The Price of Knowledge : A Study of Challenges to Change in Professional Organizations

Abstract: Stronger financial pressures are currently challenging previously unopposed ways of directing work within professional organizations, where strong groups characterized by power, prestige and autonomy play a major role. As a result of increased scrutiny of professions from the outside, resistance to change emerges in these settings. Earlier applied frameworks for understanding change mechanisms in a professional setting are however rather limited in their understanding of how change dynamically occurs. By designing a novel, more dynamic framework for organizational change, we aim in this thesis to develop an increased understanding for challenges to change initiatives in professional organizations. Through observational studies and open interviews at a Swedish hospital working with process development based on lean principles, we were able to identify the five discursive practices of “Shielding the Profession”, “Exempting Exceptions”, “Positioning Subjects”, “Casting the Other” and “Engaging” as being typical for professional organizations. By understanding the dynamics of discursive interplay, we could then explain how these practices contributed to three major challenges to change initiatives within professional organizations; “The challenge of novel concepts”, “The challenge of achieving managerial influence” and “The challenge of distance”. Our results should provide a foundation for further studies wanting to explore how change processes strategically can be managed, but could also be used as a tool for managers in professional organizations wanting to understand why change initiatives do not result in desired outcomes.