2
     REALIZING CHANGE
     Why is it so difficult to achieve “radical” (transformative) 
     change?
                                            3
    The structure of the health care system…
                                                         4
        Can we realize change in such a large and 
                       complex system?
       What ability do you as an “organizational actor” have…
                 to make system level change happen… 
                                   
       relative to the role of other players in the organizational 
                             context…
       and the interaction between multiple structural elements 
       (organizational structures, hierarchies, mandate letters, 
                     budgets, agreements etc)?
                                            5
      Competing interests, pressures and 
                    dynamics? 
                                                           6
        Assessing commitment to change
     • Status quo commitment of key dominant groups to 
      prevailing institutional template in use
     • Indifferent commitment with key dominant groups neither 
      committed nor opposed
     • Competitive commitment by key dominant groups to 
      different templates
     • Reformative commitment in which key dominant groups are 
      against current template in use and prefer an articulated 
      alternative (situation required for “radical” change)