The Creation of Readiness for Change of IT Professionals in Technological Change Processes and the Influence of External Change Agents

Master thesis, MSc. Business Administration - Change Management University of Groningen, Faculty of Economics and Business

April 2014 LUCIEN KLEISMAN Student number: 1712675 Knopstraat 10, 3551 ET Utrecht Phone: +31 (0)650811211 Email: l.g.j.kleisman@student.rug.nl

Supervisors University of Groningen Drs. H.P. van Peet

Drs. J.C.L. Paul

ABSTRACT

This study draws on a qualitative, multiple case study to contribute to the existing body of literature by giving insights in how change readiness of IT professionals arises during technological changes. Next to that, it gives external change agents an emerging understanding about how to involve IT professionals in order to positively influence their change readiness which will result, eventually, in a higher chance of change success. The research incorporates the insights obtained from in-depth interviews with seven IT professionals at two teaching hospitals as well as with three external change agents who facilitated the change processes. The findings show that there are six mechanisms which are important for the development of change readiness of IT professionals regarding the quality of communication, the participation in the change and content understanding by external change agents. These mechanisms are 1) a concrete roadmap for the IT professionals, 2) a clear functional question for the IT professionals, 3) dialogue between the external change agents and the IT professionals, 4) a structured collaboration between the external change agents and the IT professionals, 5) the moment of involvement of the IT professionals and 6) the knowledge of the IT environment by the external change agents. According to the IT professionals, all six mechanisms could have been performed better by the external change agents. Therefore, they indicated that their change readiness would probably have been higher when these mechanisms were performed more desirable by the external change agents. Finally, this study leads to six propositions that provide researchers with ideas about the development of change readiness of IT professionals as a starting point for further research.

Keywords: readiness for change, IT professionals, technological change processes, external change agents, multiple case study.

Acknowledgements

TABLE OF CONTENT

2.1 Readiness for change...8

2.2 Professionals...9

2.3 External change agents...12

2.4 Context understanding...13

2.5 Quality of communication...13

2.6 Participation in the change...15

2.7 Conclusion theoretical part...17

3. METHODOLOGY ... 18 3.1 Organizational context...18 3.2 Case descriptions...19 3.3 Case selection...20 3.4 Data collection...21 3.5 Measurements...22 3.6 Data analysis...23

3.7 Validity and reliability...25

4. RESULTS ... 27

4.1 Within-case analyses...27

4.2 Cross-case analysis...39

5. DISCUSSION AND CONCLUSION ... 42

5.1 Propositions...49

5.2 Managerial implications...51

5.3 Limitations & further research...52

REFERENCES... 53

1. INTRODUCTION

“The only thing constant within organizations is the continual change of these organizations”. This is a famous and often used quote within the change management literature (Elving, 2005). In the outside world are many competitive forces and organizations respond to this by creating change (Eby, Adams, Russel and Gaby, 2000). Unfortunately there are only a minority of changes that become successful. According to Beer and Nohria (2000) most organizational changes do not reach their intended outcome and only 33% of these initiatives achieve some kind of success.

Organizational change can be seen as a process that consists of different phases (Armenakis & Harris, 2002; Lewin, 1951). A well-known theory of organizational change is the three stage model of Lewin (1951). He stresses that there are three stages employees have to go through in order to change successfully namely, unfreezing, moving and refreezing. In the unfreezing phase, employees have to break with the status-quo to be able to unlearn old behavior. In the moving phase, the actual change will be implemented and in the refreezing phase the change will be institutionalized in order to stick to the new way of working. The concept of unfreezing is similar to the concept of change readiness (Armenakis, Harris and Mossholder, 1993; Bernerth, 2004). Change readiness is expressed in people’s attitudes, beliefs and intentions related to the need for change and the organization’s ability to achieve the intended outcomes (Armenakis et al., 1993). Armenakis et al. (1993) and Bernerth (2004) argue that this first stage of unfreezing needs to be realized before there can be proceeded with the second stage. In other words, there cannot be a shift to the new way of working if employees are not ready to change and still show resistance (Rowden, 2001). Therefore it is important that the implementers of the change try to create change readiness among the employees in order to get support for the implemented change in the end (Gates, 2007). Change readiness is a widely discussed concept and many authors agree upon the fact that it reduces resistance and is therefore an important factor in increasing the success rate of a change (Holt, Helfrich, Hall and Weiner, 2010; Elving, 2005; Eby et al., 2000; Armenakis et al., 1993). As can be read above, many studies have revealed the concept of change readiness. Due to this importance of readiness for change for eventual success of a change it will be subject of this research.

employees, who mostly learn their tasks on the job and are shaped by the existing organizational culture (Drucker, 1952).

Also in several studies there is only focus on the internal change agent (Armenakis et al, 1993). Cawsey et al. (2012) state that it may be necessary to make use of an external agent in organizational change. Reasons to bring in an external agent are his or her fresh perspective through ideas that worked somewhere else and he or she can provide the organization with independent, credible and trustworthy support. However, in the study of Harison & Boonstra (2008) one expert argued the opposite: “external project managers (i.e. change agents) are often missing a profound insight in the history of the organization, such as failed projects and competition among departments. Understanding the context of a technochange project is so important for project managers (i.e. change agents)”. Although these are two opposing views on how useful an external agent is, his or her role in the change process is still an underexposed area.

Besides the underexposed area of external change agents, Bloomfield and Danieli (1995) stress that IT is becoming more and more important in today’s organizations and that the implementation of IT systems is still problematic and may cause several issues. They argue that the role and the impact of external change agents who are focused on technological change projects remains relatively unknown. If external agents want to be successful, Bloomfield & Danieli (1995) state that they not only need the required technical skills but they also need to have sufficient communicating and negotiating skills. They say that change agents often notice that “the IT system is all right but management is lacking”. Although the latter can be the case, Bloomfield & Danieli (1995) argue that this statement is also a vital characteristic of an IT consultant’s claim to expertise. Also Oreg, Vakola and Armenakis (2011) state that it is likely that change agents play an important role in the success or failure of a change and that it is not only a change recipient issue (Ford, Ford and D’Amelio, 2008).

regarding professionals. However, there is little known about the influence of context understanding by change agents and actions undertaken by them if these change agents are surrounded by professionals. For this reason there will be investigated to what extent the knowledge of external agents about the specific change context plays a role in the development of change readiness of professionals and in the overall success of the change. In the following paragraph, the research questions will be elaborated.

