Service improvement in health care: understanding change capacity and change context

This article uses the stream of literature relating to receptive contexts for change to explore the variations in progress on change implementation between different organisations within healthcare. The aim of the article is to develop our understanding of change processes as they unfold in complex organisations. The article uses empirical data from 11 healthcare sites in the UK to explore how variations can be explained and what impacts on an organisation's capacity to manage changes effectively . Analysis of the data identified three contextual features common to all sites which impacted on progress in organisational change. These features were: the presence or absence of change leaders, at several levels throughout the organisation a coherent change strategy a sound foundation of relationships between managers and clinical professional groups. Using these empirical results, we review and refine the concept of 'receptive contexts' for change in healthcare and develop ideas about how contextual characteristics impact change implementation.