article review on leadership and change management

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Image courtesy of Edgar and Peter Schein

When social psychologist Edgar Schein joined MIT’s Sloan School of Management in the 1950s, the school had just launched its great experiment of teaching management through formal disciplines like mathematics, social psychology, economics, and history. That was a radical departure from expounding “the practice of management” through cases taught by professors who had been managers for most of their careers. The new approach sparked close, unlikely collaborations and deep, innovative thinking about leadership, group cultures, and organizational change — all nascent fields of study at the time. It was in this environment that Ed and his colleagues embarked on what he calls “an exciting quarter century of model building,” which helped define how people thought about and engaged with organizations.

Decades later, in a digital era, Ed says it is time for a new model, one that is built on close professional relationships, openness, and trust. He and Peter Schein, his son and collaborator, have been working on this model for the past few years. After earning a degree in anthropology and an MBA, Peter spent most of his career as a strategy executive at a number of Silicon Valley companies. In 2015, he decided to join Ed in analyzing and describing the changes afoot as the tasks of management become more complex, interdependent, and volatile. In this conversation, they share their perspectives on organizational life, a brief history of ideas leading up to this moment, and their thoughts about the future.

Ed Schein: Peter, in our recent work together, you have advocated for combining culture, change, and leadership into an integrated process, rather than viewing them as three separate topics of importance. Why this approach?

Peter Schein: Most of us at work these days, in organizations large and small, implicitly accept that culture matters . Whether or not it eats strategy for breakfast, culture is a deep substrate: coercive, empowering, good, or toxic. It does not change when our business has a bad quarter or when we proclaim, “We have a culture problem.�

About the Authors

Edgar H. Schein is a professor emeritus of the MIT School of Management. Peter A. Schein is a strategy consultant in Silicon Valley. They are the authors of Humble Leadership: The Power of Relationships, Openness, and Trust (Berrett-Koehler, 2018). Their new book, the third edition of The Corporate Culture Survival Guide: Culture Change Leadership (forthcoming), strongly articulates the need for new models of management and leadership.

1. See E.H. Schein and P.A. Schein, Humble Leadership: The Power of Relationships, Openness, and Trust (Oakland, California: Berrett-Koehler, 2018).

2. B. Johansen, The New Leadership Literacies: Thriving in a Future of Extreme Disruption and Distributed Everything (Oakland, California: Berrett-Koehler, 2017).

3. See, for example, B.J. Robertson, Holacracy: The New Management System for a Rapidly Changing World (New York: Henry Holt, 2015).

4. J. Doerr, Measure What Matters: How Google, Bono, and the Gates Foundation Rock the World With OKRs (New York: Portfolio/Penguin, 2018).

5. F. Laloux and E. Appert, Reinventing Organizations: An Illustrated invitation to Join the Conversation on Next-Stage Organizations (Brussels, Belgium: Nelson Parker, 2016), 161.

6. D.A. McGregor, The Human Side of Enterprise (New York: McGraw Hill, 1960).

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Research Article

Leadership Models and Change Management: A Systematic Review

Biniam Getnet Agazu, Zerihun Ayenew Birbirsa, Shimels Zewdie Werke

This is a preprint; it has not been peer reviewed by a journal.

https://doi.org/ 10.21203/rs.3.rs-2075522/v1

This work is licensed under a CC BY 4.0 License

You are reading this latest preprint version

The goal of the study was to thoroughly examine the organizational change management and leadership paradigms utilized in various industries. There are various leadership models that can be applied in various situations and change models that are used in various organizations, but there is no evidence of the effectiveness of these models when it comes to managing organizational change, and they aren't discussed as a group in a systematic way either. A research topic that has been highlighted by the studies is to present and examine the leadership models that are most frequently utilized in organizational change management. The past literature on empirical and theoretical topics is compiled via a systematic review. An analysis of the content that is qualitative and descriptive was planned. Scopus, Web of Science, Taylor & Francis, Google Scholar, Emerald, and PubMed search results were for research. The following leadership theories were examined: the Great-Man Theory, the Trait Theory, the Behavioural Theories, the Contingency Theories, the Situational Leadership Theory, the Path-Goal Theory, the Leader Participation Model, the Leader-Member Exchange Theory, the Transformational Theory, the Transactional Theory, the Authentic Leadership theory, the Ethical Leadership theory, and the Servant Leadership theory. Various change management models were also examined, including ADKAR, Kurt Lewin's Change Model the majority of researchers worked on separately examining leadership models and change management in various businesses, but they mostly focused on transformational leadership combined with change management strategies that are helpful in organizational transition. The findings of this study support the widespread use of transformational leadership styles in businesses that were undergoing change. Therefore, it is advised that rather than generalizing the theories, future scholars conduct study by filling up these gaps and concentrating on geographical areas where it is possible to apply leadership models to certain sectors.

Systematic review

Change Management

Content analysis

Introduction

Leadership is the most important contextual factor that influences and shapes team performance and ultimately contributes to the effectiveness and success of the organization (Owens et al., 2013 ). Leaders are responsible for the process of social influence, defining team goals, structuring, and motivating team members with the goal to fulfil the team mission (Pudelko et al., 2015 ). For the successful completion of any change management plan, it needs to be carefully planned and fully budgeted. Along with these important constraints, leadership is also a spirit for the manager to capture employees back into work and to produce maximum benefits from change. The leaders are more effective than managers during the process of change (Bejestani, 2011 ). Change management is the process, tools, and techniques to manage the people side of change to achieve the required business outcome, it incorporates the organizational tools that can be utilized to help individuals make successful personal transitions resulting in the adoption and realization of change (Ahn et al., 2010 ). Efforts to make major changes in the way organizations run are a regular occurrence in business and government entities throughout the world. Despite the regularity of these efforts, studies show that the majority of all change efforts are deemed failures by a variety of stakeholders (Pasmore, 2015 ).

leadership is dyadic and dynamic process, where leaders understand and professionally influence followers to transcend self-interest for the greater good of the organization, through motivating, inspiring a shared vision, and supporting higher level of need of the followers; and defining a competent rewarding system, so as achieve the challenging organizational goals, effectively and efficiently, through collective efforts (Bhattacharyya & Jha, 2018 ). The great men became irrelevant and consequently growth of the organizations (Samad, 2012 ). On the amount of direction and guidance, the dynamic among these factors was established; socio-emotional support and task behaviour, in performing a task the readiness level (commitment and competence) of the followers and relationship behaviour required by the followers functions and objective (Ryan & Tipu, 2013 ).

Traditional organization development models are giving way to new intervention methods and models in an age of uncertainty, complexity, globalization, and accelerating change (Karakas, 2010 ). There are a number of leadership models that have been implemented in various organizations and proven to be effective and instructive. However, the business world is changing rapidly with the advancement in information technology and many organizations as Riordan Manufacturing (RM) transformed to a global organization. Consequently, many facets have to be taken into consideration when developing a leadership model for RM as global organization (El-sherif, 2014 ).

Kotter (1988) Colin A. Carnall ( 2010 ) identifies a number of the ‘characteristics needed to provide effective leadership’, overcoming the problems identified in the syndrome outlined above. To be effective, leaders need a range of knowledge of industry, business functions and the firm. Also needed are a broad range of contacts and good working relationships in the firm and the industry. Linked to this will be a good track record in a relatively broad set of activities.