1.1 Research questions

The main research question that will be answered in this study is:

How do interpersonal mechanisms used by external change agents influence the development of change readiness of IT professionals in technological change processes and what is the influence of context understanding on these interpersonal mechanisms?

In this research the interpersonal mechanisms are participation in the change and quality of the communication. Sub questions are made for both concepts to gain more insight in these concepts and the process by which they influence the development of change readiness of IT professionals. Furthermore, a sub question is made for the concept context understanding to see how this influences the interpersonal mechanisms. The sub questions are:

1. How does the quality of the communication by external change agents influence the development of change readiness of IT professionals in technological change processes?

2. How does the participation in the change organized by external change agents influence the development of change readiness of IT professionals in technological change processes?

3. How does context understanding of external change agents influence the quality of communication and the participation in the change organized by external change agents in technological change processes?

Figure 1. Conceptual model before results

As can be seen from the conceptual model above, the following concepts will be examined in the next theoretical chapter:

1) Readiness for change 2) Professionals

3) External change agents 4) Context understanding 5) Quality of communication 6) Participation in the change

2. THEORY

In this chapter, the concepts from the conceptual model will be explained by means of a literature review. First, the concept readiness for change will be described. Later on, the concepts of professionals, external change agents and context understanding will be explained. Subsequently, the interpersonal mechanisms quality of communication and participation in the change will be elaborated. At the end of this chapter there will be a concluding theoretical part to summarize the theoretical section.

2.1 Readiness for change

As stated in the introduction, the concept of change readiness is a widely discussed concept with a large amount of existing literature and many authors agree upon the fact that change readiness reduces resistance and is therefore an important factor in increasing the success rate of a change. Several authors defined readiness to change in slightly different ways.

inclined to accept, embrace, and adopt a particular plan to purposefully alter the status quo.” (Holt et al., 2007, p. 235). According to Backer, David and Saucy (1995), change readiness need not be seen as a fixed condition of employees, but as a condition that is amenable to change, because it is affected by internal and external circumstances. Also Choi (2011) emphasizes that the attitude of employees regarding the change may vary per time and that these attitudes depend on situational factors. He argues that the attitude of employees regarding change therefore can be considered better as a situational condition than as a personal trait of employees.

These attitudes of organizational members regarding readiness for change, also stated in the definition of Holt et al. (2007), can be divided into three dimensions, namely the cognitive, emotional and intentional dimension (Piderit, 2000). The cognitive dimension refers to the beliefs and thoughts of an employee regarding the change, the intentional dimension refers to the actual behavior of the employee regarding the given change and the emotional dimension refers to the feelings of an employee regarding the change. This conceptualization of change readiness into three attitude dimensions is used in this study to capture the complexity of this concept properly.

When linking readiness for change to organizational change, many authors agreed upon the fact that change readiness reduces resistance and is therefore an important factor in increasing the success rate of a change (Holt et al., 2010; Elving, 2005; Eby et al., 2000; Armenakis et al., 1993; Bouckenooghe, 2010). It is possible to start change projects with low readiness, but if that leads to low motivation than those initiatives have a higher change to fail, research showed (Backer et al., 1995). Thus, interventions to increase readiness can be made and can enhance the probability to overall success of the change (Backer et al., 1995). To finalize, one can assume that when employees experience high levels of readiness on all three attitude dimensions (Piderit, 2000), the change initiative will be more successful (Elving, 2005).

2.2 Professionals

makes organizations capable of facing today's rapid changes and at the same time they can renew the other levels of operation to remain competitive (Quinn et al., 1996). From above it is now more transparent which skills professionals need within an organization in order to perform well.

In the study of Smits, McLean and Tanner (1993) emerges that professionals see themselves as punctual, organized, intelligent, educated and independent. While most of the positive traits that professionals gave themselves are found to be true, also some negative characteristics are grounded in the literature. Some of these are interpersonal insensitivity, poor people skills, and a preference for working alone (Smits, McLean and Tanner, 1993). Research of Vermaak & Weggeman (1999) illustrates that the majority of satisfaction criteria of professionals can be found in their own work, such as pleasure and progress in their own work and atmosphere in their own group. The length of work and financial rewards are less important. Professionals dislike for example slow procedures, bureaucracy and interference of management (Vermaak & Weggeman, 1999).

others and they are only interested in their own profession. Especially views from their supervisors are less valuable, because these supervisors often come from outside their professionals’ craft. Therefore, they tend to surround themselves with people who have similar backgrounds (Vermaak & Weggeman, 1999). Raelin (1989) supports this view and argues that most professionals are shaped by their discipline and culture and execute their responsibilities as a member of a professional group.

Next to the difficult controllability of professionals, Vermaak & Weggeman (1999) argue that professionals can be divided roughly in two types of professionals: the improvisation professional called the I-prof and the routine professional called the R-prof. The I-profs have large autonomy, they choose their own clients, they have colleagues from their external network and they are focused on their own needs in their development. R-profs have limited autonomy, their client is the organization, they have colleagues from their internal network and they are focused on the needs of the company (Vermaak & Weggeman, 1999). Looking at the differences between the two types of professionals, one can assume that R-profs are easier to manage for external change agents in terms of communication and participation than I-profs because they are more focused on the needs and the clients of the organization. On the other hand there can be assumed that I-profs are more amenable to change than R-profs because of their improvisation capacity. R-profs may be stuck in their routine and therefore it may be possible that they have more difficulty which changing processes.

