Longo Francesco
Health and Social Care Management Research Center (CERGAS), Bocconi University, Milan, Italy.
Health Care Manage Rev. 2007 Jul-Sep;32(3):213-25. doi: 10.1097/01.HMR.0000281620.13116.ce.
There has been much innovation in primary care in the past few decades. Although external and systemic constraints for health care organizations are relevant for their managerial evolution, there is also evidence that organizations operating under the same external pressures reach different levels of maturity.
Which of the internal drivers available explain and foster change? Is it possible to rank change drivers by looking at their rate of efficacy in order to define a general change management path in the relationship between managers and physicians? The study is a hypothesis-generating work, designed to discuss a framework, consistent with the complex adaptive systems literature, for more effective internal change management approaches.
We employed a qualitative approach to conduct a multiple case study in order to directly observe the evidence and to ask "key change players" for their perceptions. We studied different organizations all subject to the same external constraints in order to focus on the effects of internal change drivers.
According to key players' opinions, the main drivers for managerial development are characteristics of the actors involved: their motivation, leadership, and commitment; the quality of relationships among the main actors; and how the resources dedicated to manage change are used. Given these criteria, any organizational strategy and goal seems to be achievable. This is consistent with the suggestions coming from the complex adaptive system literature. MANAGERIAL IMPLICATIONS: Managers have to consider the management of the relationship with professionals as the key success factor for implementing change. Managerial leadership has to be diffused in the organization both in the vertical and horizontal dimensions. Innovations need a medium or long-term perspective to become widely applied, and this requires a strong commitment which is related to managerial stability. Resources for innovation are to be considered a critical driver for fostering the relationship between managers and professionals.
在过去几十年中，初级医疗保健领域有诸多创新。尽管医疗保健组织面临的外部和系统性限制与其管理发展相关，但也有证据表明，在相同外部压力下运营的组织会达到不同的成熟水平。
哪些可用的内部驱动因素能够解释并促进变革？是否有可能通过观察其效力率对变革驱动因素进行排序，以便在管理者与医生之间的关系中定义一条通用的变革管理路径？该研究是一项提出假设的工作，旨在讨论一个与复杂适应系统文献相一致的框架，以实现更有效的内部变革管理方法。
我们采用定性方法进行多案例研究，以便直接观察证据并询问“关键变革参与者”的看法。我们研究了所有受相同外部限制的不同组织，以关注内部变革驱动因素的影响。
根据关键参与者的意见，管理发展的主要驱动因素是相关行为者的特征：他们的动机、领导力和承诺；主要行为者之间关系的质量；以及用于管理变革的资源的使用方式。基于这些标准，任何组织战略和目标似乎都是可以实现的。这与复杂适应系统文献提出的建议一致。
管理者必须将与专业人员关系的管理视为实施变革的关键成功因素。管理领导力必须在组织的纵向和横向维度中得到传播。创新需要中长期视角才能得到广泛应用，这需要与管理稳定性相关的坚定承诺。创新资源应被视为促进管理者与专业人员之间关系的关键驱动因素。
