Change management for services redesign in healthcare: a conceptual framework.

Introduction: The introduction of process innovations in healthcare organizations faces challenges in knowledge sharing and incorporating best practices due to a strong professional autonomy, leading to resistance to change. The healthcare paradigm is shifting towards value-based organizations with a patient-centered approach, requiring multidisciplinary care. Change management is crucial, but current approaches are often limited. This study proposes a conceptual framework to support change management in healthcare services redesign. Methods: The proposed conceptual framework was developed applying Jabareen's multidimensional and multi-method approach. The methodology involved 8 steps consisting in literature review, thematic and content analyses, concepts deconstruction and aggregation, graphical design of the framework, external validation and revision. Results: The framework integrates 53 evidences from the literature, 3 macro areas of interest and 42 change management models applied to the healthcare context, through 244 implementation actions. Aggregation of concepts led to 15 macro topics applicable to all levels of change and composing the proposed framework. Interviews validated the framework, emphasizing the importance of people-focused approaches and addressing resistance to change. Moreover, steps most and less cited in the literature are highlighted and differences between developed countries and economies in transition or developing countries are explored. Conclusions: The article proposes a 15-step framework for change in healthcare services redesign. It integrates evidence from literature and change management models, emphasizing stakeholder involvement. A case study in South Africa highlights the importance of awareness, planning, communication, training, and continuous review. Further validation and adaptation are recommended.