From the review above one can argue that by linking professionals and professional organizations to change, several issues may arise. For example, as elaborated above, the three core problems of professional organizations (Vermaak & Weggeman 1999) and the clash between control and autonomy (Raelin, 1989). The art of managing professionals during change lies in the heart of communication. The existence of these core problems can be derived from the fact that a professional is a loner. Is it possible to create a situation where professionals work together towards a collective ambition instead of being divided? According to Vermaak & Weggeman (1999), managers (i.e. external change agents) can transform the core problems of professional organizations into inspiration, growth and dedication through dialogue. They argue that dialogue can help managers by bringing different views of professionals together and that it can be used to bridge these differences making clear that listening to each other is more important than only giving arguments for your own point of view. Through dialogue it is easier to find common interests between views of professionals and eventually it may be the case that possible differences complement each other and give a more complete wisdom of the problem that was drawn in the beginning (Vermaak & Weggeman, 1999).

(1999) state that professionals want to contribute to the collective ambition of the company but managers (i.e. external change agents) have to create the right circumstances to make these contributions possible. They argue that this collective ambition is only possible if managers (i.e. external change agents) let professionals participate in the process of goal setting and in other agreements about the work that have to be done. Those targets have to be discussed between the two parties and the manager (i.e. external change agent) have to organise a dialogue around this negotiation in order to reach agreement about the desired results (Vermaak & Weggeman, 1999).

The above literature shows the importance of communication, participation and dialogue in creating a collective ambition in target setting and other work agreements regarding professionals and external change agents. In this research there will be investigated if and to what extent external change agents use these concepts to overcome possible issues regarding managing professionals.

2.3 External change agents

2.4 Context understanding

According to Holt et al. (2007) there is a large amount of literature that argues that also the context of the organization where the change takes place is an important contributor to change readiness. Bouckenooghe et al. (2009) support this by stating that the context is one of the antecedents of readiness. According to Holt et al. (2007), the context includes the conditions and environment in which employees are working. Bouckenooghe et al. (2009) mention the context of change which they define as the perception of employees of the internal conditions in which the change takes place. The difference in both definitions is that Holt et al. (2007) explains what the context consists of and Bouckenooghe et al. (2009) argues how employees see their context during a change. In this study the definition of Bouckenooghe et al. (2009) will be used, because it is important for external change agents to understand and anticipate on the context that professionals perceive as their context during the change initiative. As the expert in the study of Harison & Boonstra (2009) said “Understanding the context of a technochange project is so important for project managers”. Harison & Boonstra (2009) present an assessment model in which they state that one of the criteria of a change agent is that he or she needs to have the ability to understand the specific context of the organization. Managing a technochange is not about managing a technical project only, but about managing a technical project in a specific organizational setting (Harison & Boonstra, 2009). They stress the importance of understanding the contextual elements by change agents in order to increase the probability of the overall success of the change. There is literature that examined the influence and importance of context understanding if change agents are surrounded by lower levelled employees. However, there is little known about the importance and influence of context understanding if change agents are surrounded by professionals. Due to this underexposed area, it is interesting to find out whether context understanding by external change agents is of different kind of interest when they are surrounded by professionals instead of lower levelled employees and how this context understanding influences the development of change readiness of professionals.

2.5 Quality of communication

Several authors stress the importance of communication in organizational change (Schweiger & Denisi, 1991; Elving, 2005; Dolphin, 2005; Armenakis et al., 2002). Bennebroek Gravenhorst et al. (2003) argue that communication is important for today’s organizations and that change managers need sufficient communicative skills to operate successfully on a daily basis.

and these transactions are intended to design (and redesign) organizations and coordinate day-to-day activities” (p.172). The definition of Dolphin is wider than the definition of O’Reilly & Pondy (1979), because it makes the reasons for communication more clear. According to Bouckenooghe (2009) the quality of communication refers to “how change is communicated. The clarity, frequency, and openness determine whether communication is effective” (p. 599) The definition of Bouckenooghe (2009) is leading in this research, because it explains what quality of communication includes and it refers to change, relevant in this study.

In order to face the importance of good communication in changing organizations, several authors developed a communication strategy. Klein (1996) explicated some key principles for communication that can, taken together, shape a strategy. According to Klein (1996), from these principles one can see that a good communication strategy includes message redundancy, the use of several media instead of one, personally relevant information instead of abstract, unfamiliar information and the preferred medium is face-to-face communication. According to Armenakis et al. (2002) there are five areas that a change message must cover. These five domains are discrepancy, efficacy, appropriateness, principal support and personal valence. Discrepancy covers the gap between the present state and the desired future state. The employees concerned must belief the need for change. Efficacy is the degree of confidence an employee has in his own ability regarding performance associated with the change. Principal support covers the degree of involvement of the management in the proposed change. Appropriateness refers to the idea that an employee may see the need for change, but disagrees with the proposed change. Also known as the extent to which the employee thinks the proposed change is suitable for the organization. The fifth and last area a change message must cover is personal valence: the extent to which the employee thinks he or she is benefitting from the proposed change also known as the question: “what is in it for me?” (Armenakis et al., 2002). Armenakis et al. (2002) also developed three different strategies a change agent can choose to carry out the change message. First they can use a persuasive communication strategy, also known as direct communication. This can be in the form of newsletters, memos or speeches. Secondly, change agents can use active participation. In these strategies, employees are directly involved in activities. Thirdly, the management of information can be used as a strategy. Here the change agent uses internal and external sources to feed employees with information about the change (Armenakis et al., 2002). The difference between the first and the third strategy is that in the third strategy also external sources of information are used. In general the idea is that more than one information source, especially when it comes from outside the organisation, is seen as more plausible (Armenakis et al., 2002).

readiness of their employees than organizations who do not (Elving, 2005; Schweiger & Denisi, 1991; Klein, 1996; Bouckenooghe, 2009; Miller, 1994; Armenakis et al., 2002). Additionally, communication can foster support and participation among employees (Choi, 2011). Also Schweiger & Denisi (1991) state that organizations who communicate caring and concern regarding organizational members, may expect increased employee commitment. Their main idea is that the content of the message is not always leading as long as employees feel that the organization cares about them (Schweiger and Denisi, 1991). One can assume that high quality of communication is even more important for the change readiness of professionals than for lower levelled employees, because of the issues that can arise between professionals and the rest of the organization due to culture differences. Vermaak & Weggeman (1999) support this by stressing that managers can transform the core problems of professional organizations into inspiration, growth and dedication through dialogue. Therefore this study will try to provide insights in the influence of communication by external agents on the development of change readiness of professionals.

