This article illustrates how distributed change agency can implement complex organizational changes in the absence of formal management plans, roles, and structures. Distributed change agency typically involves small teams and senior groups. In this qualitative study of service improvements in the treatment of prostate cancer at an acute hospital, Grange, change roles were distributed more widely, with responsibilities `migrating' among a large informal cast supporting four central characters. This distribution appears to have been triggered by the change goals and substance, and by the network organization through which services were delivered. Cross-case comparisons with other hospitals, Henley and Norwood, suggest that a combination of factors contributed to the development of a distributed approach. Analytical generalization invites speculation concerning the transferability of this model, with `nobody in charge', to other settings. One policy implication concerns the provision of development in change agency competencies to staff other than those in senior positions.
Addicott, R. , McGivern, G. & Ferlie, E. Networks , organizational learning and knowledge management : NHS cancer networks . Public Money and Management, 2006, 26, 87—94 .
2.
Beatty, C.A. & Gordon, J.R.M.Preaching the gospel: The evangelists of new technology . California Management Review, 1991, 73—94 .
3.
Beer, M. , Eisenstat, R.A. & Spector, B.Why change programs don't produce change . Harvard Business Review, 1990, 158—66 .
4.
Bennett, N. , Wise, C. & Woods, P.Distributed leadership. Nottingham: National College for School Leadership , 2003 .
5.
Brooks, I.Leadership of a cultural change process . Leadership and Organization Development Journal, 1996, 17, 31—7 .
6.
Bruce, A. & Hill, S.Relationships between doctors and managers: The Scottish experience . Journal of Management in Medicine, 1994 , 8, 49—57 .
7.
Bryman, A.Leadership in organizations. In S .R. Clegg , C. Hardy & W.R. Nord (Eds), Handbook of organization studies. London: Sage , 1996, pp. 276—92.
8.
Buchanan, D.A.The logic of political action: An experiment with the epistemology of the particular . British Journal of Management, 1999, 10, 73—88 .
9.
Buchanan, D. Demands , instabilities, manipulations , careers : The lived experience of driving change . Human Relations, 2003, 56, 663—84 .
10.
Buchanan, D. & Storey, J.Role taking and role switching in organizational change. In I . McLoughlin & M. Harris (Eds), Innovation, organizational change and technology . London: International Thomson , 1997, pp. 127—45.
11.
Buchanan, D.A. , Fitzgerald, L. & Ketley, D. (Eds). The sustainability and spread of organizational change: Modernizing healthcare . London: Routledge , 2007.
12.
Butler, R.Stories and experiments in social inquiry . Organization Studies , 1997, 12, 927—48 .
13.
Caldwell, R.Models of change agency: A fourfold classification . British Journal of Management, 2003, 14, 131—42 .
14.
Caldwell, R. Agency and change : Rethinking change agency in organizations. Abingdon: Routledge , 2005.
15.
Calman, K. & Hine , D. A policy framework for commissioning cancer services. London: Department of Health , 1995 .
16.
Cleveland, H.Nobody in charge: Essays on the future of leadership. New York: Wiley , 2002.
17.
Davies, H. & Harrison, S.Trends in doctor—manager relationships . British Medical Journal, 2003, 326, 646—9 .
18.
Dawson, P.Organizational change: A processual approach. London: Paul Chapman , 1994.
19.
Dawson, P.Reshaping change: A processual approach. London : Routledge , 2003.
20.
Denis, J.-L. , Lamothe, L. & Langley, A.The dynamics of collective leadership and strategic change in pluralistic organizations . Academy of Management Journal, 2001, 44, 809—37 .
21.
Denis, J.-L. , Langley, A. & Cazale, L.Leadership and strategic change under uncertainty . Organization Studies, 1996, 17, 673—99 .
22.
Department of Health.The new NHS, modern, dependable. London: Department of Health , 1997.
23.
Department of Health.The NHS plan: A plan for investment, a plan for reform. London: Department of Health , 2000a.
24.
Department of Health.The NHS cancer plan: A plan for investment, a plan for reform. London: Department of Health , 2000b.
25.
Department of Health.NHS leadership qualities framework. London: NHS Modernisation Agency Leadership Centre , 2002.
26.
Department of Health.The NHS improvement plan: Putting people at the heart of public services. London: HMSO , 2004.
27.
Dyer, W.G. & Wilkins, A.L.Better stories, not better constructs, to generate a better theory: A rejoinder to Eisenhardt . Academy of Management Review, 1991, 16, 613—19 .
28.
Ferlie, E. , Ashburner, L. , Fitzgerald, L. & Pettigrew, A.M.The new public management in action. Oxford: Oxford University Press , 1996.
29.
Ferlie, E. , Fitzgerald, L. , Wood, M. & Hawkins, C.The (non) spread of innovations: The mediating role of professionals . Academy of Management Journal, 2005, 48, 117—34 .
30.
Fitzgerald, L. & Dufour, Y.Clinical management as boundary management: A comparative analysis of Canadian and UK health care institutions . International Journal of Public Sector Management, 1997, 10, 5—20 .
31.
