What It Takes to Manage Change: A Qualitative Study of Healthcare Managers' Role Perceptions in Supporting and Sustaining TeamSTEPPS Implementation.

Introduction: Sustaining interprofessional collaboration in healthcare settings requires more than formal change functions such as designated roles. It depends on leadership commitment, professional values, and structural alignment. While local champions play a key role in implementation, the role, perceptions and strategic involvement of institutional leaders remain underexplored. Methods: This qualitative study investigates how institutional leaders at the Geneva University Hospitals conceptualized and enacted their roles in the implementation of TeamSTEPPS framework. We conducted semi-structured interviews with 11 participants, including physician and nursing leaders and quality coordinators. Data were thematically analyzed using a predefined multi-level framework encompassing individual, inter-individual, and inter-group perspectives. Results: Our findings show that at the individual level, leaders' role perceptions were strongly influenced by their professional backgrounds, values, and institutional positioning. Physician leaders leaned toward strategic oversight, while nursing leaders and quality coordinators emphasized practical application and staff commitment. Despite shared collaborative practices, participants faced constraints such as limited time, unclear role expectations, and institutional silos. At the inter-individual level, the local champions' training enhanced interprofessional trust and skills. Success was associated with locally adapted strategies, participative leadership structures, and visible institutional support. At the inter-group level, tensions between promoted institutional values and operational reality such in communication and resource allocation hindered sustained engagement. Conclusion: Effective implementation of collaborative practices depends on leaders' ability to align institutional goals with frontline realities. Supporting this alignment requires clearer role definitions, dedicated coordination, and strategic integration of change processes. A participative leadership approach is essential to foster ownership, coherence, and sustainability in healthcare transformation efforts.