2.6 Participation in the change

According to Cotton, Vollrath, Froggatt, Lengnick-Hall and Jennings (1988) there are six forms of participation that cover most studies, namely: Participation in work decisions, Consultative participation, Short-term participation, Informal participation, Employee ownership and Representative participation (Cotton et al., 1988). Participation in work decisions includes that employees are involved in decisions about the work itself. Consultative participation refers to circumstances where employees involve in long-term, formal and direct participation. In this latter form, the employee has more influence in the decision-making process. The third one, short-term participation, is contradictory to consultative participation in the way that it refers to short-term participation. For instance, training sessions are suitable for this form (Cotton et al., 1988). Informal participation arises when employees can participate in decision-making processes with their managers, because of their interpersonal relationship with them. Employee ownership is formal and indirect participation. This is the case when an employee has the formal right to participate, but only through an indirect source such as elections. Representative participation is the last form which means formal, indirect and of medium to low influence (Cotton et al., 1988). The latter form of participation is almost similar to employee ownership, but the difference is the lower level of employee influence in representative participation (Cotton et al., 1988).

Linking participation to readiness for change, most authors agree that employees who perceive high levels of participation also have a higher change readiness and acceptance (Oreg et al, 2011; Armenakis et al., 1993; Kotter & Schlesinger, 2008; Eby et al., 2000). Armenakis et al. (1993) stress that active participation ensures that employees can learn through own experience. This in turn has a positive effect on the change readiness of an organizational member. Holt et al. (2007) argue that the positive relation between participation and readiness for change may come from several mechanisms. First, those who can participate in a change can exert influence on the proposed change. In turn, those with direct influence may become committed to the change which will result in more readiness. Second, those who can participate in a change initiative will be able to grasp more information about the change than employees who cannot participate. This larger amount of information about the change may lead to better understanding about the reasons for change. This in turn may lead to more readiness for change (Holt et al., 2007).

2.7 Conclusion theoretical part

3. METHODOLOGY

In this chapter there will be elaborated on the methods used in this study. According to Cooper & Schindler (2008), qualitative research is suitable to answer ‘how’ and ‘why’ questions. Also this type of research is relevant to obtain rich and detailed information about change processes (Cooper & Schindler, 2008). Since this study is focusing on exploring instead of testing change situations and because the research question in this study tries to answer ‘how’ and ‘why’ questions, qualitative research will be performed.

In this research the case study method is used for developing the qualitative research, because this method is relevant in circumstances where ‘how’ and ‘why’ questions need to be explained (Yin, 2009). According to Cassell and Symon (2004), case study research contains detailed examination of phenomena placed in their context. In case studies the phenomena and the context are not separated from each other, like in laboratory research, because the goal is to find out how processes and actions are influencing the context and vice versa (Cassell and Symon, 2004; Yin, 2009). According to Eisenhardt (1989), there are several strengths of case studies. First of all, case studies have a high likelihood of generating novel theory. Second, emergent theory is likely to be testable with constructs that can be readily measured. Third, the resultant theory is likely to be empirically valid. In this study, two cases within the healthcare sector will be examined and therefore a multiple-case study will be conducted. According to Yin (1994), a case study is relevant “when how and why questions are being posed, when the investigator has little control over events, and when the focus is on a contemporary phenomenon within some real-life context” (Yin, 1994, p. 1). Within multiple case studies it is possible to use research data cumulatively which means that patterns can be found and compared between cases. In other words, there is a possibility for replication logic (Yin, 1994). Multiple case studies enables the researcher to get a deeper understanding of the subject (Cooper & Schindler, 2008). Below, information about the consultancy firm of the external change agents will be elaborated. After that, the two cases will be explained and the selection of these cases will be made clear.

3.1 Organizational context

3.2 Case descriptions

3.2.1 GIOCA – WLZ (FTP server)

This case is about a change process with information technology in healthcare whereby an external agent has been involved. The parties involved are Waterland hospital in Purmerend, the expertise center Gastro-Intestinaal Oncologisch Centrum Amsterdam (GIOCA) in Academic Medical Center (AMC), Zorgring Noord-Holland-Noord and the role of Soulve Innovations as an external change agent.

In March 2013, GIOCA indicated the need for a simple way of (digital) image transfer from referrers of GIOCA to GIOCA. After research Waterland hospital proved to have interest in this project as one of the referrers of GIOCA. The goal of this project is to reduce the time for complete referral information between Waterland hospital and GIOCA, resulting in a patient diagnosis process that can start earlier.

The proposed solution involves setting up a secure-FTP server at foundation Zorgring Noord-Holland-Noord, coordinating body of digital data exchange for healthcare providers in the region of Noord-Holland. This secure-FTP server makes it possible to place and retrieve radiological images in a fast and simple way. In July 2013, consensus is reached between the IT departments of both hospitals and the technicians of Zorgring Noord-Holland-Noord on how information can be transferred in a safe way. After consultation with a change agent of Soulve Innovation, IT-professionals of Waterland hospital build an application to make it possible for a radiological employee to place data on the FTP server. After that, IT-professionals of AMC have to establish a connection with the FTP server on their turn to make it possible to retrieve the specific data. Since the consensus reached in July 2013, the project did not make progress anymore. Through the whole period of the project, a change agent of Soulve Innovations had much contact with the IT professionals of both hospitals (Waterland hospital and AMC) and Zorgring Noord-Holland-Noord. In the end, the change agent has made several attempts through meetings, phone calls and e-mail, to support technicians from AMC to establish a connection with the FTP server and thereby accomplish the goals of the project, but without success.

3.2.2 UMC Utrecht (MediMapp)

From May 2012 till October 2012, several meetings were held with different stakeholders from UMC Utrecht, Soulve Innovations and with external general practitioners to design IT functionalities that could contribute to the improvement of the rapid diagnosis of colorectal cancer. The solution proposed in this project is an application, MediMapp, for rapid diagnosis of colorectal cancer. It is a smart digital application suitable for tablet and computer, that gives patients dosed information about their disease and treatment process. For this application, all technological resources and IT solutions are available for process support. This application is primary designed to improve customer experience and to deliver a diagnosis of colorectal cancer within 48 hours.