A systematic review is a process for reviewing relevant literature using a comprehensive, pre-planned strategy to locate existing literature, evaluate its contribution, analyse and synthesise findings and report on evidence to allow conclusions to be reached about what is known and what is not and Originating in the medical sciences, a systematic review differs from conversional reviews in that it aims at synthesising research in a systematic, transparent and reproducible manner (Ionescu, 2014 ). Most systematic review studies, focused on leadership theories and change management in case of different organizations specifically, in education and health sectors (e.g. Zakeer Ahmed et al., ( 2016 ); Gumus et al., ( 2016 ); Linda et al., ( 2017 ); (Rudolph et al., 2021 ); Deshwal & Ali, (2020); Schott et al., ( 2020 ); Mehrad, ( 2020 a); Aij & Teunissen, ( 2017 ); Laumann, (2018)). Aiming to address gap, the current study builds on multi-level perspective by posing two research questions: What are discussed leadership models mostly with change management?, What methodological debates are discussed by past studies with related leadership models and change management?. Therefore, this review of systematic were answer those questions to fill the gaps on literature with combining leadership models used in organizational change management using content analysis that describe the different literatures finding and explore the most leadership models used in changing organizations.

Theoretical And Empirical Studies

Leadership models.

Leadership is the process of influencing others to understand and agree about what needs to be done and how to do it, and the process of facilitating individual and collective efforts to accomplish shared objectives (Yukl, 2012 ). The role of a leader is vital, and thus it cannot be overlooked. As time passed, various theories of leadership emerged, but due to change in scenario and environment, these theories also needed to have some modification in that because one single theory does not fit fully in different situations. The success or failure of an organization directly relates to the effectiveness of the organization. There are various stories in which even a sick organization revive it and move towards the way of success, and it happened only because using the right style of leadership (Deshwal & Ashraf Ali, 2020 ).

A leadership model is a theoretical framework for how best to manage employees. It typically suggests a corresponding response style to employee and organizational needs that has proven useful in that model. Although leadership models are similar to leadership styles, these are two separate concepts. While the model serves as the conceptual structure to explain what makes a leader great, the style represents the pattern of leadership behaviours they exhibit in pursuit of that greatness (Samarakoon, 2019 ).

Great-Man Theory

The Great Man Theory of leadership is centred on the ideas of prominent historians of the 19th century. The literature of the century, including Frederick Adam Woods’s book The Influence of Monarchs: Steps in a New Science of History and many like it, analyze the influence of major rulers primarily in the Western world. The Great Man Theory thrives on the notion that most of history can be explained by the influence of male leadership figures. These men often appeared to rise to power out of nowhere and lead their people to success, and their “greatness” was often derived from military leadership. Great Man Theory reigned as the most popular theory of explaining leadership well into the mid-20th century, supposedly explaining the influence of big names such as Abraham Lincoln, Julius Caesar, and Alexander the Great (Carlyl, 2012 ).

Trait Theory

Trait theory is the approach to study a human personality that identifies & measures the degree to that convinced personality traits; very often recurring patterns of thoughts and behaviour of any human, like anxiousness, shyness, pessimist thought, optimist thought, openness to new things that exist from individual to individual (Penney et al., 2015 ).

Behavioural Theories

Behavioral theories of leadership indicate that leadership can be learned, unlike trait theory. Behavioural theories of leadership presuppose that particular behaviours are what distinguish leaders. That is, these theories begin with the assumption that an effective leader in any achievement context is one who exhibits the behavior’s that are most conducive to group productivity and group psychosocial growth (Kovach, 2018 ).

Contingency Theories

Those theories argue that the best type of leadership depends on situational variables and that no one style of leadership pertains or should be followed to all given workplace situations. For this reason, effective leaders can adapt their leadership style based on the nature of the group, the situation, and the objectives to be achieved (Kovach, 2018 ). The Fielder Model, In the year 1967, Fred Fiedler made the Fiedler Contingency Model, which states that the performance of the group depends upon the match between leaders’ style of interaction with his subordinates and the level of degree which the situation gives the leader control and influence. Least Preferred Co-worker (LPC) is developed by Fielder to identify whether a leader is a task-oriented leader or relationship oriented. Along with this, he also identified three contingency dimensions that are leader-member relations, task structure, and position power.

Situational Leadership Theory

Paul Hersey and Ken Blanchard (1969) defined situational leadership; it assumes that the effective leadership style does not remain static, and it changes as per the situation, and to be an effective and successful leader should adopt his style and approach to different situations. Situational leadership means that leaders have to change the degree of supportiveness and directness to their employees according to the given situation of subordinates and their level of motivation.

Path-Goal Theory

In 1971 Robert House developed path-goal theory. He was a graduate at Ohio State University; later, this theory was and revised in 1996. It uses initiating structure, consideration, and expectancy theory of motivation to make the theory. It defines states that a leader should clarify the path of the followers and lead him effectively towards goal by reducing roadblocks. When a task is stressful and ambiguous, directive leadership is preferable. In a structured task, supportive leadership yields high performance and satisfaction.

Leader Participation Model

The Vroom–Yetton contingency model is made by Victor Vroom and Phillip Yetton in 1973 and later in 1988 with Arthur Jago. It concluded that the best leadership style depends on the situation. Five styles are suggested, and these are Autocratic Type 1, in which leaders exercise decisions basis on the readily available information. Second, Autocratic type 2 styles, in which information is taken up by the leader from followers but takes a decision on his own. The third style is Consultative Type 1, leader’s share problems with only a few followers who are relevant enough and not all, but one by one, and followers are not allowed to discuss among them. Fourth, Consultative Type 2, in this a leader consults with followers in a group, but their ideas are heard, but the decision is taken by leader only by his own, Fifth, Group based Type 2, in which problems are discussed by leader with followers, and that decision is taken which is accepted by group.

Leader-Member Exchange Theory

Leader-member exchange theory originally made in 1975 states that because of time pressure, a leader and some members build a special relation, and this group is known as in-group, and those members who are not the part of this group come in our group. Those followers who are the part of in-group get some favourable attitude from the employees in comparison to those members who are the part of out-group. The focus of the leader-member theory is on the relationship quality of a leader and his subordinates (Kovach, 2018 ).

Transformational theory

Transformational leadership distinguishes itself from the rest of the previous and contemporary theories, on the basis of its alignment to a greater good as it entails involvement of the followers in processes or activities related to personal factor towards the organization and a course that will yield certain superior social dividend. The transformational leaders raise the motivation and morality of both the follower and the leader (House & Shamir, 1993). It is considered that the transformational leaders “engage in interactions with followers based on common values, beliefs and goals”. This impacts the performance leading to the attainment of goal. As per Bass, transformational leader, “attempts to induce followers to reorder their needs by transcending self-interests and strive for higher order needs". This theory conforms the Maslow (1954) higher order needs theory. Transformational leadership is a course that changes and approach targets on beliefs, values and attitudes that enlighten leaders‟ practices and the capacity to lead change (Tarker, 2019 ).

Transactional theory

Transactional leadership style comprises three components: contingent reward, management-by-exception (active) and management-by-exception (passive). A transactional leader follows the scheme of contingent rewards to explain performance expectation to the followers and appreciates good performance.

Authentic Leadership theory

Bill George wrote about the authentic leadership in his book ‘Authentic Leadership’ in 2003, although it was originated in 1960 to explain how an organization presents itself authentically through leadership. This style is influenced by the ethical behavior of a leader. Authentic leadership comprises with self-awareness of a leader he knows his strengths and weaknesses, makes positive relationships with employees by inspiring and encouraging them. “According to George’s concept, several dimensions in authentic leadership include knowing the authentic self, learning from one’s life story, integrating all elements of life (work, family, community and friends), building support teams, balancing the intrinsic and extrinsic motivations, practicing personal values and empowering people to lead. “ (Ghazzawi et al., 2017 )

Ethical Leadership theory

Ethical leadership revolves around due respect and faith in ethics, beliefs, and values. It takes into consideration the rights and dignity of other persons. Trust, faith, fairness, honesty, consideration are the main elements of ethical leadership. Ethics refers to the values and morals which a person or a society as a whole finds reasonable to follow. It is related to the virtuousness of a person and his motives. The choices of a leader are also affected by his morality. Ethical leadership is empirically related to some of the similar related constructs such as transformational, servant, and authentic leadership, but argued that it is well distinct from these constructs (Bansal & Kumar, 2018 ).

