modèle des phases de préoccupations de Bareil, 2004) et prendre en considération les niveaux d’appropriation envers chaque changement pourraient contribuer à faciliter le soutien et l’accompagnement des cadres intermédiaires afin qu’ils deviennent des agents efficaces de transformation. Des focus groupes ont été utilisés à trois reprises et des questionnaires à deux reprises, auprès d’environ 90 cadres intermédiaires travaillant dans des établissements de santé, durant la mise en œuvre de trois changements majeurs, sur une période de 27 mois. Les résultats de cette recherche démontrent que non seulement l’appropriation des changements par les managers est demeurée modérée et stable dans le temps mais qu’elle a même régressé dans le cas d’une fusion de trois établissements, en dépit des conditions favorables mises en place. Également, les cadres ont vécu de nombreuses préoccupations, intenses, constantes et spécifiques à la difficulté de conduire plusieurs changements radicaux durant une même période, sans pour autant que le mouvement interphase ne se produise. En fait, l’évolution des préoccupations s’est située davantage dans un mouvement intra-phase. Finalement, il semble que les cadres intermédiaires aient tendance à avoir de vives réactions qui évoluent lentement au cours des deux premières années d’une transformation.

Purpose – Two complementary objectives are addressed in this paper. First, several studies are introduced based on the assumption that organizational change is now excessive. The purpose of this paper is to propose an operational definition to change excessiveness, and the authors assess whether it is a generalized phenomenon at a societal level. Second, these studies are habitually mobilizing coping theories to address their purpose. However, an integrated model of coping, including appraisals and coping reactions towards change is still to be tested. Thus, the assessment is anchored in an application of the Stimulus-Response Theory of Coping (SRTC). Design/methodology/approach – A quantitative study is conducted by administering questionnaires to a nationwide representative sample ( n =1,002). Anderson and Gerbing (1991) two-step approach is used to validate the study and tests its hypothesized model. Change excessiveness is measured in order to observe if it is a generalized phenomenon in the working population. Its effects on coping are modelled through the fully mediated SRTC. Therefore, the hypothetical model predicted that the relationships between the perception of excessive change contexts and negative coping reactions is fully mediated by negative appraisals towards change contexts. Findings – Perceptions of excessive change is a normally distributed and a statistically centralized phenomenon. As hypothesized, an structural equation modelling test of the SRTC shows a full mediation effect of negative appraisal between change intensity and negative coping to change. Originality/value – This paper empirically tests a nationwide sample where organizational change may be too excessive for individuals’ positive coping. It is the first to generalize the observation of change excessiveness as perceived by employees to a nationwide level. Moreover, it addresses the gap between change excessiveness and coping theories in modelling the SRTC through its three components: event, appraisals, and coping reactions. Finally, it presents managerial discussions towards the strategic necessity for organizational change and its potential “too-much-of-a-good-thing” effects.

BACKGROUND:Facilitation is a powerful approach to support practice change. The purpose of this study is to better understand the facilitation roles exercised by both external facilitators and interprofessional facilitation teams to foster the implementation of change. Building on Dogherty et al.'s taxonomy of facilitation activities, this study uses an organizational development lens to identify and analyze facilitation roles. It includes a concise definition of what interprofessional facilitation teams actually do, thus expanding our limited knowledge of teams that act as change agents. We also investigate the facilitation dynamics between change actors.METHODS:We carried out a qualitative analysis of a 1-year process of practice change implementation. We studied four family medicine groups, in which we constituted interprofessional facilitation teams. Each team was supported by one external facilitator and included at least one family physician, one case manager nurse, and health professionals located on or off the family medicine group's site (one pharmacist, plus at least one nutritionist, kinesiologist, or psychologist). We collected our data through focus group interviews with the four teams, individual interviews with the two external facilitators, and case audit documentation. We analyzed both predetermined (as per Dogherty et al., 2012) and emerging facilitation roles, as well as facilitation dynamics.RESULTS:A non-linear framework of facilitation roles emerged from our data, based on four fields of expertise: change management, project management, meeting management, and group/interpersonal dynamics. We identified 72 facilitation roles, grouped into two categories: "implementation-oriented" and "support-oriented." Each category was subdivided into themes (n = 6; n = 5) for clearer understanding (e.g., legitimation of change/project, management of effective meetings). Finally, an examination of facilitation dynamics revealed eight relational ties occurring within and/or between groups of actors.CONCLUSIONS:Facilitation is an approach used by appointed individuals, which teams can also foster, to build capacity and support practice change. Increased understanding of facilitation roles constitutes an asset in training practitioners such as organizational development experts, consultants, facilitators, and facilitation teams. It also helps decision makers become aware of the multiple roles and dynamics involved and the key competencies needed to recruit facilitators and members of interprofessional facilitation teams.