Fitzgerald, L. , Lilley, C. , Ferlie, E. , Addicott, R. , Buchanan, D. & McGivern, G.Managing change and role enactment in the professionalized organization . Final Report to the SDO Commissioning Board, February 2006 [www.sdo.lshtm.ac.uk].
32.
Goldstone, J.A.Comparative historical analysis and knowledge accumulation in the study of revolutions. In J . Mahoney & D. Rueschemeyer (Eds), Comparative historical analysis in the social sciences. Cambridge: Cambridge University Press , 2003, pp. 41—90.
33.
Griffiths, L. & Hughes, D.Talking contracts and taking care: Managers and professionals in the British NHS internal market . Social Science & Medicine , 2000, 51, 209—22 .
34.
Gronn, P.Distributed leadership as a unit of analysis . Leadership Quarterly , 2002a, 13, 423—51 .
35.
Gronn, P.Distributed leadership. In K . Leithwood , P. Hallinger , K. Seashore-Louis , G. Furman-Brown , P. Gronn , W. Mulford & K. Riley (Eds), Second international handbook of educational leadership and administration. Dordrecht: Kluwer , 2002b, pp. 653—96.
36.
Gustafson, D.H. , Sainfort, F. , Eichler, M. , Adams, L. , Bisognano, M. & Steudel, H.Developing and testing a model to predict outcomes of organizational change . Health Services Research, 2003, 38, 751—76 .
37.
Hoque, K. , Davis, S. & Humphreys, M.Freedom to do what you are told: Senior management team autonomy in an NHS acute trust . Public Administration, 2004, 82, 355—75 .
38.
Ichniowski, C. , Kochan, T.A. , Levine, D. , Olson, C. & Strauss, G.What works at work: Overview and assessment . Industrial Relations , 1996, 35, 299—333 .
39.
Iles, V. & Sutherland, K.Organizational change: A review for health care managers, professionals and researchers. London: NHS Service Delivery and Organization Research and Development , 2001.
40.
Kipnis, D. , Schmidt, S.M. , Swaffin-Smith, C. & Wilkinson, I.Patterns of managerial influence: Shotgun managers, tacticians and bystanders . Organizational Dynamics, 1984 , 58—67 .
Nadler, D.Champions of change. San Francisco, CA: Jossey Bass , 1998.
46.
NHS Executive.Manual of cancer services standards . London: NHS Executive , 2000.
47.
Ottaway, R.N.The change agent: A taxonomy in relation to the change process . Human Relations, 1983, 36, 361—92 .
48.
vretveit, J.Total quality management in European healthcare . International Journal of Healthcare Quality Assurance, 2000 , 13, 74—9 .
49.
vretveit, J. & Gustafson, D.Using research to inform quality programmes . British Medical Journal, 2003, 326, 759—61 .
50.
Parker, H. , Meredith, P. , Kipping, R. , McLeod, H. & Ham, C.Improving patient experience and outcomes in cancer: The early phase of the NHS cancer services collaborative. Birmingham: The University of Birmingham, Health Services Management Centre , 2001.
51.
Pearson, R. , Reilly, P. & Robinson, D.Recruiting and developing an effective workforce in the British NHS . Journal of Health Services Research and Policy, 2004, 9, 17—23 .
52.
Pettigrew, A.M.The awakening giant: Continuity and change in ICI. Oxford : Basil Blackwell , 1985.
53.
Pettigrew, A.M. , Ferlie, E. & McKee, L.Shaping strategic change: The case of the National Health Service . London: Sage , 1992.
54.
Powell, M.J. , Brock, D.M. & Hinings, C.R.The changing professional organization. In D.M. Brock , M.J. Powell & C.R. Hinings (Eds), Restructuring the professional organization. London and New York: Routledge , 1999, pp. 1—19.
55.
Rueschemeyer, D.Can one or a few cases yield theoretical gains? In J . Mahoney & D. Rueschemeyer (Eds), Comparative historical analysis in the social sciences . Cambridge: Cambridge University Press , 2003, pp. 305—36.
56.
Schneller, E.S. , Greenwald, H.P. , Richardson, M.L. & Ott, J.The physician executive: Role in the adaptation of American medicine . Health Care Management Review, 1997, 22, 90—6 .
57.
Schön, D.A.Champions for radical new inventions . Harvard Business Review , 1963, 41, 77—86 .
58.
Spurgeon, P. , Barwell, F. & Kerr, D.Waiting times for cancer patients in England after general practitioners' referrals: Retrospective national survey . British Medical Journal, 2000, 320, 838—9 .
59.
Stace, D.A. & Dunphy, D.Beyond the boundaries: Leading and re-creating the successful enterprise . Sydney: McGraw-Hill , 1994.
60.
Stjernberg, T. & Philips, A.Organizational innovations in a long-term perspective: Legitimacy and souls-of-fire as critical factors of change and viability . Human Relations , 1993, 46, 1193—221 .
61.
Tsoukas, H.The validity of idiographic research explanations . Academy of Management Review, 1989, 14, 551—61 .
62.
Van de Ven, A.H. , Polley, D.E. , Garud, R. & Venkataraman, S.The innovation journey. New York and Oxford: Oxford University Press , 1999.