From November 2012, a project team has been composed which consisted of IT- and healthcare professionals, to use their expert opinion, and change agents of Soulve Innovations. Subsequently, several meetings were held as well as telephone and e-mail contact between change agents of Soulve Innovations and the professionals of UMC Utrecht about the application and the integration of this application, MediMapp, with the electronic hospital information system of UMC Utrecht.

In May 2013, there were some problems around the integration of MediMapp with the electronic hospital information system of UMC Utrecht, because of insufficient knowledge about this integration. Therefore, the frequency of contact between Soulve Innovations and the professionals of UMC Utrecht has been increased in order to cover all the issues that were faced.

From September 2013, the integration has been fully understood, whereby the application was ready for implementation in UMC Utrecht. In January 2014, Soulve Innovations has handed over the project leadership to UMC Utrecht. In the coming months, the final step has to be made by UMC Utrecht. The application MediMapp needs to be tested in the hospital in the form of a pilot.

3.3 Case selection

The cases described above are used, because they meet all requirements for answering the research question developed in the theoretical section of this study. That is, both cases include the concepts of IT professionals, external change agents and are both dealing with IT implementations.

three times longer than the duration of the GIOCA – WLZ case. Thirdly, after consulting the change agents of Soulve Innovations, there can be said that, according to their experiences, the UMC Utrecht project was more complex and more innovative than the GIOCA – WLZ case. Due to this higher complexity and a higher degree of innovation, the UMC Utrecht project was also more uncertain in both the content and the process during the whole trajectory according to the experiences of the change agents of Soulve Innovations. Due to the higher complexity and uncertainty of the UMC Utrecht project there can be presumed that the context in which the project is moving is more uncertain. Therefore it may be possible that, for external change agents, it is harder to understand and anticipate on the specific context of the UMC Utrecht project compared to the GIOCA – WLZ case.

3.4 Data collection

The data collection consists of semi-structured interviews with IT professionals and external change agents. Additionally, there is secondary source data used.

3.4.1 Semi-structured in-depth interviews

Because this study is focusing on exploring instead of testing change situations, in-depth interviews are carried out. In-depth interviews are a form of qualitative research and are used in this research to obtain rich and detailed information about the change processes (Cooper & Schindler, 2006). Besides the rich and detailed information of in-depth interviews, they also make it possible to exert control on the sequence in which questions are asked and it offers the interviewer the opportunity to clarify ambiguous questions (Thomas, 2004). These in-depth interviews are also suitable to use for sensitive subjects, like change readiness in this research (Thomas, 2004). The questions in the face-to-face interviews were predetermined, but the answering options were open. These interviews are also known as semi-structured face-to-face interviews (Blumberg, Cooper and Schindler, 2011). Additionally, these semi-structured interviews make it possible to control the topic to some extent during the interviews (Holloway and Wheeler, 2002). The interview consisted out of four core concepts which were change readiness (emotional, cognitive, intentional), quality of communication, participation in the change and context understanding. The interview protocol of the external change agents and the interview protocol of the IT professionals can be found in appendix A.

involvement and experiences within the project. Cooper & Schindler (2008) call this purposive sampling, participants chosen for their experiences. Not more than four IT professionals were interviewed, because there were not more IT professionals involved in this project. These four professionals were interviewed to create a complete overview of all parties and perspectives of the IT professionals in this project. One external change agent has been interviewed in this project, because he was the only change consultant who facilitated the change project. In the UMC Utrecht case, three IT professionals were interviewed. These three professionals (all from UMC Utrecht) were also selected on the basis of their involvement and experiences within the project. Not more than three IT professionals were interviewed, because there were not more IT professionals involved in this project. Also here, these three professionals were interviewed to get multiple insights in the perspectives of the IT professionals in UMC Utrecht about the project. Two external change agents have been interviewed in this project, because they were the only two consultants who facilitated the change project.

The interviews were held between the 17th of January and the 5th of February. The interviews lasted on average one hour and were kept on site. Before the start of the interview, confidentiality and anonymity were guaranteed regarding the interviewee.

3.4.2 Secondary source data

The secondary data that is used consists of internal documents about both projects, like business cases and sub-reports. Additionally, there are e-mails, field notes and other information examined to support and to extend the data obtained from the interviews.

3.5 Measurements

concept quality of communication and for question 14 of the concept participation are based on the OCQ– C, P, R questionnaire of Bouckenooghe (2009). Question 13 about the concept participation in the change is based on the CATOCQ (2008) questionnaire. For the remaining concepts and questions in both interviews that are not mentioned above, there are no existing instruments available where questions can be based on. Also there is no literature found about the relations between these concepts and therefore these concepts are part of this research. There are some presumptions made about patterns between the concepts in the theoretical section above and therefore the questions assigned to these concepts are used to see if these patterns exist.

The change agents are interviewed to examine their view about their influence on IT professionals and on project success through the interpersonal mechanisms, quality of communication and participation in the change. It is also the intention to get information about the importance of context understanding by external change agents and whether they took this specific context into account with regard to the involvement of IT professionals. The IT professionals are interviewed to find out whether and to what extent they perceived that the external change agents used these interpersonal mechanisms with regard to them and whether the change agents took the specific context of the IT professionals into account with regard to their actions. Overall, the interviews and the other internal documents are used to investigate the influence of the approach of external change agents on the development of the change readiness of IT professionals.

3.6 Data analysis

1 below. In this table, all categories are deductive which means that these categories were predetermined. All codes are inductive which means that these codes emerged from the interview data. During the interviews and the data analysis, it came to light that the IT professionals did not mention issues about the change context, but more about the change content. Therefore, the category context understanding is changed in content understanding. In addition, it has become clear after the data analysis that content understanding by external change agents has no direct influence on the quality of communication and on the participation in the change, but directly on the change readiness of IT professionals.

