What happened to the no-wait hospital? A case study of implementation of operational plans for reduced waits.
BACKGROUND
Both research and practice show that waiting lists are hard to reduce. Implementing complex interventions for reduced waits is an intricate and challenging process that requires special attention for surrounding factors helping and hindering the implementation. This article reports a case study of a hospital implementation of operational plans for reduced waits, with an emphasis on the process of change.


METHODS
A case study research design, theoretically informed by the Pettigrew and Whipp model of strategic change, was applied. Data were gathered from individual and focus group interviews with informants from different organizational levels at different times and from documents and plans.


RESULTS
The findings revealed arrangements both helping and hindering the implementation work. Helping factors were the hospital's contemporary savings requirements and experiences from similar change initiatives. Those hindering the actions to plan and agree the changes were unclear support functions and unclear task prioritization.


CONCLUSIONS
One contribution of this study is to demonstrate the advantages, disadvantages, and challenges of a contextualized case study for increased understanding of factors influencing organizational change implementation. One lesson for current policy is to regard context factors that are critical for successful implementation.
Department of Learning Informatics Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden. Johan.L.Hansson@ki.se
Johan
J
Hansson
Sara
S
Tolf
John
J
Øvretveit
Jan
J
Carlsson
Mats
M
Brommels
D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006739:Hospital Administration; D006801:Humans; D019982:Organizational Case Studies; D009937:Organizational Objectives; D011787:Quality of Health Care / Q000458:organization & administration*; D013997:Time Factors; D014850:Waiting Lists