introducing the components of organizational changeability as... · 2015-10-28 · changeability...

Introducing the

components of

organizational

changeability

THIS ACADEMIC PAPER INTRODUCES THE DEEP STRUCTURES THAT INHIBITS OR ENABLES AN ORGANIZATION’S ABILITY TO EMBRACE AND DRIVE CHANGE AUTHORS: BIRGITTE CLAUSEN & HANNE KRAGH

Paper presented at the Annual Academy of Management Conference August 2015,

Vancouver, Canada BC Paper no.14172

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Why Don’t They Just Keep on Doing It? Understanding the Challenges

of the Sustainability of Change

AUTHORS

Birgitte Clausen, E-MBA,- Partner, Walk The Change

Hanne Kragh, PhD, Associate Professor, Dept. of Management Aarhus

ABSTRACT

Creating sustained change represents an important managerial challenge as indicated

by the high failure rate of change initiatives. Challenges are not only related to

managing actual change projects, they also arise from organizational structures and

attributes which are counterproductive to change. This paper addresses the nature of

the deep organizational structures that impact the sustainability of change. Deep

structures are endurable organizational orders that may limit or enforce change and

they are often so implicit that they remain undisputed. Based on a single case study of a

change initiative in the hospital sector, we identify twelve deep structures that are

grouped into four meta-structures: networking structures, narrative structures,

psychodynamic structures and leadership structures. The deep structures are dynamic

and interactive, and in this case study they mainly inhibit sustainability of the change

project studied. We discuss each of the structures in relation to existing theory and

argue that making these deep structures explicit may result in increased likelihood of

creating sustained change initiatives.

Keywords:

Change management; sustaining change; deep structures; hospitals



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Why Don’t They Just Keep on Doing It? Understanding the Challenges

of the Sustainability of Change

Introduction

Estimates suggest that up to 75% of all change initiatives fail (Beer & Nohria, 2000;

Burnes, 2005; Higgs & Rowland, 2005). Too often change is short-lived, and then life

returns to how it was before (Hayes, 2010). The lack of sustained change is costly for any

organization. Equally important are managers’ and employees’ frustration and

demotivation that follow from spending time and energy on implementing changes just

to witness a relapse to old structures and routines once focus is off the project. Although

sustainability of change is an implicit or explicit goal of almost any change project, the

high failure rate of change initiatives indicates that sustaining change is difficult.

Buchanan, Fitzgerald, and Ketley (2007) propose that sustainability of change is defined

as “… anchor, embed, maintain, perpetuate, normalize, routinize, integrate, or

institutionalize change”. They argue that managing for sustainability requires an

understanding of the contextual factors, which support or threaten the sustainability

corresponding to Lewin’s (1947) “driving” or “restraining” forces in relation to changes in

group-dynamics.

The main focus of change management literature is at the front-end of change,

typically prescribing checklists for the various phases of change processes, whereas

work on the sustainability of change is relatively underrepresented in literature and is

characterized by fragmented research (Buchanan et al., 2005). Generally, existing

literature on sustainability of change is rooted in a functionalistic paradigm where

certain changes in conditions, structures, and processes are prescribed to move an

organization towards a desired change (e.g. Buchanan et al., 2007). In contrast to this

approach, we seek to address the sustainability of change through the lens of social

constructionism where reality is perceived as socially constructed through inter-

individual actions and reactions, behaviors, and perceptions (Gergen, 2002). As such,



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we view organization and leadership as social constructs (DeRue & Ashford, 2010), and

change is neither static nor time-bound but should be understood in its context while

recognizing that current and future thinking and behavior are conditioned by past and

current events (Pettigrew, 1987). In this perspective, change is sustained once behaviors

and perceptions grow into objective truths after having been around for so long that

they become culturally embedded by a certain level of shared acceptance of their

existence (Gergen, 2002).

One way of addressing this cultural embeddedness is through Gersick’s (1991) notion of

deep structures. Deep structures are highly durable organizational orders that may

hinder, limit, or enforce change. These orders are the consequence of organizational

members’ more or less deliberate choices. Deep structures consist of different parts

whose interaction maintains the structures’ existence. Gersick argues that inertia to

change prevails as long as such deep structures are intact, and their power may pull

attempts to deviate back in line. Sustaining change thus becomes a quest for

identifying and altering such deep structures (Gersick, 1991).

An understanding of the components and the nature of deep structures might enable

intervention to loosen restraining forces while accentuating enabling forces, and this

could improve the likelihood of achieving sustainability of change. Hence, the research

question for this study is: Which deep structures impact sustainability of change and

how? The purpose of the paper is to contribute to the less researched area of sustaining

change, particularly by focusing on the structures that threaten or support sustained

change and by creating a deeper understanding of the dynamics impacting these

structures.

We investigate the research question by means of a case study of the sustainability of

change at a Danish hospital where a change in management behavior is under

implementation.

The paper proceeds as follows: First, we describe the empirical context of our study.

Next, we present an overview of literature on sustainability of change with a particular

focus on sustainability of change in hospital settings. We present and argue for the

relevance of the concept of deep structures to further understanding of sustainability of



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change. Then, we present our methodological considerations. In the following analysis,

we develop four categories of deep structures and discuss how each one may promote

or hinder sustained change. Finally, we discuss theoretical and managerial implications

of our findings.

Empirical Context

Changes in core beliefs and behaviors precede changes in structure and strategy

(Pettigrew, 1987). This was also the conclusion of a Danish hospital management team

in a strategy process in 2013, where the 50 management team members were gathered

to discuss and align the strategic directions for the following three years. The contextual

environment was characterized by ever-changing needs to cope with political and

demographic changes, introduction of new technology and bio-medical advances in

treatment, growing public demand for speed and quality of service, at the same time

facing productivity demands and cost reductions. Furthermore, structures and practices

traditionally dominated by the medical elite were challenged, and the hospital had

taken the first steps into a re-engineering process moving from organizing based on

clinical specialties towards organizing around patient flows, which contested

institutionalized power structures, working practices, and professional identities. In

parallel, hospitals faced politically motivated consolidations of hospitals and medical

specialties.