Servant Leadership

The term servant leadership was given by Robert K. Greenleaf in 1970. The new angle of ethical leadership is servant leadership. This type of leader pays more attention to the growth and development of followers. Persuasion is the tool to get the work done. A Servant Leader pays more attention to the needs of the employees helps them to grow and develop. Here the leader is there who serves the followers and shares his power with them. Those people who accept servant leadership experience high-level satisfaction, trust, recognition, creativity in their work. By using servant leadership, one can achieve organizational goals without using positional and authoritative power. (Bansal & Kumar, 2018 )

A successful change includes therefore three aspects: unfreezing (if necessary) the present level L1, moving to the new level L2, and freezing group life on the new level and Since any level is determined by a force field, permanency implies that the new force field is made relatively secure against change. Kurt Lewin was seen as one of the foremost psychologists of his day, He is now best known for his three-step model of change. However, this has been criticized for its “simplicity,” and it has even been suggested that Lewin “never developed such a model,” yet this ignores its links to the rest of Lewin’s work. Surprisingly, there appears to have been no rigorous attempt to understand the connection between Lewin’s early work on field theory and his later work on social and organizational change. In addressing this gap in the Lewin literature, this article will not only show that the three-step model of change is far from being simplistic but also that it was a well-thought-out approach to change based on his development of field theory. The main difference between the two is one of nomenclature rather than substance (Burnes, 2020 ).

Cummings (2010) presented a model to obtain effective change management including 5 activity steps: 1) motivating change, 2) creating a vision, 3) developing political support, 4) managing the transition, and 5) sustaining momentum. The first activity step, motivating change, includes creating readiness for change and helping the change recipients address resistance to change. The second step, creating a vision, is a leadership task where the leaders are to create the ‘why’ and ‘what’ of the upcoming change. During the third step, developing political support, the leaders need to gain employees’ support to implement the change and avoid individuals and groups from blocking it. As a fourth step, the management needs to create an activity plan for the change activities. In addition, it is the management’s task to plan how to keep the employees committed and to build a management structure to guide the organization through the planned change. The fifth activity, sustaining momentum, includes providing resources for change, building a support system for change agents, developing new competencies and skills, reinforcing new behaviours, and staying the course to complete the change process.

Managers in modern organizations consider change as a constant and continuous factor that can be utilized to enhance organizational performance form finance, customers’ satisfaction, and internal process, and learning and growth perspectives. In order to manage the change, managers adopt different change management models such as ADKAR, Kurt Lewin’s change model, Kotter 8 steps model, and Mckinsey 7s model (Sheikh Hamdo, 2021 ).

ADKAR Change Model

Jeffrey Hiatt, the successful entrepreneur and the founder of Prosci Learning Centred, introduced ADKAR model of change management in 2006. managers need to reinforce the change process by implementing a comprehensive control and evaluation system that can point out challenges faced by all stakeholders in the organization, the employees particularly, so they help them overcome these challenges and motivate them keep engaged in the change process (Sheikh Hamdo, 2021 ).

KURT LEWIN’S Change Management Model

In 1947 Lewin, the social psychologist, introduced his three stages model of change process: unfreeze, change, refreeze. Lewin argued that change starts first in unfreezing the status quo.

KOTTER’S 8 Steps Change Management Model

Kotter provided his change management model that consists of eight steps: creating urgency, forming a powerful guiding coalition, creating a clear vision for change, communicating the vision, empowerment actions, achieving wins in the short- run, building on the change base reached, making change stable.

MCKINSEY 7S Model

Introduced by Waterman, Peters, and Phillips in 1980 Mckinsey 7s model analyses organization from seven perspectives: strategy, structure, system, skills, staff, style, shared values, considering the first three ones as hard Ss and other four ones as soft Ss. Mckinsey 7s model is an effective analysis tool that enables managers determine the consistency level among organization’s main dimensions and specify the change needed. Transformational leaders are highly concerned with their employees’ individual needs. This is appreciated by the employees who, in their turn, will be highly committed to ensure change success to achieve goals set by their managers. Besides, through their cordial relationships with their subordinates, transformational leaders can deal with the situational resistance against the change effectively. According to Hussain et al., ( 2016 ) the transformational leadership style affects the organizational change process. In this type of leadership style, the leader coordinate with employees, share their knowledge, give opportunity in making decisions in organizational level.

Research Gap

After going through various studies, it is found that all the theories of leadership models and change management are not discussed collectively in a systematic way while leadership styles focused studies in articles and change management models studied with related only transformational leadership theories. Different papers were found which were discussing leadership models, theories and styles differently related with change management models, and all theories were not found under an umbrella. Thus, these studies need to fill the gap on reviewing systematically leadership models and change management for choosing leadership models in organizational changing environment.

Research Methods

This study employed a systematic review leadership models and change management. Systematic review is characterised by a methodical, transparent, replicable methodology and presentation. They involve a comprehensive and systematic search to locate all relevant published and unpublished work that addresses one or more research questions, and a systematic presentation and integration of the characteristics and findings of the results of that search. The best reviews synthesize studies in order to draw broad theoretical conclusions about what a literature means, linking theory to evidence and evidence to theory (Siddaway et al., 2019 ).

Data Collection

This study was started by setting review procedure, adopted (Mehrad, 2020 ) from Fig.  1 ” displays the PRISMA that were obtained based on the research objective. As displayed below, a total of only 30 of the original 529 articles were ultimately included in the investigation, which enables to precisely outline and plan to be followed in the process of review. The review procedure enables this study to create a systematic, replicable, and transparent analysis and the paper followed a systematic article selection process as summarized.

Selection of databases

In the systematic review, databases were systematically searched for eligible studies and the data were derived from the databases Scopus, Web of Science, Taylor & Francis, Google Scholar, Emerald, and PubMed. Based on this review, the researcher selected 30 articles from amongst 529 papers that were uncovered in the databases and were somehow related to the object of study: “leadership models, Leadership theories and Change Management”.

Inclusion and exclusion

The current study used some inclusion and exclusion criteria. Three inclusion criteria were employed such as search boundary, time of publication, language and keywords. As per the recommendation of Tasdemir & Gazo ( 2018 ), to ensure search completeness some additional journals were added to the list but were published in international peer-reviewed journals which are considered to be the most reliable sources.

The results of the search were obtained from English-language journal articles published from 2010–2021 in peer-reviewed journals. For the initial search, the search keyword terms were as follows: a) “leadership”, b) “leadership models”, c) “Leadership theories” and d) “change management”. Each of the searches consisted of two of these keywords along with “OR” and “AND”: ((Leadership) OR (Leadership models) OR (Leadership theories) AND (Change Management). Besides, the study used a series of inclusion criteria to screen papers for the review. These factors included: English language, years of papers publication > 2010, papers that had been published in peer-reviewed journals and dealt with leadership models or theories and Change Management as the main aim of the study.

The exclusion criteria include relevance, quality and duplication. It was done via reading of abstract and conclusion of downloaded articles from different databases. The relevance was determined by deciding whether articles fit to keywords used as search string and to ensure the quality, the study excluded unpublished articles, working papers and conference papers so as to enhance the findings from this review. Duplicated articles were excluded by assigning ID code for each article and manual detection.

Data Analysis

This study used descriptive content analysis, as well as review questions that were established at the start of the review process. The descriptive analysis was carried out using the data extraction form's categories (Snilstveit et al., 2012 ).It was accomplished by tabulation, specifically for the discussion of research characteristics results based on databases, kind (theoretical or empirical), and level of analysis. Qualitative with descriptive content analysis. A systematic review is used to summarize the previous empirical and theoretical literatures. The descriptive analysis aids the research characteristics sub-part, which provides the reader with a brief background of the reviewed publications in this study.

After search process finalized, the leadership models and change management in were summarized through grouping by publication year, authors, title of study, objectives of study, findings of study and type of research depend on the source of data focus of leadership theories and change management.

