The Role of the Champion in Primary Care Organizational Change—an Initial Theory

Context Primary health care services have undergone many transformations in recent years and are still in movement. Several studies have examined the factors that contribute to the success or failure of organizational change. The champion is a member of an organization who promotes innovation through social influence. Champions appear to be a critical factor in the success of organizational change. However, the causal relationship between the presence of the champion and the success of the organizational change is complex and still not well researched. There is a need to understand the underlying characteristics and mechanisms of the champion to understand when, why, and how they help facilitate organizational change.

Objective To propose an initial theory based on the current literature that explains the mechanisms by which the champion can facilitate change in primary care. Study Design and Analysis Critical interpretive synthesis. Dataset Publications retrieved from MEDLINE, CINAHL, PsychINFO, and EconLit. Population Studied A total of 57 studies were included. Instrument The PHOENIX theoretical framework was used as a starting point. Outcome Measures Elements of context, process mechanisms, and outcomes were identified and integrated into an emerging theoretical framework to formulate hypotheses about plausible reasons and responses that explain the champion’s effect according to context.

Results The champion uses several actions to induce changes depending on the context. Our synthesis shows that no one specific action enables a champion to facilitate change, but rather change is achieved through a combination of small actions. Actions like coaching, providing training and feedback, resolving barriers, and involving the right people are recognized as affecting the process of change. The context within which a change is introduced, including the change’s setting and characteristics, the champion’s position, and the perception of peers, also modifies the champion’s choice of actions and their effects. These actions seem to affect change through five main mechanisms: adapting the context to be conducive to change, sensitizing peers to the change, creating a positive perception of the change, striving for the social norm, and maintaining momentum during the change process.

Conclusion This theory raises several hypotheses that will be tested and refined in a multiple case study and provides a solid foundation for a realistic evaluation of the champion.