The management team comprised 50 leaders, i.e. executives, nurse directors, medical

directors, and their opposite numbers in laboratories, rehabilitation areas, support and

administrative areas. The future strategy had three elements: ‘patient focus’, ‘a

coherent hospital’, and ‘transition ability to new conditions’. The strategy headlines

called for operational initiatives that remained to be scoped, but in three workshops the

leaders collectively identified, distilled, and committed to a series of leadership

behaviors perceived to be vital enablers of the strategy. They concluded that they

could change their leadership behaviors without implementing the strategy, but they

would never implement the strategy if they did not change their behavior.



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The strategy process had been awkward surfacing suppressed emotions and bringing

organizational skeletons out into the open. The leaders publicly expressed concerns and

experiences that had so far only been addressed behind closed doors, and it appeared

that the same apprehensions were generally shared. Many felt vulnerable in the process

due to past experience of public ridicule and repercussions. The process identified three

desired behavioral changes:

Optimize meetings and decision-making processes to secure mutual understanding of

and adherence to topics of discussion, what is decided, and who is responsible

Create a ‘one-for-all all-for-one’ culture where execution and follow-up on decision-

related actions are emphasized and supported by all management team members

Relate and communicate in a collaborative and supportive way

All leaders recognized that the required changes could seem rather banal. However,

voices of concern asserted that such change was easier said than done as stated by

this manager: “we are enormously impacted by the past. How can we free ourselves?

Where do we find the trust? How do we maintain this? How can we help each other

keep our spirits up? It isn’t going to fly on its own … if we can’t, we’ll end up at square

1.”

The strategy process concluded with a handshake agreement that all members of the

management team would do their best to live up to the goals by instantaneously

adopting the outlined behaviors in their daily practices and encounters.

Implementation took the shape of a self-assembled “just do it” process with no formal

implementation plans or structures in place, and the accountability for the desired

change was with the individual. It was thus a simplistic “DIY” approach primarily building

on local and proactive initiatives (Higgs & Rowland, 2005).

Sustainability implies that new practices persist for a period appropriate to the setting

(Buchanan et al., 2005). This study took place on-site 3-5 weeks after the final workshop.

The leaders had thus had several weeks to practice the behaviors. This is long enough to

expect some change, yet not long enough to assess if change is fully sustained. The

timing was somewhere between in the change and after the change, and this ‘pre-



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mortem’ timing was perceived optimal for an exploration of the deep structures

impacting the sustainability of change.

Theoretical Framework

Buchanan et al. (2007) have researched sustainability of change in healthcare settings

with the progress of the British National Health System (NHS) modernization plan, which

was initiated in 2000 and lasted ten years. This comprehensive project aimed at radically

rethinking, redesigning, and improving patient care and was considered amongst “the

largest and most systematic organization development ever undertaken, in any sector,

anywhere” (Buchanan et al., 2007: p. xxi). Buchanan et al. (2007) argue that

organizational change processes depend on the complex, cumulative effects of

multiple interwoven factors, conditions, and path dependencies, which make change

attempts potentially fragile. Hence, managing for sustainability requires abandonment

of static notions of cause and effect and replacement by a focus on contextual

processes, event sequences, and narratives. They argue that the ability to sustain

change depends on organizational readiness for change which is framed by three

overlapping themes: the cultural climate, a ready and receptive context, and the

organization’s absorptive capacity.

Cultural climate is defined by two contrasting cultural organisms (Kanter, 1983), of which

integrative cultures display holistic problem solving, co-operative internal networks,

sense of direction, and an ability to overthrow the past. In contrast, segmentalist cultures

demonstrate compartmentalized problem solving with an emphasis on hierarchies, rules

and efficiency. Attributes from integrative cultures have shown to stimulate change,

while attributes from segmentalist cultures stifle change. Organizational culture is

distinguished from organizational climate by asserting that climate is the lived

manifestation of culture (Ekvall, 1996), and some cultural climates are more capable of

mastering change than others. Ekvall asserts that change mastery is found in

organizational cultures, where people experience work as joyful, meaningful, and

challenging, and where there is freedom, trust, and confidence to connect, debate,

experiment and decide without fear of reprisal or ridicule.



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Complementary to this, Pettigrew, Ferlie and McKee (1992) highlight a series of attributes

whose nature, configuration, and level of presence indicate organizational

receptiveness to change in a British healthcare setting:

Collaborative orientation: team orientation and cross-functional collaboration instead of

preoccupation with hierarchies

Drivers for change: mechanisms for idea generation and exchange instead of emphasis

on efficiency and rules

Clear strategy: Long-term focus, broken into actionable elements and clear benefits

that win commitment

Skilled leadership: Team builders instead of “macho” management, interpersonal skills

matter more than status or rank, planning is combined with flexibility

External pressures: Adaptable to triggering change without creating crisis or draining

energies

Supportive culture: Challenges beliefs, encourages cross-boundary work, supportive HR

policies, risk-taking approach, and positive self-image

Good managerial-clinical relations: Seeking common ground, involving key players,

efforts to build climate of trust, honesty in communication, fostering alliances

Co-operative networks: Trustful opportunities for informal and purposeful exchange,

bargaining, and decisions

Clear goals and priorities: Limited set of change priorities, insulated from short-term

pressures, agenda broken into manageable activities

Fit between change agenda and organization: nature of workforce and local/regional

stakeholders, local/regional political culture

Nuancing this, Cohen and Levinthal (1990) frame an organization’s absorptive capacity

as a function of a) the sum of the absorptive capacities of its employees and their

constant practicing until the practice is reliably learned, and b) an organization's ability

to exploit individuals’ absorptive capacities. However, the effectiveness of absorptive



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capacity is conditioned by collegial inclination to help, the nature of personal

relationships, internal competition, and managerial crankiness (Szulanski & Winter, 2002).