Background Seven chronic disease prevention and management programs were implemented across Quebec with funding support from a provincial-private industry funding initiative. Given the complexity of implementing integrated primary care chronic disease management programs, a knowledge transfer meeting was held to share experiences across programs and synthesize common challenges and success factors for implementation. Methods The knowledge translation meeting was held in February 2014 in Montreal, Canada. Seventy-five participants consisting of 15 clinicians, 14 researchers, 31 knowledge users, and 15 representatives from the funding agencies were broken up into groups of 10 or 11 and conducted a strengths, weaknesses, opportunities, and threats analysis on either the implementation or the evaluation of these chronic disease management programs. Results were reported back to the larger group during a plenary and recorded. Audiotapes were transcribed and summarized using pragmatic thematic analysis. Results and discussion Strengths to leverage for the implementation of the seven programs include: (1) synergy between clinical and research teams; (2) stakeholders working together; (3) motivation of clinicians; and (4) the fact that the programs are evidence-based. Weaknesses to address include: (1) insufficient resources; (2) organizational change within the clinical sites; (3) lack of referrals from primary care physicians; and (4) lack of access to programs. Strengths to leverage for the evaluation of these programs include: (1) engagement of stakeholders and (2) sharing of knowledge between clinical sites. Weaknesses to address include: (1) lack of referrals; (2) difficulties with data collection; and (3) difficulties in identifying indicators and control groups. Opportunities for both themes include: (1) fostering new and existing partnerships and stakeholder relations; (2) seizing funding opportunities; (3) knowledge transfer; (4) supporting the transformation of professional roles; (5) expand the use of health information technology; and (6) conduct cost evaluations. Fifteen recommendations related to mobilisation of primary care physicians, support for the transformation of professional roles, and strategies aimed at facilitating the implementation and evaluation of chronic disease management programs were formulated based on the discussions at this knowledge translation event. Conclusion The results from this knowledge translation day will help inform the sustainability of these seven chronic disease management programs in Quebec and the implementation and evaluation of similar programs elsewhere.

Implementing interprofessional collaborative practices in primary care is challenging, and research about its facilitating factors remains scarce. The goal of this participatory action research study was to better understand the driving forces during the early stage of the implementation process of a community-driven and patient-focused program in primary care titled "TRANSforming InTerprofessional cardiovascular disease prevention in primary care" (TRANSIT). Eight primary care clinics in Quebec, Canada, agreed to participate by creating and implementing an interprofessional facilitation team (IFT). Sixty-three participants volunteered to be part of an IFT, and 759 patients agreed to participate. We randomized six clinics into a supported facilitation ("supported") group, with an external facilitator (EF) and financial incentives for participants. We assigned two clinics to an unsupported facilitation ("unsupported") group, with no EF or financial incentives. After 3 months, we held one interview for the two EFs. After 6 months, we held eight focus groups with IFT members and another interview with each EF. The analyses revealed three key forces: (1) opportunity for dialogue through the IFT, (2) active role of the EF, and (3) change implementation budgets. Decision-makers designing implementation plans for interprofessional programs should ensure that these driving forces are activated. Further research should examine how these forces affect interprofessional practices and patient outcomes.

The aim of this article is to identify the factors facilitating the invention, dissemination and diffusion phases of the innovation process. An action-research was conducted in a hospital setting using mixed methods (participant observation, interviews and questionnaires). A triple case study illustrated the invention of a change management methodology, its dissemination using an interactive learning strategy and its diffusion within and outside the organization. Ten factors from various research traditions emerged. No model was able to explain all factors facilitating one phase. Phases of the innovation process were carried out dynamically, as a continuously reactivated process.