The study adopted a systematic review that have been reviewed by the researchers were analysed in quantitative, qualitative and mixed approach research terms based on Leadership models/theories and Change Management. This study adopted a systematic review in investigating the research issues of leadership models and change management. In addition, the current study aimed to examine the deliverables of this study, descriptive analytical synthetic approach was used to reach on conclusion and recommendation.

By reading selected papers displayed in Table 1 , it was found that nowadays researchers focused on the different types of leadership theories such as great man theory, trait theory, behavioural theory, and contingency theory, autocratic, transformational and transactional theories. Whereas change management is focused on four models ADKAR, Kurt Lewin’s change model, Kotter 8 steps model, and Mckinsey 7s models. The concerns of researchers were systematically review leadership theories related with change management models.

In general, as shown in the Table 1 , most researchers concentrated on transformational leadership in conjunction with change management methods that are beneficial in organizational transition. To select the right leadership style to utilize in a given situation, a leader must first determine the maturity level of his or her followers in relation to a specific task, according to Hersey-Blanchard leadership. According to this leadership paradigm, a low level of follower readiness is best matched with a telling style. A modest level of follower readiness is best matched with a selling technique. It promotes two-way conversation. The leader, on the other hand, is in charge of making decisions. Followers can make decisions when their leader uses a participative leadership style. Transformational leaders may make their followers feel like they are an important part of the organization and show them how they can contribute.

In general, all change management models recognize the importance of human resources in the change management process, albeit some of these models place a more emphasis on this aspect than others. Managers must not only grasp change management methods, but also embrace the appropriate leadership style to effectively manage change. Managers can use a variety of leadership styles to deal with organizational transformation. Common leadership styles include autocratic, democratic, transactional, and transformational leadership, among others. Managers in autocratic leadership do not consult their subordinates before making decisions. Managers that use a democratic leadership style, on the other hand, debate their decisions with their staff so that everyone has a say in the decisions that need to be made. Although this leadership style could be effective for some situations, it does not seem to be effective to manage the change in modern organizations (Jennifer M. George, 2011 ).

Managers that practice transformational leadership attempt to drive their subordinates through the influence of their amicable relationships in such a way that these employees trust themselves and realize their underlying abilities and talents, allowing them to perform at their best. Transformational leadership style is, in fact, a critical determinant in managers' ability to effectively lead change. Transformational leaders are those who can convince their employees of the value of their jobs (Jennifer M. George, 2011 ).

They can effectively influence employees' behavior to get them to adopt the change vision using their emotional intelligence. Furthermore, transformational leaders can boost employees' creativity and lead them to develop creative ways to overcome all hurdles that may arise as a result of the change process, hence improving change management effectiveness. Individual requirements of employees are a top priority for transformational leaders. Employees will appreciate this, and they will be strongly devoted to ensuring the success of the transition in order to meet the goals set by their management. Furthermore, transformational leaders can effectively cope with situational resistance to change through their cordial relationships with their subordinates.

Study characteristics

Aiming to provide readers with a brief introduction regarding the reviewed articles, the study used points such as databases characteristics as follows.

Figure 3 below shows the pie chart showing the databases used to search articles for review. The result is presented as follows.

The above pie chart shows that 42 of articles used for review, in this study, were accessed from Scopus 26.2% followed by Google Scholar 14.3% and Emerald 14.3% while PubMed 9.5%, Taylor & Francis 4.8% and Web of Science 4.8%.

As shown in the pie chart above, majority (93.3%) of reviewed studies were Mixed approach while few of reviewed studies (3.3%) were qualitative and (3.3%) quantitative research of articles were theoretical and empirical studies.

As presented in the Fig.  5 above, exactly in year 2019 were 20.0% followed by in year 2020 16.7% of reviewed studies adopted while small number of reviewed 3.3% in year 2011 of them systematically reviewed articles.

As shown in the pie chart above, majority (53.3%) is research article followed by (30%) of systematic review studies while small number of reviewed (6.7%) were critical review studies.

The study findings are discussed as follows:

According to the results of this systematic review, previous studies who have conducted them specifically recommend transformational leadership on organizational change. They also say that organizational support makes an effective contribution to performance, attitude, the organizational behaviour of employees, and their engagement. These realities should be explained or introduced more comprehensively to managers, leaders, and the heads of various workplaces. This study reviews ADKAR, McKinsey 7s, Lewin’s, and Kotter’s change management models. In principle, all models provided some stages through which change should be managed. Although all the mentioned models considered the importance of human resources in attaining the change, ADKAR model was that one which focused on the importance of people side the most. Further, McKinsey 7s model is found to be more useful in determining the organizational areas where the change should be conducted. Also, Kotter’s model pointed out very important point which is the importance of short- run wins that employees should receive in order to reach high level of employees’ engagement in the change process. On the other hand, this study points out the importance of managers’ role in change management. More specifically, the study refers to the leadership style that managers should adopt which is transformational leadership style. Transformational leaders, through their cordial relationships with employees, their emotional intelligence, and their concern with their subordinates’ individual needs, can effectively deal with situational resistance against change and stimulate the employees’ creativity to ensure the success of change process.

Change became inevitable thing in the modern organizations. Financial factors, technological factors, marketing factors, and human resources related factors are the most important driving factors of change in the contemporary business environment. Scientists and professionals became aware of this importance and introduced different change management models. This study reviews ADKAR, McKinsey 7s, Lewin’s, and Kotter’s change management models. In principle, all models provided some stages through which change should be managed. Although all the mentioned models considered the importance of human resources in attaining the change, ADKAR model was that one which focused on the importance of people side the most. Further, McKinsey 7s model is found to be more useful in determining the organizational areas where the change should be conducted. Also, Kotter’s model pointed out very important point which is the importance of short- run wins that employees should receive in order to reach high level of employees’ engagement in the change process. On the other hand, this study points out the importance of managers’ role in change management. More specifically, the study refers to the leadership style that managers should adopt which is transformational leadership style. Transformational leaders, through their cordial relationships with employees, their emotional intelligence, and their concern with their subordinates’ individual needs, can effectively deal with situational resistance against change and stimulate the employees’ creativity to ensure the success of change process.

Leadership has always been considered as one of the most important factors of success and failure in any organization and numerous researches have been conducted in this field. In recent decades, transformational leadership has attracted lots of attentions to itself. Transformational leaders employ their personal abilities to promote ideals of others and transfer individuals to higher level of performance. Transformational leaders play critical role in organizational performance. In other words, whatever characteristics of transformational leadership are evident; members will be more encouraged to enhance organization’s performance. Because transformational leaders make people motivated. Obviously, when leaders have great personalities, pay attention to individual differences and high level needs of people and provide mental stimulation, thereby, they increase members’ involvement and their tendency to make greater effort to succeed and create high-performance in the organization (Moradi Korejan & Shahbazi, 2016 ). Transformational leadership is the process of engagement of the leader with subordinates in order to create a connection that advances and promotes the degree of inspiration and ethics in both the leader and the subordinates (Northouse, 2013).

A transformational leader can also, indoctrinate pride and faith in groups, as well as inspire and empower groups. Thus, in my opinion, transformational leadership style can help to reduce resistance to change. As, resistance to change can be one of the many reasons for the failure of change initiatives. Hence, it is crucial to go deeper in this field while observing organizational change (Elsan Mansaray, 2019 ).

To eliminate the problem of generalizability future researchers should employ this study in other services sectors including Banking (Private commercial banks, foreign commercial banks), Insurance, and Telecommunication and engaged in other services to empirically validate the findings of the study. The researcher has examined only the influence of transformational leadership for change implementation. Hence, it is suggested to use the full range of leadership styles from Transactional to Laissez-Faire to further investigate how each leadership style influences change management. These findings would contribute to the existing theory and also broaden the knowledge in the realm of change management. Finally, it is suggested to examine the demographic linkages such as gender, age, working experience and educational qualifications with transformational leadership (S, 2021 ).