Table 1 Coding of interviews

Categories Codes Description / relationship with conceptual model Quality of

communication

Concrete roadmap The use of a roadmap that gives insight in the status of the change project

Clarity of functional question The question that answers the added value of the change project

Dialogue Through dialogue a communication technique

starts were views of professionals can be brought together

Participation in the change

Structured collaboration A collaboration were all activities are undertaking in the appropriate sequence of order

Moment of involvement The moment when the IT professionals are involved in the change project

Content understanding

Experience in healthcare The experience in healthcare of the external change agents

Knowledge of IT environment The knowledge of the IT environment by the external change agents

The codes were applied to the interviews with the IT professionals as well as for the interviews with the external change agents. Below is displayed how this is done on the basis of two text fragments, one of the IT professional and one of the external change agent.

Code: Moment of involvement

External change agent: "We had to involve the IT department two months earlier, but not right from the start. We started the project by figuring out all possible solutions, without looking at the technical feasibility. I still think that's a major strength of this project". (Transcript external change agent, case B)

Because there are two cases under study in this research, first a within-case analysis is performed for both cases. After that, a cross-case analysis is performed between the two cases. By performing two different analyses (within-case and cross-case analysis), the internal validity has been be improved, because the data is analyzed in multiple ways (Van Aken, Berends & Van der Bij, 2007). Finally, due to an amount of data that could be analyzed manually, there is no software program used for analysis.

3.7 Validity and reliability

A research design is supposed to represent a logical series of statements. Therefore, one can judge about the particular design according to certain logical tests (Yin, 2003). To assess and guarantee the quality of a qualitative research technique, four tests that are prepared by Yin (2003) can be used. These tests are often used to determine the quality of empirical social research. Because case studies are a form of this type of research, these tests are also relevant for assessing the quality of case studies (Yin, 2003). The tests are related to the construct validity, the internal validity, the external validity and the reliability of the research (Yin, 2003):

 Construct validity: determine the appropriate measures for the studied concepts.

 Internal validity: determine the causal relationship, whereby certain conditions demonstrate that they lead to other conditions and are distinguished from spurious relationships.

 External validity: determine the domain to which the research findings can be generalized.

 Reliability: demonstrating that the work of the study, including data collection procedures, can be repeated with the same results.

Table 2 Conducted case study tactics regarding the reliability and validity according to Yin (2003)

Test Tactic Phase in research Activity undertaken in this study

Construct validity

1. Use of multiple data sources

Data collection phase Interviews were conducted from various experts and additionally internal documents of Soulve Innovations are used as secondary source data 2. Determine chain proof Data collection phase All interviews are recorded

with an audio recorder and subsequently elaborated 3. Use of key informants

for control of the transcripts

Composition All transcripts are checked for errors by the respondents before the data analysis was performed

Internal validity 4. Discovering patterns Data analysis phase Patterns were identified when

comparing the results of the interviews and the analyses 5. Building explanatory

clarification about the cases

Data analysis phase Resulting theories were monitored during subsequent interviews. On these arising results, the theory is developed further

6. Handle competitive explanations / theories

Data analysis phase Competitive explanations / theories are elaborated in the theoretical section and later on in the discussion compared to the findings of this study 7. Use of logical models Data analysis phase Conceptual models are

developed for the structured display of the theory as well as the results emerged from this research

External validity 8. Use of theory in single

case studies

Research design Not applicable due to the multiple cases

9. Use of replication logic in multiple case studies

Research design Interviews conducted in two cases with partly the same characteristics

Reliability 10. Use of case study

protocol

Data collection phase During all interviews there is made use of an interview protocol

11. Develop case study database

4. RESULTS

In this section there will be elaborated on the results of the empirical research. First, the results will be presented per case, the within-case analysis. In the within-case analysis, the discovered mechanisms and codes from the data analysis will be elaborated. Subsequently, at the end of each within-case analysis, the patterns derived from this within-case will be shown. The goal of this result section is to expose the mechanisms and patterns that are found within the core categories: 1) quality of communication, 2) participation in the change and 3) content understanding and how these mechanisms and patterns influence the development of change readiness of IT professionals. Eventually, the patterns of both cases will be compared in a cross-case analysis. This section continues with a short description of the first case, GIOCA - WLZ.

4.1 Within-case analyses

4.1.1 GIOCA - WLZ (Case A)

This case is about a change process with information technology in healthcare whereby an external agent has been involved who is asked to facilitate this project. The parties and persons involved are one IT professional of Waterland hospital in Purmerend, two IT professional of the expertise center Gastro-Intestinaal Oncologisch Centrum Amsterdam (GIOCA) in Academic Medical Center (AMC), one IT professional of Zorgring Noord-Holland-Noord and one external change agent of Soulve Innovations. Comparing this case with the other one, there are some differences that can be noticed. The throughput time of this case was six months, three times shorter than the other case, contained less technical complexity and was less innovative than the other case. In this case, four parties were involved, two more than in the other case. In the following section the results regarding this case will be elaborated.

Quality of communication

Concrete roadmap. Three of the four IT professionals stated that there was no structured

entirely clear who had to do what and when in this project". The external change agent argues: "I think I was a little bit too careful in my formulation towards the professionals, where I should have been more directive and concrete perhaps". These two IT professionals argued that this role ambiguity had a negative impact on their willingness at that moment. They wanted to do something, but they didn’t know what to do.

Clarity of functional question. One of the four IT professionals from hospital A, argues that the

technical solution was directly addressed in the conversation between him and the external change agent. He says that it is hard to find out what the functional question is in that way and therefore he missed the logic behind the technical conversation. The external change agent acknowledges that he overlooked these issues during the project. The IT professional indicated that if he could have participated in the process of setting up the functional question, the urgency of this project would have been more clear for him. Subsequently, he would have been more willing to put energy and time in this project and his change readiness would probably be higher, because then he would know to which goals he would contribute.

Dialogue. Three of the four IT professionals stated that there was no communication about the

steps that had to be taken to complete the project. The IT professionals wanted such a roadmap, but only if they could participate in the preparation of this roadmap. Now there was no roadmap at all. They also argued that there was no conversation about the division of roles during the project what caused role ambiguity. The IT professionals indicated that this could have been prevented partly by organizing a kick-off meeting between the IT professionals and the external change agents in the beginning of the project, where all the goals and agreements about the project could have been negotiated. This would also have led to better insights in the urgency of the project. The IT professionals indicated that a kick-off meeting and subsequent structured meetings could have led to a more complete overview of all the different individual standpoints which would have eased the problems that were encountered now. They stated that when these events were organized, where dialogue is encouraged, they would probably have created more readiness for working on this project.