Having followed the 10-year progression of the British NHS modernization plan,

Buchanan et al. (2007) conclude that cultural climate, receptiveness to change, and

absorptive capacity are relevant determinants for sustaining change in healthcare

settings. However, it remains unexplained how these conditions arise and what prevents

their occurrence. Accordingly, Buchanan et al. (2007) observe that some hospital

problems seem to exist forever despite numerous attempts to eliminate them. Still,

limited attention is paid to potential, underlying deep structures that may be the hidden

drivers pulling change initiatives back in line. Instead, Buchanan et al. (2007)

recommend managing for sustainability by keeping the storyline going preventing sub-

plots and diversions from taking over. Accordingly, structural, causal ‘if-then’

interventions are prescribed to circumvent the decay of change processes (e.g. if

powerful stakeholders block progress via counter-implementation tactics, then develop

a ‘counter-counter-implementation’ strategy to neutralize their tactics and influence

and marginalize their positions).

We find that such recommendations are rooted in the underlying premise that

undesired reactions to the change process relate to the change itself and can be

countered with change-related responses. Furthermore, they originate from rational,

functionalistic and mechanistic thinking prescribing certain changes in conditions,

structures, and processes to move an organization towards a desired change. This

resembles logics of replacement (Weick & Quinn, 1999) which assume that change

occurs when something existing is replaced by something different. Logics of

replacement are primarily macro, spurred by top-down change initiatives e.g. changes

of structure, processes, or systems. Logics of replacement advocate for managing

change by telling people what to do. The alternative, logic of attraction, is about

managing change by force of example coaxing people into change. Logics of

attraction are driven by leaders who model the change they want to see in others

(Weick & Quinn, 1999) and sustainability of change depends on the leaders’ ability and

willingness to apply the same attitudes, behaviors, and skills to themselves as they want

from their subordinates (Beer, Eisenstadt, & Spector, 1990). Hence, logics of attraction



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reckon on the dynamic, cumulative pull effects of micro-level changes enacted by

individuals over time as opposed to instrumental and linear push strategies driven from

the macro level.

Cumulative effects result when organizational individuals perceive and create a social

reality by enacting and transmitting their social reality to other organizational individuals

(Zucker, 1977). Consequently, changes and complexity at the macro level are gene-

rated through the diversity and interrelatedness of the conversations and actions on the

micro level (Ford & Ford, 1994; 1995). Social structures are rarely rationally ordered,

emotion-free zones where people behave in reasonable and preditable manners, and

ideal organizations hardly exist (Kersten, 2001). Irrational, abnormal behaviors are more

usual than unusual, and it is thus not enough to assume that behaviors are conscious,

predictable and transparent phenomena that can be managed to a desired change

by linear and programmatic processes (Kets de Vries, 2004).

The concepts of cultural climate, receptive and absorptive capacities describe

attributes that may apply to organizations driven by logics of attractions; however they

fail to address the deeper structures that drive such logics, also they do not describe the

dynamics between micro and macro-levels of change. Gersick’s (1991) explorations of

the punctuated equilibrium theory of change does not fully explain these dynamics

either. However, she observes that groups maintain organizational equilibria through

rather implicit and highly durable underlying organizational orders, i.e. deep structures,

which are frameworks of “integrated webs of performance strategies, interaction

patterns, assumptions about and approaches to the group’s task and outside context”

(Gersick, 1991: 15). These deep structures are interrelated micro-dynamics that are

reinforced through mutual feedback loops; they hinder and limit change unless the

deep structures are addressed, dissembled, and reconfigured to enforce

transformation. Metaphorically, deep structures can be compared to the “design of the

playing field and the rules of the game” (Gersick, 1991: 16) and periods of equilibrium

compare to the game being in play. In periods of equilibrium, the game may look

turbulent on the surface and players may try to master the game, however the game is

loyal to the rules and every game reinforces the rules of playing, i.e. the deep structures,

while the nature of the game itself remains unchanged. Internal or external issues may



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generate a need for change; however the forces of intact deep structures may

potentially derail any attempt to change. Hence, change management should not only

focus on managing the change but particular attention should be paid to managing

the deep structures that jeopardize the sustainability of the desired change.

Deep structures may thus represent a missing link that can connect the micro and

macro levels of sustainability of change; however, a more detailed and collated

overview of the nature and dynamics of such deep structures remains to be established,

and it is this gap that our study seeks to address.

Methodology

Our study of the deep structures influencing the sustainability of change rests on

assumptions that meaning and social structures are “built and rebuilt by its members in a

dialectical process and does not exist independently of, or beyond, these members”

(Arbnor & Bjerke, 2009). Accordingly, leadership behavior takes place between people

and interlink social and psychological phenomena in-between and within single

individuals. Arbnor and Bjerke (2009) posit that individuals act and interact in social

realities, i.e. an “everyday reality” that is rarely articulated or questioned. Understanding

the deep structures of the social reality of leadership behavior calls for a social

constructivist view as research framework, and this view applies to the current study.

Understanding the social reality that constructs the deep structures impacting change

requires attention to how collective experience and communicative interaction mold

the reality in question. This reality is a non-eliminative, inclusionary, multi-voice

conversation with no final solutions ever reached (Shotter, 2002). Organizational

members negotiate their personal interpretations of reality with each other, and this

leads to a shared organizational understanding of an objectified social reality (Arbnor &

Bjerke, 2009).

As described above, we conducted a single case study of the transition to more

collaborative behaviors in a management team at a Danish hospital. We interviewed 23

management team members, i.e. executives, nurse directors, clinical directors, and their

opposite numbers in laboratories, rehabilitation areas, support and administrative areas.



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In addition, we interviewed three internal consultants, who had been deeply involved in

the strategy process.