Background: The chronic care model provides a framework for improving the management of chronic diseases. Participatory research could be useful in developing a chronic care model–based program of interventions, but no one has as yet offered a description of precisely how to apply the approach. Objectives: An innovative, structured, multi-step participatory process was applied to select and develop (1) chronic care model–based interventions program to improve cardiovascular disease prevention that can be adapted to a particular regional context and (2) a set of indicators to monitor its implementation. Methods: Primary care clinicians (n = 16), administrative staff (n = 2), patients and family members (n = 4), decision makers (n = 5), researchers, and a research coordinator (n = 7) took part in the process. Additional primary care actors (n = 26) validated the program. Results: The program targets multimorbid patients at high or moderate risk of cardiovascular disease with uncontrolled hypertension, dyslipidemia or diabetes. It comprises interprofessional follow-up coordinated by case-management nurses, in which motivated patients are referred in a timely fashion to appropriate clinical and community resources. The program is supported by clinical tools and includes training in motivational interviewing. A set of 89 process and clinical indicators were defined. Conclusion: Through a participatory process, a contextualized interventions program to optimize cardiovascular disease prevention and a set of quality indicators to monitor its implementation were developed. Similar approach might be used to develop other health programs in primary care if program developers are open to building on community strengths and priorities.

Restricted accessAbstractFirst published online July 1, 20122012 Abstracts and Posters Canadian Pharmacists Association Conference June 1–4, 2012 • Whistler, BCVolume 145, Issue 4https://doi.org/10.3821/145.4.cpjS1

Résumé La vie au travail est ponctuée de multiples changements que le cadre intermédiaire doit intégrer dans les pratiques quotidiennes de son unité. Pour optimiser les chances de succès de ces changements organisationnels, celui-ci doit apprendre à décoder les préoccupations qui sont à la source des résistances aux changements. Ce diagnostic des préoccupations est nécessaire pour maintenir un dialogue constructif avec ses employés, son supérieur immédiat, ses collègues et les autres parties prenantes et pour intervenir adéquatement auprès d’eux. Apprendre à décoder les préoccupations des destinataires constitue une habileté clé que le cadre doit maîtriser en vue de favoriser l’appropriation du changement. Cet article vise à aider les gestionnaires à exploiter de manière positive la résistance à l’aide du modèle des phases de préoccupations. Certaines difficultés liées à la prise en compte des préoccupations et des résistances des acteurs sont aussi traitées et, finalement, des conseils et des conditions de succès sont présentés.

Résumé La mise en œuvre d’un changement majeur repose en grande partie sur les épaules des cadres, qui agissent comme intermédiaires entre les orientations de la direction et la concrétisation du changement pour le personnel. Que savons-nous des meilleures pratiques auxquelles les cadres peuvent recourir pour mettre en place le changement? Comment la direction peut-elle appuyer ses cadres afin qu’ils démontrent une plus grande efficacité envers trois enjeux cruciaux : la légitimation du changement, sa réalisation et son appropriation par les personnes concernées? De nombreuses pistes de soutien sont proposées aux dirigeants pour qu’ils aident les cadres à devenir des acteurs clés dans la conduite d’un changement important.

It is generally believed that individuals are predisposed to organizational change and have a natural tendency to react in the same way, regardless of the change. This study deals with this popular belief by determining the level of discomfort experienced by 321 employees of the same organization who were simultaneously confronted with three organizational changes: a structural reorganization, a relocation of the workplace, and a technological change. The overall results reveal that each change creates a distinct level of discomfort. However, at an individual level, these results overshadow the presence of two patterns of discomfort with change: a dispositional pattern for almost a quarter (23%) of respondents, for whom the level of discomfort remains identical regardless of the change, and a situational pattern, prevalent among 77% of respondents, for whom the level of discomfort differs from one change to the next. In addition, regardless of the occupational group considered, the proportion of respondents who show a situational pattern of discomfort with change is always much higher than the proportion of individuals who have a dispositional pattern of discomfort. These results bring an important clarification to popular beliefs by showing that although certain individuals have a tendency to react to change in a stable manner (dispositional pattern), this pattern is prevalent only among a minority of employees. For the majority, the situational pattern predominates.