From Theory to Practice: A Qualitative Study Exploring Change Managers' Experiences Applying Change Management Frameworks in Hospital Redevelopment Across One Australian State.

Background: Hospital redevelopment projects are among the largest and most costly changes undertaken in health systems. Despite abundant methodologies and frameworks that offer theoretical guidance, the literature reports persistent gaps in managing change of this scale effectively. To examine this gap between theory and implementation of change management in practice, we explored change managers' experiences of leading change in hospital redevelopment projects across one Australian state, using a qualitative approach. We aimed to understand the change management approaches used, the perceived value and limitations of those approaches, the capabilities change managers need to lead change, and the barriers and enablers encountered through the change cycle. Methods: Semi-structured interviews were conducted with 28 change managers of varying levels of experience and project scope in hospital redevelopments. Data were analysed using the Framework method. Subthemes were developed inductively from the interviews and then mapped deductively onto the three stages (planning, implementing, and sustaining change) of a statewide health infrastructure change management framework that guided practice in this setting. Inductive subthemes not able to be classified using the framework formed a fourth theme on change managers' capabilities. Findings: Four themes were developed: 1) Planning for change, 2) Implementing change, 3) Sustaining and reinforcing change, and 4) Change managers' capabilities and support. Participants described several effective approaches to managing change in hospital redevelopment, including progress tracking, prototypes, site visits, and ongoing stakeholder consultations, with local staff central to facilitating engagement. Executive sponsorship was repeatedly identified as an enabler of change, although securing it early and sustaining it across the project proved a recurring challenge. Further challenges included aligning change plans with broader project processes, transitioning change into business as usual once the project ended, and evaluating whether the change delivered its intended benefits. Some participants reported not being aware of available resources and how to utilise them. Conclusion: Change management frameworks offered useful guidance particularly for less experienced change managers. However, participants often described challenges utilising these frameworks for effective stakeholder engagement, for sustaining change in long-term projects, or where change management and project processes were misaligned. The findings have practical implications for successful change management in redevelopment projects, including the importance of structured training and mentoring for change managers, a need for early and sustained executive and stakeholder engagement, planned transition to business as usual, and closer alignment of change management with project delivery so that the people side of change is supported throughout the project lifecycle.