Data collection consisted of both semi-structured interviews and group interviews. The

majority of interviews were group interviews. Group interviews are well suited for

exploratory purposes, since lively interaction between participants may produce more

spontaneous, expressive and emotional views than individual interviews (Kvale &

Brinkmann, 2009), thus enabling exploration of how beliefs and perceptions are

constructed (Barbour & Kitzinger, 2001). The purpose of the interviews was to obtain an

understanding of the deep structures influencing current and future collaborative

behaviors. Literature on sustainability of change, in particular on organizational climate,

receptiveness to change, and absorptive capacity as described above, was used to

develop 28 statements that were sent to the informants prior to the interviews. The

document sent outlined the purpose and format of the interviews, and the informants

were asked to prepare for the interview by reviewing and rating (on a 1-5 scale) the

level of presence of each of the 28 attributes in their organizational life. This apparently

quantitative approach served as a means to enforce qualitative reflections on the

degree to which the statements resonated with each informant’s perception of reality

and why. Hence, it prepared the informants for the interview by creating an off-set for a

reflective discourse which helped us focus the interview without narrowing it too much.

The informants broadly recognized the 28 statements as relevant to their context, but

they expressed ambiguity when it came to rating of the statements. Their rating would

differ depending on the level of analysis, as stated by this informant “it depends on

whether I think about colleagues, my own team, or our executive team”. Yet, this

ambiguity enabled further exploration of the constructs of each individual’s perception

of reality.

In the group interviews, we applied a process where each informant was interviewed

individually before a broader dialogue in the group was open-ended. The informants

promised each other full discretion, and our only guidance to the conversation was to

avoid discussions looking for shared denominators or battles for right or wrong

arguments (Arbnor & Bjerke, 2009). This approach was selected to ensure that silent

voices received adequate exposure (Barbour & Kitzinger, 2001). Interviews lasted from



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60-120 minutes with an average of 90 minutes. All group interviews were recorded and

transcribed including nuances as changes in tonality, sighs, laughs, pauses, emotion in

expression, etc. (Kvale & Brinkmann, 2009).

When analyzing the raw data, we adopted a process resembling Orton’s (1997)

iterative grounded theory. This process involves moving back and forth between theory,

data, and knowledge processing while looking for a common set of meaning and

understanding constituting an objectified everyday reality for the organization under

study (Arbnor & Bjerke, 2009). As data were coded and themes emerged, literature was

consulted for similar findings.

The transformation of raw, unstructured data into manageable categories was a

manual, subjective, and interpretative “aggregation of instances until something can

be said about them as a class” (Stake, 1995: 74). First, broadly representative and

significant statements were identified across informants. There were overlaps between

the perspectives shared by the CEO and the co-executive, more overlaps between the

perspectives offered by the co-executive and the leaders, and significant overlaps

across leaders’ perceptions irrespective of occupational role. Two leaders

acknowledged the shared beliefs appointed by others, but their personal experience

pointed in other directions. Next, statements were grouped and regrouped while

looking for meaningful patterns with no explicit structure or goal in mind. Gradually,

clusters of statements of similar nature emerged, and we looked for verbal constructs

that could denominate the clusters as categories. Eventually, 12 deep structures

materialized, and further exploration surfaced thematic similarities organizing the

structures into four meta-structures. The meta-structures were labelled with relatively

familiar constructs to enable comparison and validation of a naturalistic generalization

gaugeable by others (Stake, 1995).

Findings

The interviews revealed several shared objectified realities, which portray interactive

and interwoven deep structures with an impact on the sustainability of change. As

illustrated below, these structures are grouped into four main structures with several

underlying structures.



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Figur 1. Structures impacting the sustainability of change

Network Structures

‘Network structures’ is a label chosen to describe how internal order is created more or

less consciously by groupings, relations and ways of communicating. This order differs

from the structures outlined by official organization charts, policies and values.

Fault Lines

The interviews surface organizational fault lines. Fault lines are dividing lines that may

split a group into coalitions or sub-groups (Gover & Duxbury, 2012; Lau & Murnighan,

1998). Typically, they are ascribed to negatively impact group performance and

change as they cause emotional and task-related conflicts. A hospital is a professional

bureaucracy (Mintzberg & Waters, 1985) and fault lines tend to exist between powerful

occupational groups. One informant says “We talk as if we are one big group, but we

are not”, and another adds “e.g. head nurses have their own little forum…where they

• Psychologicalcontract

• Emotions

• Dominant behaviors

• Leadership context

• Change agency

• Competing values

• Defining stories

• Defining metaphors

• Defining moments

• Fault lines

• Relations

• Communicationpatterns

Network structures

Narrative structures

Psycho-dynamic

structures

Leadershipstructures



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do not welcome therapists and midwives, even though working conditions and

challenges are similar”. Two additional fault lines exist in this organization:

Between the CEO and the co-executive officers. The general perception across all

informants is that the CEO is a domineering character that does not leave much room

for the co-executives.

In-groups and out-groups. There is talk about A, B and C teams with limited interaction.

A-team members are almost exclusively medical leaders. Certain behaviors are

ascribed to this groups: “the A team is fighting for power…it is a savannah culture…the

young lions are waiting for the old lion to falter…the B team is playing to survive, to

promote fair play, decency, and integrity,… the C team is on their way out”.

Relations

Several interviews started by informants introducing themselves to their fellow leaders by

name. Others asked the interviewer for name and occupation of fellow participants.

Apparently, several leaders did not know each other even though they had been on

the same management team for years. This observation was confirmed, as stated by an

informant: “I thought we [the management team] were supposed to help each other. I

thought we could talk. But we don’t. It is so compartmentalized. We do not know what

happens in the next room…”.

Personal and inter-group relations are often recognized as a source of disruptive inter-

group conflicts (Hogg et al., 2012). These deep relational structures have dismissed

attempts of alteration. Several informants note that attempts to mix groups tend to be

obstructed by participants who shift nametags across tables to secure sitting next to

their usual table-mates. The strategy process involved a new grouping of the leaders,

and a positive effect on subgroup relationships is being recognized: “previously, we

minded our own business and nobody cared about the next ward. We only cared

about our own budgets and didn’t bother about the hospital as a whole. You were all

on our own. Now, we are beginning to talk about a coherent hospital, we do colla-

borate, it is coming along...people have moved, the tendency is there…and the will.”