The complexity of the organizational process cannot be explained just by using comprehensive one-way predictive models. What is required is to understand the inter-linkages among the variables of the study. This study contributes to understanding the interrelationship between leadership, change readiness and commitment to change using the partial least square methodology. It was once thought that leadership affects commitment directly. But, empirical evidence in our study suggests the opposite. However, the generalization made in our study is limited to the organization under study. More research is needed to explore the issues in greater detail. However, we believe that this study has paved the path for future research to consider and expand the link between leadership, change readiness and commitment to change (Santhidran et al., 2013 ).

Theoretical and Managerial Implications

Theoretical implications.

The findings of this study show that leadership style and employee involvement in change is encouraging step for change process of organization. Armstrong ( 2015 ) presented a model to obtain effective change management including 5 activity steps: 1) motivating change, 2) creating a vision, 3) developing political support, 4) managing the transition, and 5) sustaining momentum. The first activity step, motivating change, includes creating readiness for change and helping the change recipients address resistance to change. The second step, creating a vision, is a leadership task where the leaders are to create the ‘why’ and ‘what’ of the upcoming change. During the third step, developing political support, the leaders need to gain employees’ support to implement the change and avoid individuals and groups from blocking it. As a fourth step, the management needs to create an activity plan for the change activities. In addition, it is the management’s task to plan how to keep the employees committed and to build a management structure to guide the organization through the planned change. The fifth activity, sustaining momentum, includes providing resources for change, building a support system for change agents, developing new competencies and skills, reinforcing new behaviours, and staying the course to complete the change process. However, the effect of Kurt Lewin’s model is indirect through separate phases in the process.

Transformational leaders employ their personal abilities to promote ideals of others and transfer individuals to higher level of performance (Moradi Korejan & Shahbazi, 2016 ). The transformational leadership style has been studies as the most important factor for change process in prior studies (Hussain et al., 2018 ).

Managerial implication

Different organizations use different organizational change model for stay in competition in the market. All previous studies that leadership is the key factor for change process. The study indicates the dominant role of leadership, employee involvement and sharing knowledge in change process of Lewin’s model. As we see the knowledge sharing is an important catalyst for unfreezing stage and moving stage for the process. On the same time employee involvement is the main factor for shifting of organization from one phase to another, so all these factor are interrelated for the current change process (Hussain et al., 2018 ). Leadership style that managers should adopt which is transformational leadership style. Transformational leaders, through their cordial relationships with employees, their emotional intelligence, and their concern with their subordinates’ individual needs, can effectively deal with situational resistance against change and stimulate the employees’ creativity to ensure the success of change process (Sheikh Hamdo, 2021 ).

Future Research Direction

This study is believed to offer several opportunities for future research in leadership models and change management. First, this study provides opportunity to empirically examine in different views leadership models with changing organization. To carry out research on these topic empirical studies should recognize the bridging position of leadership models and change management models in changing organizations. Therefore, this study suggests that to review all models with different sector organization with geographical location that feasible to implement leadership models on specific sectors rather than generalize the theories.

Limitation of the study

This paper limited with studies published from the period from 2011 to 2021 only keywords leadership, leadership models, Leadership theories and change management. This study faces yet another limitation due to the adoption of descriptive content analysis as a method of data analysis. Such method of data analysis is susceptible to possible subjectivity although the systematic approach was employed by the researcher to ensure potential biases in the study. Thus, future studies can reduce subjectivity problem by using various software tools as tools enable a researcher to reduce the subjectivity that frequently occurs during the use of traditional content analysis and in the implementation of codifications manually done by an academic (Graneheim et al., 2017 ).And also not used software as it allows researchers to identify structures, recurrences, patterns in the text that have not necessarily been imagined a priori. Finally, this systematic review does not include geographical and sector categories in their analysis to find the specific result implications.

The main purpose of this systematic review to know the most effective used leadership model with change management depend on different literatures. Leadership also deals with employee motivation and development, increasing their intellect and making them more effective and efficient, and their models can be used more effectively in the change management processes. Thus, most exponents identified transformational leadership as the most famous leadership style that will be in position to address the trials and difficulties of the emerging administrative practices. To them a transformational leader has the potential to stir his group to deliver more than anticipated by the organisation Elsan Mansaray, ( 2019 ), Tariku ( 2021 ), Sheikh Hamdo ( 2021 ), and different authors confirm transformational leadership models mostly effective on changing organizations in efficient and effectiveness. A transformational leader can also, indoctrinate pride and faith in groups, as well as inspire and empower groups. Thus, in my opinion, transformational leadership style can help to reduce resistance to change. As, resistance to change can be one of the many reasons for the failure of change initiatives. Hence, it is crucial to go deeper in this field while observing organizational change (Elsan Mansaray, 2019 ). Therefore, future researchers are suggested to carry out research by filling these gaps and focusing on unexplored issue depend on their geographical areas with their organizations.

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Abbreviations

• ADKAR -  Awareness, Desire, Knowledge, Ability and Reinforcement
• LPC -  Least Preferred Co-worker  

Declarations

We the undersigned declare that this manuscript is original, has not been published before and is not currently being considered for publication elsewhere. We would like to draw the attention of the Editor to the following publications of one or more of us that refer to aspects of the systematic review manuscript presently being submitted. We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome.

We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed.  We further confirm that the order of authors listed in the manuscript has been approved by all of us. We confirm that we have given due consideration to the protection of intellectual property associated with this work and that there are no impediments to publication, including the timing of publication, with respect to intellectual property.  In so doing we confirm that we have followed the regulations of concerning intellectual property.  

We understand that the Corresponding Author Mr. Biniam Getnet Agazu is the sole contact for the Editorial process (including Editorial Manager and direct communications with the office).  He is responsible for communicating with the other authors about progress, submissions of revisions and final approval of proofs.  We confirm that we have provided a current, correct email address which is accessible by the Corresponding Author and which has been configured to accept email from  [email protected] . 

• Open access
• Published: 05 September 2022

The effect of change leadership on employees’ readiness to change: the mediating role of organizational culture

• Zimbelachew Masresha Engida 1 ,
• Abebe Ejigu Alemu 2 &
• Meselu Alamnie Mulugeta 1  

Future Business Journal volume  8 , Article number:  31 ( 2022 ) Cite this article

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Metrics details

The purpose of this study was to look into the impact of change leadership on employee readiness to change in a few public organizations in Ethiopia's Amhara national regional state. The study's population consists of 2546 employees from eight public organizations that had begun implementing various change initiatives. Quantitative survey method was applied to conduct this study. A total of 514 employees were chosen for the survey using a simple random sampling technique. The measurement instruments' reliability and validity were tested using exploratory and confirmatory factor analysis methods. The data were analyzed, and the hypotheses were tested using structural equation modeling method. Change leadership and organizational culture, as well as organizational culture and employee readiness to change, were found to have a significant relationship. However, change leadership has no direct effect on employees' readiness to change, and organizational culture does not affect the relationship between change leadership and employee readiness to change. The study will add knowledge and provide a base for future research.

Introduction

There is a pressing need for public organizations to implement organizational change in today's world [ 56 ]. However, implementing organizational change in public organizations is a huge challenge [ 33 , 37 ]. For organizational change to take place, both individuals and organizations must be willing to change [ 3 ]. Several studies have shown that a large percentage of change initiatives fail [ 13 , 36 ]. There have been numerous reasons cited for such failures in change implementation. The most common reason was discovered to be a lack of employee readiness to change. The theories and approaches of change management do not provide a clear framework on how to manage change successfully. Previous studies disclosed the inherent contradictions and lack of empirical evidences about organizational change management [ 14 ]. The main question here is where to begin and how leaders can prepare their employees for change. These questions have prompted researchers to seek out appropriate solutions for successful change.

