Facilitation of Change in the Healthcare Context - Learning from an Action Research Project at an Operating Unit

Abstract: Healthcare is under pressure and a development towards a more integrated and efficient healthcare requires better communication and collaboration across boundaries. This thesis is about facilitation of change process in the healthcare context with learnings from an authentic project, carried out with the clinic for reconstructive plastic surgery at the Karolinska University Hospital. The methodological approach was based on action research. The project deals with improving the utilisation of a clinic's operating rooms through promoting cross-boundary collaboration and finding new ways to structure work and counter deficient cultures. Through collection of qualitative data from interviews, workshops and observations a comprehensive picture of the organisation and its individuals was acquired, along with a legitimacy of the facilitator. By interpreting the data and concurrently facilitating a process of formulating and implementing change initiatives at the clinic, reflections could be made on the complexity of challenges in interprofessional teamwork and decisive factors in change processes. Based on participative leadership and empowerment the clinic staff was supported to enhance their cross-boundary collaboration and capacity to problem-solve. The clinic staff did, among other changes, improve the communication in the process of planning surgeries and introduce a systematic and formalised process on following up on the surgeries’ time consumption to deal with root causes for delays and cancellations. A representative challenge at the clinic, related to interprofessional teamwork, proved to be the difficulty of getting started in the morning in time with everyone present. This challenge requires cultural change with conviction of the problem and a willingness to improve the cross-boundary collaboration. Throughout the process of formulating the problem and solution paths as well as initiating implementation, the facilitator’s role constituted of gathering the group and guiding the progress with an approach of humbleness and diplomacy. The learnings from the study are relevant when discussing the approach and involvement of external actors in healthcare in order to pursue organisational development and change management.