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Communication Patterns

Gossip, speculation, slander and rumors are perceived to be dominant communication

forms: “the stories are contaminating…but I hear myself talking badly about people. It is

part of our culture. They are a bit thrilling, and you can’t help passing it on”. There are

countless reports on the CEO’s intimidating rage, repercussion, and ridicule of

individuals; however gossip also serves as a means to obtain positive attention from the

executive team, as indicated below:

A: “I have found myself gossiping about other co-leaders with our executives. I share

what others have done and what they have not done. We do that…”

B:”yes, we are almost encouraged to talk more and more about people that we are

discontented with”

A:”…and it gets quite personal when we are all together. We all know who we are

talking about, even when no names are shared, and we are all afraid to be exposed”

B:”The management ought to set a stop it. They are nurturing a culture where we can

gossip and slander each other. You are almost encouraged to be an informer”

A: “I have not yet participated in a 1:1 with the executives where we do not gossip

about others. But then we get some contention, some appreciation”

B: “It’s a sick culture. … a culture where talking badly about somebody else removes

focus from yourself, then you’ll save your arse this time”

Bordia, Jones, Gallois, Callan, and Difonzo (2006) suggest that (negative) rumors and

gossip serve as a mental preparation for worst case scenarios. Their existence can thus

be regarded as symptoms of employee concern and stressful circumstances during or-

ganizational change. Decoster et al. (2013) add that gossiping is a typical payback

reaction from employees who feel treated adversely, e.g. being intimidated, ridiculed,

humiliated, or being yelled at. This study supports both interpretations of rumors and

gossiping. Negative rumours florish, and they may outnumber the emerging tales of

positive experiences with the new leadership behavior. Many ascribe this behavioral

pattern to a competitive environment and a clinical practice grooming emloyees to

find errors.



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Narrative Structures

Buchanan and Dawson (2007) suggest organizational change be viewed as a history of

competing narratives that can shape trajectories of change into the future. Narratives

may signify deep structures that impact change, unless contested by new and stronger

narratives. This study presents three variants of narratives that we have labelled defining

moments, defining stories, and defining metaphors.

Defining moments

Many informants refer to defining moments that may tip the sustainability of change of

leadership behavior. The moments have not yet occurred, but many speculate as to

whether or when they might occur. Such moments symbolize ‘make it’ vs. ‘break it’

situations, and they are mainly tied to CEO behavior. The sustainability of change is

perceived to break if the CEO has a public outburst of rage, repercussion or ridicule, or if

the CEO will bully or fire a person, who became particularly visible at a workshop where

she openly invited the CEO outside for a dialogue about the impact of his behavior. “It’s

positive that she is still here, that nothing bad has happened to her, that the expected

did not happen. It’s positive that he has chosen to collaborate with her”, says one

informant. Many leaders recognize their own role in tipping the change in the right

direction, “we are the ones that can make it happen, the executives cannot do it

alone”, says one informant. Yet, generally the leaders see themselves as followers in

relation to this particular change, whereas the CEO’s behavior is regarded as role

modeling, symbolic, and defining.

Defining Stories

”Our hospital is built on old tales. Somehow it is acceptable to talk in this way, create

sensations, drama…In reality, there may not be so many stories, but we talk a lot about

the ones there are. The executive team is also part of it. They tell many odd, old

anecdotes. Old stories are everywhere”, says one informant. Many of these stories seem

to have grown into conditional, objective realities as illustrated by this informant: “these

are not myths. It is a fact of life”. They may thus constitute a deep structure that impacts

the course of change.



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“We have an enormous degree of freedom” is a shared story. The leaders perceive

other hospitals to be top-down managed and bureaucratic, but at this particular hos-

pital they can do as they like as long as they perform above a certain standard. Some

have left because of the climate and returned because they missed the freedom. Their

stories are repeatedly retold to explain why this hospital is a better place to work.

“Conflicts remain unsolved” is another shared story. “Our executives bail us out when

there is a conflict…We need someone to conclude, to decide, but they don’t, and the

conflicts go on forever…The illusion that we can get help has vanished”. Yet, the CEO

argues “apparently it’s a provocation when I tell them that it’s so damned easy to solve

their problems, but that is because they don’t like where we are heading [cost

reductions]”. However, recurring stories relate heated arguments where leaders, who

dispute CEO arguments or priorities, are subjected to public pseudo terminations by a

CEO with his blood boiling after company wine & dine. There are similar stories about

leaders in bad standing. The reason for bad standing is not questioned, but the leaders

talk about executive harassment, exclusion, and slander leading the unlucky one to the

door after long indignant processes that are offensive to both victim and witnesses.

Defining Metaphors

Some stories grow into defining metaphors. “An HJ” [the initials of a former manager]

has become synonymous with bad standing events: “if you open your mouth too often,

you risk being subjected to ‘an HJ’…there will be a witch-hunt, and you’ll soon be past

tense around here”. Others share that “the CEO has an annual quota of five

terminations before somebody above him starts wondering”, and it is highlighted that

“This is a fact that is well known, even outside this hospital”.

“The term of the year around here is ‘flying below the radar’”, says one informant.

Another explains “I’ve learnt to stay under the radar…that is what is most important

around here …I’m holding back, leaning back …things do not come out in the open”.

Some informants convey that variants of this narrative have been in circulation for

decades, and it is part of the socialization of new colleagues: “in the beginning they

reach out to our executives. The rest of us sit and wait saying he just needs to learn that

he’d better not approach him. We are better off on our own”.



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“Smashed against the wall” is another frequent metaphor depicting how it feels to be

subjected to an outburst of CEO rage. The three metaphors often work together, e.g.

informants describe that they ‘fly below the radar’ to avoid being ‘smashed against the

wall’ or being subjected to ‘an HJ’, or having experienced being ‘smashed against the

wall’ makes people ‘fly below the radar’.