According to research, the readiness of employees to change is a key factor in change's success [ 19 , 39 ]. However, in many previous studies, this critical factor was frequently overlooked [ 56 ]. Many researchers have focused on individual behaviors that contributed to the failure or success of change implementations. Taking this into account, numerous studies have emphasized the importance of increasing employee readiness for a specific change initiative [ 3 ]. During organizational change, the importance of change leadership has been emphasized [ 19 ]. Previous research has looked into and demonstrated how transformational leadership can help employees support a specific organizational change. They did, however, overlook leadership behaviors that have been discussed in the literature on change management [ 19 , 56 ]. Researchers suggest that the majority of studies arguing for the importance of change leadership in government organizations are qualitative case studies [ 55 ]. As a result, little empirical evidence exists about how and to what extent change leadership contributes to the change process [ 19 , 22 ].

Government in developing countries shoulder a major responsibility for maintaining the stability and the promotion of rapid economic and social development. One possible way of achieving this is by delivering effective and efficient public service to citizens. Change management is not only essential component of public sector transformation, but also a crucial factor to the success of efficient public service delivery. In the context of public sector institutions, change management should focus on how to bring a transition from old public administration approach to modern adaptive processes. Ethiopian government organizations have been implementing a variety of change initiatives. Most of these change initiatives have been part of public management reform programs aimed at making public organizations better in terms of service deliver through process and structural changes. These change initiatives were aimed at improving the performance and service delivery in a more efficient and transparent manner. These include change packages from the federal government through sponsorship (sometimes by imposition) by international donor agencies and foreign governments. When we see the civil service reforms programs implemented for the last two decades in the country, it can be concluded that most of them (if not all) did not achieve their desired results and failed. However, because the majority of them claimed to have failed, the success rate for change is lower than expected. Ethiopian public institutions can be characterized by lack leadership commitment, slow official decision and action, staffed by old aged people, common practice of nepotism, and unresponsive to the public.

This study was made on the fact that public organizations in Ethiopia faced with problems in terms of effectively implementing change initiatives. The problem of change leadership in Ethiopian public organizations can be supported by the prevalent nationwide challenge in change implementation. This challenge is due to change fatigue [ 50 , 51 , 52 ]. Change initiatives were short-lived, and new change initiatives introduced before the evaluating the outcomes of the previous one. These reduced the civil service willingness to accept new change initiatives. The main problems associated with the problem include resistance, ignorance of context during implementation and lack of leadership capacity. This indicates that the change management practice in Ethiopian public sector organizations needs to be examined. This piqued the researchers' interest in why change initiatives fail and what factors can improve employees' readiness for change.

The above-mentioned realities necessitate identifying the most effective factors that will assist change leaders in scientifically understanding change processes. They may be able to solve problems of change resistance as well as improve their readiness to change by doing so [ 28 ]. The purpose of this study was to look into the role of organizational culture in mediating the relationship between change leadership and follower change readiness. As a result, the following two research questions are addressed in this study: (a) How does change leadership affect employee readiness to a specific change in government organizations? And (b) How does organizational culture influence the relationship between change leadership and employee change readiness? Based on this, the objective of this research is to investigate the effect of change leadership behavior on employees’ readiness to change and how the relationship between change leadership and employees readiness is mediated by organizational culture.

The researchers believe that this research will be useful and have both practical and theoretical implications. First, this research contributed to the literature on change management. In future studies, the research model will be validated and replicated. The model could be useful in the future. Second, the findings of this study will encourage change leaders in Ethiopian government organizations to prioritize change readiness as a key factor. Finally, the study assists change leaders in obtaining and utilizing study data, which may be used to assess, design, and evaluate new and existing change initiatives.

Theoretical and conceptual framework

Change leadership and employees’ readiness to change.

Leadership often cited as an important element in terms of creating conducive environment for effective change implementation. Literature on organizational change management indicates that boosting employees’ readiness for change depends on specific attributes of the leader and how the leader promotes the change leader [ 2 , 42 ]. There are different styles of leadership, and most studies mention transformational and change leadership’s effect on employees’ readiness for change, but there is some level of difficulty of differentiating between them. Some writers and researchers tend to use them interchangeably, asserting that they share common elements [ 19 ]. One criterion to differentiate between the two is time orientation. Transformational leadership argued to emphasize on long-term effects on followers, while change leadership focuses on short-term and specific change project [ 19 , 39 ]. Most change leadership dimensions such as communicating the plan for change, building a guiding coalition, developing a sense of urgency or a compelling rational for the change and providing support can be linked to one or more dimensions of transformational leadership [ 19 , 39 , 56 ]. On the other hand, transformational leadership is related to strategic leadership, while change leadership is more attached to tactical leadership behavior [ 19 ].

Change leadership is defined as the behavior of direct supervisors, which aimed at framing and shaping organizational change, and creating capacity among change recipients to implement change [ 1 ]. Change leadership involves enhancing favorable attitude among change recipients concerning change [ 56 ]. Change leadership behaviors include ensuring the need for change, providing vision and plan, building support and commitment, and monitoring the implementation [ 2 ]. Leaders by exhibiting change leadership behaviors such as high-quality change information and employee participation, communication about change and providing individual employees the opportunity to contribute in the change process [ 19 ]. Specific attributes of a leader and the way how he or she promotes the change is one critical factor to increase individual employee’s readiness to change. The attribute and change-promoting behavior embraces the concept of change leadership. Change leadership can be conceptualized as the behavior of direct supervisors, and it is aimed at framing and shaping organizational change along with boosting the capacity of employees to implement the change initiative [ 1 ]. It involves crating favorable attitudes among change recipients regarding the change [ 56 ]. It includes ensuring the need for change, providing vision and plan, building support and commitment to the change, and monitoring its implementation [ 2 ]. Change leaders should also show behaviors such as high-quality change information and employee participation, communication about the change and providing individual employee the opportunity to contribute in the change process [ 19 ].

Many failure stories of change implementation reported along with various factors as a reason [ 13 ]. Among these, individual employees’ lack of readiness to change is one of the commonly mentioned reasons for change ineffective implementations [ 29 ]. Change leaders can influence their employees’ readiness to a given change, and they can use numerous factors. Among others, participation in decision making [ 29 , 44 , 56 ], communication and information [ 21 , 44 ], organizational support [ 21 , 29 ], organizational culture [ 8 , 21 , 38 , 44 ] are the factors that change leaders could use to enhance their employees’ readiness to change.

Empirical studies have also indicated the positive and significant effect of leadership in employees’ readiness to change [ 49 ]. Change leader’s attribute found to be crucial in the process of creating employees’ readiness to change. Bakari et al. [ 28 ] suggest that successful implementation of change requires its leader to boost employees’ readiness and provide behavioral support for change. Employees’ participation in the change management process found to create a feeling of empowerment, control and motivation [ 44 , 56 ]. Diab et al. [ 23 ] reported a positive correlation between employees’ readiness to change and leader’s behavior. In addition to this, psychological empowerment by the change leader [ 43 ] and support by the change leader [ 16 , 29 ] found to significantly predict employees’ readiness to change. Thus, the following is hypothesized:

Change leadership is positively related to individual employee’s readiness to change.

Change leadership and organizational culture

The emergence of organizational culture as a pivotal variable in determining the successful effort to implement institutional change has been mentioned by authors. They argued that organizational culture determines employees’ readiness to a given change initiative [ 38 ]. Change initiatives that are aligned with the organizational culture may be embraced with enthusiasm and implemented quickly [ 17 ]. Organizational culture can be defined in many ways perhaps the central essence of these different definitions circulates around relatively similar concepts. Organizational culture can be defined as “a pattern of shared basic assumptions [ 47 ], as “beliefs and behavioral norms [ 53 ], and as “a belief, attitudes, and intentions of employees [ 8 ]. The core values of an organization begin with its leadership [ 53 ]. Leaders have to play their role in shaping and maintaining an organization’s culture [ 38 ]. They have to ensure consistent behavior between members of the organization [ 53 ]. They should also be explicit about the type of culture and underlying behaviors that will best support the new ways of doing things, and find opportunities to socialize, model, and reward those behaviors [ 38 ]. Normative perspective defines organizational culture as a shared beliefs and expectations. Organizational culture in this study is viewed from this normative perspective and conceptualized including six sub-dimensions. These dimensions are teamwork and conflict, climate and moral, information flow, involvement, supervision and meeting.

