title: People and teams matter in organizational change: professionals' and managers' experiences of changing governance and incentives in primary care.
abstract: OBJECTIVE
  To explore the experiences of governance and incentives during organizational change for managers and clinical staff.
  
  
  METHODS
  Three primary care settings in England in 2006-2008.
  
  
  METHODS
  Data collection involved three group interviews with 32 service users, individual interviews with 32 managers, and 56 frontline professionals in three sites. The Realistic Evaluation framework was used in analysis to examine the effects of new policies and their implementation.
  
  
  RESULTS
  Integrating new interprofessional teams to work effectively is a slow process, especially if structures in place do not acknowledge the painful feelings involved in change and do not support staff during periods of uncertainty.
  
  
  CONCLUSIONS
  Eliciting multiple perspectives, often dependent on individual occupational positioning or place in new team configurations, illuminates the need to incorporate the emotional as well as technocratic and system factors when implementing change. Some suggestions are made for facilitating change in health care systems. These are discussed in the context of similar health care reform initiatives in the United States.
authors.affiliation: Department of Health Sciences, University of York, Heslington, York, UK.
authors.forename: Helen T
authors.initials: HT
authors.lastname: Allan
authors.forename: Sally
authors.initials: S
authors.lastname: Brearley
authors.forename: Richard
authors.initials: R
authors.lastname: Byng
authors.forename: Sara
authors.initials: S
authors.lastname: Christian
authors.forename: Julie
authors.initials: J
authors.lastname: Clayton
authors.forename: Maureen
authors.initials: M
authors.lastname: Mackintosh
authors.forename: Linnie
authors.initials: L
authors.lastname: Price
authors.forename: Pam
authors.initials: P
authors.lastname: Smith
authors.forename: Fiona
authors.initials: F
authors.lastname: Ross
mesh_terms: D004644:Emotions; D004739:England; D018166:Health Care Reform; D006282:Health Personnel / Q000523:psychology*; D006302:Health Services Research; D006801:Humans; D007407:Interviews as Topic; D009042:Motivation; D009936:Organizational Innovation; D010348:Patient Care Team / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*
keywords: Emotions; chronic illness; health care; health policy/policy analysis; relationships