“Sacred cows” is a fourth metaphor relating to no-go topics. Everyone acknowledges

that CEO behavior cannot be addressed publicly even though he challenges everyone

else. Furthermore, leaders dare not raise issues about the communication team becau-

se it is headed by the CEO’s live-in partner. Similarly, discussions about whether some

leaders should be allowed to misbehave without consequences, because it is difficult to

replace them, are perceived impossible - in the same way as whether certain clinicians

should receive extraordinary allowances for accepting a position at the hospital.

Psychodynamic structures

Psychodynamics are concerned with dynamics and motivational forces within

individuals or groups as opposed to social constructionist theory which mainly focuses

on structures and constructs between people; however, psychodynamic dimensions

may increase the understanding of deep social structures in organizations (Neumann &

Hirschhorn, 1999). Carr (2001) argues that psychodynamics are particularly detectable

and influental during periods of change.

Psychological Contract

This case reveals that to varying degrees employee and employer believe that there

has been a breach of the psychological contract. A psychological contract is different

from a transactional contract in that it represents the structure of more or less clearly

expressed beliefs that an employee and an employer have about each other regard-

ing their relational exchange (Herriot, Manning, & Kidd, 1997). Conway and Briner (2005)

show that breach of psychological contracts produces employee turnover, lower trust,

lower job satisfaction, higher job neglect, and lower commitment to the organization.

Herriot et al. (1997) argue that fairness, discretion, humanity, recognition, justice,

benefits, security, pay,



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training, needs, consulting, and safe environment describe employer obligations as

perceived by employer and employee. Meanwhile, hours, work, honesty, loyalty,

property, self-presentation, and flexibility describe employee obligations as perceived

by both parties. In this case, the employer side (the executive level) expresses breach of

loyalty across various priorities exemplified by some leaders’ failure to reduce cost by

laying off 50 secretaries. The perception is that the leaders have put their own interests

first. On the employee side, there is a shared perception of a breach of contract,

particularly in relation to the CEO when it comes to

Fairness – “some get away with everything”, i.e. perceptions of CEO favorism of certain leaders

Discretion –“you’ll not stand a chance if you are responsible for the CEO’s pet projects or areas

of expertise”, i.e. CEO micro-management reduces some leaders’ autonomy and delegated

power.

Humanity – the leaders feel that they get support in case of personal problems. However, the

majority believes that public humiliation or ridicule is always a risk in the management team.

Recognition – it is a shared belief that recognition for achievements or particular efforts is close to

non-existent.

Justice – it is a general perception that rules and disciplinary procedures are applied

inconsistently.

Consulting – it is a common belief that consulting with the executive level is ineffective and to be

avoided.

Theory distinguishes between ‘breach’ and ‘violation’ of psychological contract.

‘Breach’ refers to a cognitive perception about failure to comply with contractual

obligations. ‘Violation’ describes the affective and emotional reactions of anger,

resentment, wrongful harm and betrayal related to this failure (Morrison & Robinson,

1997). This case reveals that many emotions are at play.

Emotions

Morrison and Robinson (1997) argue that violation of the psychological contract may

produce ”inability to stop thinking about the issue…outward expressions of anger and

distress (facial gestures, posture, tone of voice)”. A shared perception of our informants



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is that “management meetings are almost like being back in first grade…people roll

their eyes when somebody is talking. They do not speak up. Instead they use all kinds of

gestures, and then they shake their heads when they leave the room.” Contract viola-

tion may have curbed the ability to stop thinking and talking about the issue as the in-

formants keep referring to CEO behavior and how it impacts them: “Respect comes in

two forms. There is how you respect a biker gang member, and how you respect a pro-

fessional leader. Here, we are constantly on the lookout for a knife in the back.” Yet,

pointing at CEO shortcomings may also be a means to divert attention from own

imperfections.

The hospital is built on “a mire of scheming and emotions” and “talking about it in a

quiet, sensible manner is not allowed. You cannot say that you are affected by

something, that you feel intimidated. You cannot talk sensibly and in a reflected way

about this mire of emotions … emotions are ridiculed. There is a mismatch between

what you can talk about and reality”, says one.

Rationality and efficiency are often the uncontested ‘good guys’ in management while

emotions and emotionality are the opposite ‘bad guys’ to be avoided (Carr, 2001). Yet,

neglecting the existence and relevance of emotions has consequences. French (2001)

describes how low ability to contain ambiguity and emotions in a non-defensive way

leads to coalitions, fear, envy, splitting, and scapegoating in organizations. Appelbaum,

Bregman, and Moroz (1998) add that such behaviors lead to conflicts, overall chaos,

loss of productivity, and loss of trust, loyalty and satisfaction. Such attributes are often

described by informants: “the CEO has an extraordinary talent for transferring loser

projects to others … then it is their fault when things go wrong.” Many informants cons-

ider this a fact, and leaders note a growing adversity towards taking responsibility: “we

have seen all kinds of signs that this organization is bleeding, yet nobody does any-

thing…it has become the sick part of the culture…everybody knows what is right or

wrong, but they are afraid, everything gets calculated”. Instead, “people sit and watch

projects derail, then they shrug and say ‘I told you so, this was a wrong decision’”, adds

another informant.



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The organization displays symptoms of dysfunctionality, e.g. stifled communication

patterns, unsettled arguments, suppression of public disagreement, limited room for

diversity and inhibited emotionality. Such traits are often observed in autocratically led

organizations (Kersten, 2001, Kets de Vries, 2004 ), and they are damaging to the

sustainability of change (Buchanan et al., 2007).