Leadership styles are theoretically and empirically related to organizational culture. Leaders mold organizational culture; they do this through role modeling, teaching and coaching [ 48 ]. They can also shape sound organizational culture through articulating vision, direction, valuing and nurturing organizational members [ 20 ]. Leaders who can align and communicate core values and provide support can shape organizational culture. A strong positive relationship between leadership styles and organizational culture is suggested [ 5 ]. Leadership can shape the culture of an organization [ 40 ]. Framing a vision for change that catalyzes cultural elements of the organization creates a powerful means of stimulating support for change among employees [ 38 ]. Charismatic personality of a change leader largely influences followers to support the change as well as change their values, beliefs and working attitudes, which help employees understand and accept the organizational change [ 2 ]. Organizational culture that matches to employees’ change readiness should be evaluated by the change leader and change-related dimensions should be identified [ 8 , 38 ]. This will lead to change leadership efforts targets only the areas where employees’ change readiness is need to be improved [ 8 ]. Based on this, the following is hypothesized:

Change leadership is positively related to organizational culture.

Organizational culture and employees’ readiness to change

The relationship between organizational culture and employees’ readiness to change, as well as how the former influences the latter, has been investigated and reported by numerous researchers [ 8 , 27 , 44 ]. There are cases where the characteristics of organizational culture led to failures of change programs. Enhancing employees’ readiness to change requires assessment of organizational culture. Such an assessment should target the areas where improvement in change readiness is needed [ 8 , 38 ]. Understanding organizational culture enables leaders to leverage existing values and behavioral norms in designing change interventions. Thus, it is essential to identify those aspects of organizational culture targeted for modifications as well as those dimensions intended to be preserved or strengthened [ 38 ]. As a multidimensional concept, change readiness entails values, beliefs, attitudes, thoughts, emotions and intentions.

Values, beliefs, behaviors and other cultural elements are related to change readiness. Organizational culture boosts employees’ readiness to change through motivation, alignment, flexibility and trust. They are organizational culture dimensions impacting change readiness [ 32 ]. Organizational culture can impact employees’ readiness to change through intrinsic motivation. Intrinsic motivation is referred to the desire of employees to comply with organizational norms and values. Organizational identification positively affects change readiness if the values of employees match with the values levied by the change initiative. Change that is based in the existing culture value is more likely to be accepted by employees [ 21 ]. Flexibility as an organization value directly leads to employees’ readiness to a given change initiative. Organizations with flexible structures and flexibility-oriented values are more ready to change [ 31 ]. Another dimension of organizational culture that has an impact on employees’ change readiness is trust. It refers to the willingness to cooperate to achieve goals [ 54 ]. Relationships that are based on trust lead to employees’ readiness to change [ 34 ].

Empirical studies made have confirmed the direct relationship between organizational culture and employees’ readiness to change. These findings further suggest organizational culture as a crucial to successful organizational change implementation; through boosting employees’ readiness to change. Gelaidan and Ahmed [ 27 ] indicated the positive influence of organizational culture on employees’ readiness to change. They suggested that public organizations which are interested to implement change initiatives to be concerned with organizational culture. Adil [ 2 ] reported the positive relationship between organizational culture and employees’ readiness to change. Positive organizational culture found to trigger employees’ motivation and commitment to participate in the change implementation [ 44 ]. The role of culture of effectiveness in terms of increasing employees’ readiness to a change initiative is also found [ 40 ].

Based on the above theoretical and empirical assertions, the following hypothesis is posited:

Organizational culture is positively related to employees’ readiness to change.

Mediation of organizational culture

Change leaders are responsible to shape and maintain appropriate organizational culture, which is conducive to foster employees’ willingness to accept and implement change initiative. They are required to shape the behaviors and attitudes of their employees. By doing this, they create a favorable climate toward change [ 4 ]. According to Kin et al. [ 35 ], change leadership refers to leadership which possesses the necessary abilities and attributes that are crucial to shape appropriate organizational culture that enable them enhance their employees’ readiness to change [ 35 ]. This implies that leaders may positively influence employees’ readiness to change through organizational culture [ 40 ]

Leadership can be beneficial by creating cultural aspects which is favorable to organizational change. Literature suggests that leaders’ behavior greatly influences all aspects of organizational culture and indicates the expected influence of culture on employees’ readiness for change [ 27 ]. The role of organizational culture between leadership and employees’ readiness for change is reported. Organizational culture and change management have a positive return, and also organizational culture mediates the relationship between leader–member exchange and organizational change management [ 41 ]. Organizational culture has previously been reported as a mediating factor between leadership style and affective commitment to change [ 27 ]. The impact of ethical leadership on employees’ readiness for change and the partial mediation role of organizational culture between the two is reported [ 40 ]. The mediating role of organizational culture between change leadership and employees’ readiness to change is also found [ 2 ]. Therefore, this study intends to investigate the mediating role of organizational culture in the relationship between change leadership and employees’ readiness to change by postulating the fourth hypothesis:

Organizational culture will positively mediate the relationship between change leadership and employees’ readiness to change.

From the total of 2560 employees of the seven organizations, representative sample size was included in the study. Based on Morgan table, the sample size was estimated to be 334. Selecting a larger sample size to compensate for the likelihood of response rate lower than 100% is recommended by authors [ 11 ]. The researcher believes that the issues to be raised in this research are very sensitive and respondents may hesitate to give response to them. Taking into account the research culture of the country, the researcher adjusted the sample size assuming the response rate of 65%. The adjusted sample size is 513.

Krejcie and Morgan [ 46 ] formula

where s  = the required sample size, χ 2  = the table value of Chi-square for one degree of freedom at the desired level of confidence level = 95% = 3.841 = (1.96*1.96), N  = population size, P  = the population proportion (assumed to be 0.5). Krejcie and Morgan recommended 0.5 as an estimate of population proportion as this proportion will result in the maximization of variance and produce maximum sample size [ 46 ], d  = the degree of accuracy expressed as a proportion (0.05)-error the researcher wants to accept.

Using the above formula

So the adjusted sample size is 334/0.65 = 514.

Seven items from the Herold et al.’s [ 19 ] instrument were used to measure the independent variable change leadership. The organizational culture (mediating variable) instrument was adapted from Glaser et al. [ 24 ], which has 13 items for the six sub-constructs of teamwork and conflict (2 items), climate and morale (3 items), information sharing (2 items), involvement (2 items), meetings (2 items), and supervision (2 items) (2 items). Employees' readiness for change was measured using nine items from an instrument developed by Dave et al. [ 18 ] (three items for each of the three sub-constructs: intentional, emotional, and cognitive readiness). The three instruments' items are all rated on a Likert scale of 1–5, with 1 indicating strong disagreement and 5 indicating strong agreement.

A total of 340 instruments were collected out of 514, with a good response rate of around 65%. Thirteen cases were removed from the data set because they had more than 10% missing values. In addition, the data were screened for respondents who were uninterested in participating. In this case, 11 people were excluded because they answered yes or no to the majority of the questions. There were no outliers, and missing values were identified and imputed using the marching response method [ 45 ]. In terms of skewness, the indicators and all other variables have a fairly normal distribution. Statistical Package for Social Sciences (SPSS) version 22 and structural equation modeling method of analysis using Analysis of Moment Structure (AMOS) version 23 were used to analyze the data Using Structural Equation Modeling has some advantages. One advantage is that latent variables are more reliable measures than observed variables because measurement errors are estimated and removed. Another advantage is that it easily allows the researcher to examine models with multiple dependent variables [ 15 ]. It permits the estimation of the goodness of fit of an entire model. AMOS is the appropriate software for the analysis of structural equation modeling. It also has a user-friendly graphical interface and the potential to enhance conceptual understanding and communication of results [ 15 , 45 ].