Participation in the change

Structured collaboration. Three of the four IT professionals emphasized that the external agent

be organized to discuss all individual points of view, all bottlenecks and all goals of the project. All three IT professionals indicated that this structured approach is essential for a smooth collaboration. However, this was not present in this case. The three IT professionals mentioned that the presence of a kick-off meeting and the presence of buy-in from all parties would probably have created more readiness.

Moment of involvement. When considering the involvement of the IT professionals, three of the

four respondents indicated that they personally had a say in the project and they were satisfied with it. However, there is some criticism about the moment of involvement. Three IT professionals argue that the IT department of hospital A is involved too late. One of them said: "In the context of the importance of buy-in of all parties, I guess that hospital A is involved too late. That the IT department of hospital A is informed, when there was already a complete technical solution. I can imagine that motivation decreases at that moment". Another IT professional, who is working at the IT department of hospital A, says: "There was already a technical solution proposed by the external change agent and the other parties, but that was not wise in this case. There was a lot of resistance against this ad hoc solution in my IT department, because they knew it did not fit in our program of long-term solutions. We are the party that have to realize the solution, but in this way, readiness is hard to find in my department". Here the IT professional illustrates that he and his team wanted to participate in the project from the beginning, so that they could contribute ideas about the functional question. Now he had the idea that he was not needed in the first part of the project. Because he was involved in a later part of the project, there was no space for dialogue to exchange ideas and insights between the IT professional and the external change agent. This caused incomprehension by the IT professional about the reasons for change. This IT professional indicated that if he would be involved from the start, his readiness would probably have been higher. Although the other IT professionals acknowledge this too late involvement and indicate that the moment of involvement is an important influencer of change readiness, they mentioned that it did not influence their own readiness in this project, because they were involved from the beginning.

Content understanding

Experience in healthcare. Three of the four IT professionals indicated that a construction with

and around hospital A. It is very bureaucratic and complex environment, he was overwhelmed". Another IT professional supports this: "I think the external change agent had added value during the project, but he lacked experience in the healthcare sector. The IT professionals indicate that more experience in healthcare by the external change agent would have caused less demotivation and indistinctness about everyone's role in the project. Although the IT professionals did not mention exactly the relationship between experience in healthcare and change readiness of them, it sounds plausible that more experience in healthcare by the external change agent leads to more readiness of IT professionals.

Change readiness of IT professionals

Emotional. Looking at the emotional readiness for change, the respondents feelings are almost in

accordance with each other. Three of the four respondents indicated that they had a good feeling with the project and experienced it as a positive process. The remaining respondent, the IT professional of hospital A, labelled it as a laborious process. He said: "Where it has gone wrong here, there was already a technical solution, they thought about implementing an FTP server and setting up a VPN connection in a minute and ready it is, then you get resistance". In his view he should have been involved earlier to think about the underlying questions of the goals of the project.

Cognitive. Considering the cognitive readiness for change of IT professionals, they are all open

for new IT innovations in their work in general as well as for this specific project. They all indicate it as an important aspect of their work. Also they agree with each other that most of the projects they are involved in, are successful in the end. Because this project did not reach the final goals, all professionals indicated the project as not very successful.

Intentional. On the question whether they were willing to put energy and time in the project,

three of the four respondents said they were, because they liked the project. The remaining respondent, the IT professional of hospital A, was not willing to put a lot of energy and time in the project, because he did not experience enough support for this solution in the hospital he worked in. He indicated that there was already a technical solution before his IT department was involved. Therefore he felt that this, in his view, ad hoc solution did not fit in the long-term solutions the hospital wants.

Mechanisms derived from this case

In this section the mechanisms derived from this case will be elaborated on the basis of the three core categories 1) quality of communication, 2) participation in the change and 3) content understanding and their possible relationship with the change readiness of IT professionals.

1) How did the quality of the communication by external change agents influence the development of change readiness of IT professionals?

Based on the findings of this case there are three mechanisms about the quality of communication that IT professionals indicate as important for getting readiness in a project. These mechanisms are 1) a concrete roadmap, 2) a clear functional question and 3) dialogue.

1) The IT professionals stated that they often forgot what the state of the project was due to the missing roadmap and that this also caused less transparency about the goals of the project. 2) One IT professional indicated that it is hard to find out what the functional question is when the technical solution is addressed immediately and therefore he missed the logic behind the technical conversation. The IT professional indicated that if he could have participated in the process of setting up the functional question, the urgency of this project would have been more clear for him. 3) According to the IT professionals, there was no conversation about the division of roles and about a about the roadmap. A kick-off meeting was missing and subsequent structured meetings were not structured.

These three mechanisms are mentioned as important for most of the IT professionals to get change readiness. According to most of the IT professionals, these three mechanisms could have been performed better by the external change agent. Therefore, they indicated that their change readiness would probably have been higher than it is now when these mechanisms were performed in a better way as illustrated above.

2) How did the participation in the change organized by external change agents influence the development of change readiness of IT professionals?

Based on the findings of this case there are two mechanisms about the participation in the change that IT professionals indicate as important for getting readiness in a project. These mechanisms are 1) a structured collaboration and 2) the moment of involvement.

wanted to participate in the project from the beginning, so that they could contribute ideas about the functional question. Now he was involved too late. The other IT professionals acknowledge this too late involvement.

These two mechanisms are mentioned as important for most of the IT professionals to get change readiness. According to most of the IT professionals, these two mechanisms could have been performed better by the external change agent. Therefore, they indicated that their change readiness would probably have been higher than it is now when these mechanisms were performed in a better way as illustrated above.

3) How did content understanding of external change agents influence the development of change readiness of IT professionals?

Based on the findings of this case there is one mechanism indicated by IT professionals regarding the content understanding of IT professionals. This mechanism is experience in healthcare. The IT professionals indicate that more experience in healthcare by the external change agent would have caused less demotivation and indistinctness about everyone's role in the project. However, IT professionals did not mention exactly the relationship between experience in healthcare and change readiness of them. Therefore, this relationship cannot be fully confirmed by the findings. However, it sounds plausible that more experience in healthcare by the external change agent leads to more readiness of IT professionals.