Dominant Behaviors

Low ability to embrace ambiguity and emotions leads to dispersive behaviors, i.e.

habitual defense-reactive maneuvers as talk, explanations, emotional reactions, or

initiation of activities (French, 2001). In this case, management meetings are mostly

described by dispersive behaviors leading to lack of clear decisions, emotional

outbursts, or hasty and arbitrary decisions on new initiatives. “Here decisions imply a lot

of talk…We participate in countless meetings, we talk and talk. Then we leave the room

thinking ‘what was the conclusion?’”, says one informant, and another adds “He [the

CEO] doesn’t remember everything and he doesn’t prepare for meetings, hence weird

decisions are made…and everyone wonders ‘why did that argument win?’”

There is a shared perception that problems and challenges largely remain unsolved:

“we don’t talk about the problem and the solution…instead, it turns into a discussion

about who said and did what, a defense-attack way of communicating”. There are

many references to ‘we-they’ or ‘win-lose’ attitudes, which characterize competitive

climates (Furnham, 2005). In such climates people pursue their own goals in disguise,

exaggerate own importance, over-emphasise own wants regardless of the impact on

other parties: ”I’ve seen people fight over offices that they never used, even though

others needed them desperately”. The strategic direction on “a cohesive hospital”

strives for a “we-we” and a “win-win” climate. However, such a climate is characterized

by compliance and individuals’ mutual desire to satisfy the concern of all parties and to

search for mutually beneficial outcomes, and such climates only exist when people ha-

ve relational needs, when incentives support collaboration, and when it is acknowled-

ged that decision-making is qualitatively better and more likely to be carried out if

shared (Furnham, 2005). The leaders recognize the gap between the current and the

desired climate, as illustrated in this comment: “this is an emergency call to our

executives…we want visible executives, who help unify us, who speak up for us. We



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want to make this come true, we want to cooperate, but we need someone to lead

the way”.

Leadership Structures

‘Leadership structures’ frame the contextual conditions for leadership, the distribution of

change agency, and the competing leadership values that may impact the

sustainability of change.

Leadership Context

Hospital changes are often headed by managers “who have little or no management

training, work only part time as managers and do not even see themselves as

managers” (Buchanan & Macaulay, 2013). Potential problems related to this type of

management structure are found in our study: “there is something contradictory in

being a clinical leader. As a clinician you spend years building expertise in your

speciality, but a manager has to focus on making everything else but the patient play.

They like being clinicians. They have a limited desire to become full time managers. They

are clinicians 2-3 days a week and manage the rest of the time”. Furthermore, on-going

consolidation of wards and endeavors for flat organizations have brought along large

spans of control, and the leaders are tasked with multiple parallel change agendas like

IT roll outs, productivity increases, consolidation of wards, cross-speciality flows, staff

development, implementing guidelines, critical incidents and remedial actions, driving

innovation and continuous improvements while overlooking daily operation. Leaders

may thus find themselves being stretched: “they are like de-insulated cords...they are

worn thin…also being surrounded by life and death…it is a quivering organism”.

Change Agency

Detailed planning and clear roles are absent in most change initiatives, and high

impact decisions are often taken arbitrarily and bilaterally in corridors. Change agency

appears to be so distributed that nobody feels in charge:..”we have had so many

meetings. But who is coordinating it and making it into a useful roadmap…it is not

evident how we move from here to there.”



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The CEO argues that there is a layer of rockwool between the leaders and their teams,

that the leaders are reluctant to communicate and execute orders. However, leaders

argue that they try to protect daily operation from unnecessary disturbances: “If we

changed the operation everytime we heard the “Go do it”, people would go crazy

because orders change constantly. We hold back on implementations in order to be

loyal to the executives, not to compromize them. We have learned to wait and see

whether things are really going to happen or not”. Yet, it is broadly recognized that “we

are not good at cross-functional projects. When we have situations calling for strong

coherence across wards, then we move ahead independently without mutual

coordination. It leads to absurd situations and huge frustrations”.

Being prompted, the leaders acknowledge the CEO for his intelligence and visionary

skills and for allowing leaders wide limits. Yet, it is a shared perception that “we succeed,

not because of the executives, but despite of them. When we [the leaders] start

agreeing things get moving. If we succeed, we’ll be applauded, and if we don’t, our

executives will step back and say ‘told you so’. We are good at succeeding against all

odds”. This approach also has its downsides. Anarchy is a frequently mentioned word:

“When we are told what to do, some do as they are told. Then they hear that

somebody has convinced the executives to be exempted, and then they start doing

what these others do. Then the saying goes that when it’s ok to do it differently over

there, then it’s also ok to do it our way here. Then it ends in complete anarchy where we

do things in umpteen ways”.

In relation to the desired change in leadership behavior, it is unclear “who needs to

change which behavior, when and how we will see it”. Many quote the CEO for saying

that “this process does not mean a shit to anybody, and nothing will change, and to

him it is business as usual”. Hence, it remains an open question whether everyone,

someone or nobody will take charge of this initiave, however, the majority of leaders

awaits someone to take charge.

Competing Values

Cameron, Quinn, Degraff, and Thakor (2006) argue that competing values, preferences

and priorities exist in any organization, and these can be grouped in four mutally



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opposing value domains ; however, they all contribute to organizational performance.

Leaders tend to favor some domains over others, and persons with behavioral

preferences in one domain will typically perceive behaviors relating to the opposing

domain as a destroying value. This will prevent them from capturing the value created

by the dymanics across all four domain behaviors while at the same time risking a

derailment of their own preferences. The four domains are described in Figure 2.

Collaborative (do it together)

Value creation via human capacity, people

development. Reinforcing culture by means

of cohesion, satisfaction and engagement.

Consensus, team work, and involvement

across organizational borders is encouraged.

Leaders mentor and facilitate competent

human interaction through value-based

leadership.

As

oppose

d t

o

Compete (do it faster, bigger)

Create value via an outward competitive

focus. Focus on rapid response, taking

charge, moving fast, and being aggressive.

Leaders are hard driving, directive, and

competitive, welcoming challenges and

constantly setting new and stretched goals.

Power and success is measured on results and

not through their level of effort or the

methods used.

Control & stability (do it right, better,

cheaper)

Strategies aim for efficiency and

effectiveness, i.e., standardized procudures,

improving predictability, regularity, role

enforcement and uniformity. Leaders are

organizers and administrators with attention

to details, careful decisions, precise analysis

and best practice. Apply cautious, logical and

methodical approaches to problem solving

As

oppose

d t

o

Create (be the first to do it)

Create value through pioneering

breakthroughs, entrepreneurship, defining

sector trends and next practices that can

leapfrog competitors. Experimentation in

loosely coupled, self-managing systems is

emphazised. Leaders are visionaries with

discovery skills, inclined towards risk and

undertaking original actions.

Figur 2: Competing values and behaviors (after Cameroun et al., 2006)

The informants describe a CEO with strong preferences for the ‘compete’ and ‘create’

domains: “for the CEO, it is a world championship on being different from all other

hospitals. We cannot follow in the footsteps of others. We have to do it our way. That is

constantly underscored. And we are not allowed to talk about other the achievements

of other hospitals”. In parallel, the CEO expresses reservations towards behaviors relating

to the collaboration domain: “it is almost too much to listen to all this talk about

processes and collaboration…I fear that they shift their focus towards processes on how

we should treat each other…we don’t want to end up in a culture where we sit in



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circles”. The leaders also share that such behavioral preferences and non-preferences

are widely replicated throughout the organization, as says this manager: “take the

Danish Quality Model, the Treatment Guarantee, or the Diagnosis Guarantee,…we

have known it for months…but we wait till the very last minute…and then we end up in

chaos. This is taking place at our level. That it is not good enough”.

There are “some strengths related to this absence of control and order…this anarchistic

craziness causes things to happen here, that cannot happen elsewhere…it makes them

proud…and they display an exceptional pride, a kind of team spirit…we can do some-

thing together”, observes an informant. Still, many leaders ask for more gumption

relating to the control and collaboration domains, and the articulated changes in

leadership behavior relate to those two domains. The other executive is acknowledged

for representing the control and collaboration domains, and in principle the two

executives are complementary. Yet, it is a shared concern that the CEO disrespects and

disregards this complementarity as well as the general value relating to collaboration

and control.

Implications for the Sustainability of Change

Outlining the individual elements of the socially constructed reality of deep structures

makes the implicit explicit. It displays how the different parts maintain and influence

each other in ways that are counter-productive to sustainability of change. In this case,

sustained change of new leadership behaviors is complicated by a web of deep,

interwoven social structures, yet it is the very nature of these deep structures that has

necessitated the need for a change.

Is change then stuck in a catch 22? Or does the data reflect a system in equilibrium or in

change? There is no clear answer to these questions. The desired change is

simultaneously a change of deep structures. This corresponds to Gersick’s (1991)

definition of revolutionary change. Evolutionary change leaves the game’s deep

structures intact whereas revolutionary change dismantles the deep structures. “More of

the iceberg has come above the waterline, and icebergs are difficult to push back

under water” says an informant. This can be paralleled to Gersick’s (1991) observation



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that when people find that an era is coming to an end, they may consciously decide

that the approaches they chose for that era are no longer valid, and in such moments

they feel a need to reevaluate past choices and take new steps. However, being in the

change leaves the informants in an unfamiliar and uncomfortable situation. Emotionality

and tension is high, and change agency is afloat. The informants acknowledge that

changes are taking place, but they look for additional proof that ‘from now on

everything is completely different’. By doing so they may overlook how minor changes

in ‘nucleuses’ between individuals and wards can accumulate into systemic shifts

(Gersick, 1991). Sustaining the change thus requires continued, mindful, and compliant

efforts supporting the desired change.

Theoretical Implications

The findings presented in this paper support existing literature on sustainability of change

and the underlying research on cultural climates, organizational receptiveness to

change, and absorptive capacity (Buchanan et al., 2007, Cohen & Levinthal, 1990,

Ekvall, 1996, Kanter, 1983, Szulanski & Winter, 2002), which present conditional attributes

that are predictive of organizational ability to embrace and sustain change.

The findings categorize a series of deep structures which are indicative of such

attributes’ level of presence. This categorization bridges functionalist, rational, structural,

macro-level change management theory and micro-level theories on dynamic,

unpredictable, un-orderly, irrational behaviors and dynamics that influence

organizational change. The findings thus point towards a framework that may interlink

micro and macro-level theories of change.

The majority of change management literature focuses on managing a specific

change. Uncovering and changing deep structures offer a complementary approach

to change which aims at enabling overall organizational change ability. Combining

classical, functionalistic change management approaches with change approaches

targeting deep structures will reduce the risk that a perfectly orchestrated change

management initiative fails to deliver sustained change. Concurrently, initiatives

focusing exclusively on uncovering, identifying, dismantling deep structures and

reconfiguring them anew may enable new deep structures that enforce overall



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organizational change ability. By doing so, the organization may substitute logics of

replacement with logics of attraction (Weick & Quinn, 1999). Working on deep structures

thus has the potential to enhance an organization’s inherent ability and capacity to

embrace, drive, and sustain change.

Concluding Remarks

This study presents 12 deep structures that impact the sustainability of change in a

Danish hospital. The findings advance a first attempt to build a collated framework of

change-related deep structures that may impact sustained change.

The study is based on a single case. Different case studies may modify the presented

structures. Social constructionism, leadership theory, change management theory,

organization theory, narrative theory, and psychodynamic theory contribute to framing

this study. Consequently, different theoretic lenses or methodological approaches may

nuance the findings. Accordingly, an investigation of the relative strength and

reversibility of the different deep structures would enhance the determination of

effective triggers for tipping change. Hence, further research is recommended to

validate the general applicability of this framework.

“Why don’t they just keep on doing it?” The findings indicate that change inhibitive

deep structures may explain why people do not keep on doing what a change

initiative prescribes. However, the findings may equally suggest that other configurations

of deep structures may be change facilitating, thus enabling people and organizations

to embrace and adapt change by attraction.



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