4.1.2. UMC Utrecht (Case B)

This case is about a change process with information technology in healthcare whereby an external agent has been involved. The parties and persons involved are three IT professionals of University Medical Center (UMC) Utrecht and two external change agents of Soulve Innovations. Comparing this case with the other one, there are some differences that can be noticed. The throughput time of this case was eighteen months, three times longer than the other case, contained more technical complexity and was more innovative than the other case. In this case, two parties were involved, two less than in the other case. In the following section the results regarding this case will be elaborated.

Quality of communication

Concrete roadmap. Two of the three IT professionals mention that they missed a sort of

this context, the quality and status of the documentation could be better too sometimes. I missed a clear roadmap". These two IT professionals indicated that a clear roadmap would give them more insight and clarity about the next steps in the project. If the IT professionals had these insights, they could inform the external change agents better about the technical limitations of the project. Now they had to repair the damage afterwards. The IT professionals indicated that their readiness would probably have been higher when the external change agents had given insight in their plans in the form of a transparent roadmap.

Clarity of functional question. Two of the three IT professionals indicated that they didn't had a

say in the development of the functional question in this project. One IT professional argues: "I don't think we could contribute to the functional aspect of the project, because it was already fully developed functionally". Because the IT professionals were not involved in this process, the functional question was not completely clear for them at the start of their involvement. One IT professional says: "On the technical aspect we were forced to make a contribution. There were some options we have chosen which I do not fully support technically. The quality could be better, but we were encouraged to do so, because we had to". He emphasized that this technical contribution was difficult due to the a lack of clarity of the functional question. One external change agent says something about the possible ambiguity of the goals of this project: "We had to guide the IT professionals more through that process. I think we did that insufficiently. The 'why' for this project was maybe not clear enough for them. I pushed them a little bit into this project and, when looking back, that was maybe not the best move I made". The IT professionals indicated that if they could have participated in the process of setting up the functional question, the urgency of this project would have been more clear for them and they could have think along with the external change agents about the technical possibilities of the project. Now they were passed over by the external change agents. The IT professionals mentioned that if the functional question was more clear from the beginning, their readiness would probably have been higher than right now.

Dialogue. Two of the three IT professionals stated that there was no communication about the

could have make things clear and could have bring different standpoints closer together. The two IT professionals indicated that when they could have participated in setting up a concrete roadmap and when the collaboration was more structured and on location, they would probably have created more readiness for working on this project because that would encourage dialogue.

Participation in the change

Structured collaboration. When asking the IT professionals about the collaboration with the

external change agents in terms of stimulation, two of the three IT professionals said that they would prefer a more structured collaboration and on location. In their opinion, the external change agents were not enough present in their hospital and that didn't benefit the progress in the project. They argued that this project had a difficult content and therefore a collaboration on location would permit more in depth discussions about this content. The IT professionals stated that it would have helped to speed up the project. In this project it was hard to make quick progress, because the change agents were on average only once a week on location. This caused some irritation among the IT professionals, because they had the feeling that the external change agents were not listening well enough to their expertise. In other words, it was hard to get a dialogue because of the rare moments on location. The IT professionals indicated that a structured collaboration on location would probably have created more readiness, because it would create more understanding between both parties.

Moment of involvement. When considering the moment of involvement of the IT professionals,

the project. One change agent explains: "We had to involve the IT department two months earlier, but not right from the start. We started the project by figuring out all possible solutions, without looking at the technical feasibility. I still think that's a major strength of this project". All three IT professionals indicate that through the late involvement, there arise all kinds of issues that did not arise when they were involved from the start. They all mentioned that if they were involved from the start, their readiness would probably higher than is it now.

Content understanding

Experience in healthcare. Two of the three IT professionals think that the external change

agents are somewhat inexperienced with managing change projects in healthcare. One of them explains: "They didn't realize that they have to work within the constraints in an existing hospital like this, otherwise they run into problems. That's a little inexperience from their side. However, the external change agents are full of energy and they have large resolving power, that is very valuable". The IT professionals indicate that the external change agents did not know which people they had to approach in order to become more familiar with the Hospital system. Therefore it took a long time before the project could make progress. Although the IT professionals did not mention exactly the relationship between experience in healthcare and change readiness of them, it is very well possible that more experience in healthcare by the external change agent leads to more readiness of IT professionals.

Knowledge of IT environment. When asking about the importance of content understanding for

system. The IT professionals indicated that they had to repair the wrong created expectations as well as the functionalities of the project. This took a lot of time and that lowered their readiness at that time.

Change readiness of IT professionals

Emotional. Looking at the emotional readiness for change, three of the three IT professionals

agree with each other that they had positive feelings about the project. Looking at the process of the whole project, two out three IT professionals are less positive. One IT professional explains: "Now and then it was a laborious process. Our companies are only a few kilometers away from each other, but I preferred a cooperation on the same location and more structured. In this way we could have lead the project to a better end". Another IT professional supported this by saying that the process could have been more optimal when the IT department would have been involved from the start of the project.

Cognitive. When considering the cognitive change readiness, all IT professionals state that they

are open for new IT innovations in their work in general as well as for this specific project. On IT professional elaborates: "Personally I'm an 'out-of-the-box' thinker so new IT innovations fit perfectly in my alley. In this context, this project is very nice to work on". When asking whether the projects here achieve their objectives, all respondents think that most initiatives are implemented properly.

Intentional. On the question whether the IT professionals were willing to put energy and time in

the project, two of the three are positive. One IT professional argues that he liked the project, because of its exotic nature. He stated that he was willing to put energy and time in the project within the agreed resource planning that was made. Another IT professional stated that he also invested a lot of time and energy in the project, but he emphasizes the sometimes demotivating aspect of the project. He elaborates: "Sometimes we had a breakthrough and everyone was very enthusiastic, later on in the project things stagnated and motivation decreased. We had ups and downs during the project constantly". These ups and downs caused sometimes lower intentional change readiness with this IT professional.