Study result

The demographic profiles of the respondents were described before the hypotheses were tested. Table 1 shows the demographic characteristics of respondents, including their age, gender, educational status, and work experience. The majority of the workers (66.8%) are between the ages of 25 and 44. In addition, 16.8% of respondents are between the ages of 45 and 55, 16.1% are under the age of 25, and only one (0.3%) is over the age of 55. Male respondents make up 70.9% of the total, while female respondents make up 29.1%. When it comes to educational attainment, 61.1% have a bachelor's degree and 27.5% have a master's degree. Diploma, third-degree, and certificate holders make up small percentages of the respondents, accounting for 9.5%, 1.3%, and 0.6%, respectively.

The majority of respondents (36.1%) have between 2 and 5 years of work experience, while 30.4% have between 6 and 10 years of work experience. Only 5.7% of respondents have less than one year of experience, with 27.8% having more than ten years of experience. Employees' perceptions of change leadership that are rated as most important to them and their readiness for the change were determined using descriptive statistics. The descriptive table represents scores from subscales of the 316 sample when reporting the results. It is calculated descriptive statistics on employee responses to change leadership, organizational culture, and employee readiness for change. The mean, standard deviations, skewness, kurtosis, and zero-order Pearson correlations are shown in Table 2 . A check for multi-collinearity between variables was also performed. If Pearson R-values exceed 0.90, a multi-collinearity problem will be assumed [ 26 ].

Factor analysis exploratory

The researchers used principal component factoring to condense a total of 29 Likert scale items into the three required variables. Due to their low-reliability scores, eleven items (four from organizational culture, two from change leadership, and five from readiness to change) were reduced. In the confirmatory analysis, the remaining 18 items were used. For change leadership, organizational culture, and employees' readiness for change, the Kaiser–Meyer–Olkin sampling adequacy value was 0.0.876, 0.790, and 0.876, respectively, which is higher than 0.70 (Table 3 ). This indicates that each variable can be predicted with a sufficient number of items. When we look at the KMO and Bartlett's test results, we can see that the data from the questionnaire are suitable for confirmatory factor analysis.

Confirmatory factor analysis (measurement model)

A confirmatory factor analysis was conducted, which included 18 items and explained three major latent variables. Table 4 shows the results of construct and convergent validity for each of the three latent constructs, including Cronbach alpha (EFA), composite reliability (hereafter CR) of the scales, and average variance explained (hereafter AVE) (Table 4 ). To test the measurement model, major goodness-of-fit (GoF) measures were used [ 10 , 12 , 15 , 45 ]. Chi-square statistics to the degree of freedom (CMIN/DF), goodness-of-fit index (GFI), adjusted goodness-of-fit index (AGFI), normed fit index (NFI), Tucker–Lewis index (TLI), also known as the non-normed fit index (NNFI), comparative fit index (CFI), and root-mean-square error of approximation are some of the most commonly used measures (RMSEA).

The model fit the data well, with GFI = 0.905, AGFI = 0.876, NFT = 0.900, and CFI = 0.942, and the hypothesized model adequately described the sample data. The TLI value in this study is 0.930, indicating that there is a good fit (Table 5 ). The hypothesized model's RMSEA is 0.063, with a 90% confidence interval of 0.047 to 0.059 and a p-value of 0.176 for the test of the closeness of fit. This means that we can be 90% confident that the true RMSEA value in the population will be between 0.053 and 0.072 (Table 5 ). This represents a high level of precision, and it can be concluded that the model that was initially proposed fits the data well.

The overall results of the structural model analysis using SEM are shown in Table 6 . The structural model is well-fitting. The Chi-square index (CMIN/DF) 2.589 with a p-value of 0.000, as well as other fit indices (GFI = 0.892; AGFI = 0.856; NFI = 0.894; TLI = 910; CFI = 0.924; RMSEA (CLOSE) = 0.071(000), can be used to determine this (Table 6 ). All of these model fit indices are above the recommended level, indicating that the structural model has an acceptable goodness-of-fit (GoF) to the sample [ 10 , 12 , 15 , 26 , 45 ].

The researcher compared the hypothesized model to two alternative models to see if it was robust. First, alternative model 1 specified a mediation-only model that differed from the original model only in that the direct link between change leadership and employees' readiness for change was set to zero.

The model has a lower good fit (2 = 0.145) than the others. The descriptive fit indices were nearly identical (AGFI = 0.001TLI = 0.001, CFI = 0.001), with the CFI being marginally better. The second model was the direct effect only model (alternative model 2). Only the direct effect of change leadership on employees' change readiness was allowed in this study, while the other two relationships were set to zero. The model was found to be less accurate than both the original and alternative models (1(2 = 63.617 df  = 1). The descriptive fit indices GFI = 0.010, AGFI = 0.012, NFI = 0.001, TLI = 0.019, CFI = 0.017, and RMSEA (RMSEA = 0.007) all decreased. As a result, when compared to the alternative model, the original model produced a better fit. Furthermore, the original model is less resource-intensive than the two alternatives.

The variables' structural relationships

The structural part of the specified model was examined in addition to testing the appropriateness of the measurement model. Figure  1 shows the outcome of the analysis. Standardized coefficients and significant numbers were used to confirm or reject the research hypotheses (Table 7 ). The full hypothesized model shows sufficient model fit (GFI = 892; AGFI = 856; TLI = 910; CFI = 924, and RMSEA (PCLOSE) = 0.071) (2 = 333.835 df = 129 GFI = 892; AGFI = 856; TLI = 910; CFI = 924, and RMSEA(PCLOSE) = 0.071) (000).b The direct and indirect effects were accounted for in the structural model. The model shows a negative and insignificant direct path from change leadership to employee readiness for change, which contradicts H1. Organizational culture is significantly and positively linked to change leadership (= 0.42; p 0.01). As a result, H2 is accepted (see also Fig.  2 ).

The research model (adapted from literature)

Organizational culture, according to H3, should be positively related to employees' willingness to change. This hypothesis is supported by the data (= 0.15; p 0.04). A direct link between a predictor and an outcome variable is not required to postulate a mediation effect, according to one argument. As a result, we put the proposed organizational culture mediation of change leadership and employee readiness to change to the test (H4). The data show that change leadership has no indirect effect on employees' readiness for change through organizational culture (= 0.063). To claim that there is mediation, the coefficient for the indirect effect must be significantly lower than the direct effect. However, the indirect effect (= 0.063) has a higher coefficient than the direct effect (= − 0.03). As a result, H4 is not supported (Table 8 ).

The study investigates whether organizational culture mediates the relationship between change leadership and employee readiness to change. Change leadership has a negative and insignificant direct impact on employees' readiness for change, according to the findings of the study. This finding is consistent with Herold et al. [ 19 ] and Mangudjaya's [ 39 ] findings that "change leadership has no significant impact on employees' readiness (commitment) to change." There is also a lack of a direct relationship between change leadership and change recipients' commitment to change [ 56 ]. He confirmed that the link between change leadership and employees' willingness to change should be viewed as an indirect one. Other leadership styles may have a stronger relationship with followers' willingness to change as a result of this. The findings of Herold et al. [ 19 ], which found that transformational leadership was more strongly related to employees' change commitment than change leadership, could support this argument.

Change leaders and change agents can boost their followers' motivation to adapt to the desired change initiative by communicating clearly and consistently. Employee empowerment and participation in change-related problem-solving will also increase their belief that change is possible. Giving followers the authority to use resources to solve problems related to the change initiative can increase followers' intrinsic motivation to participate in the change. Change leadership and organizational cultural change have a strong relationship. Change leadership has a positive and significant relationship with organizational culture, according to this study (regression weight = 0.42, p  = 0.01). This study's finding is consistent with Adil's [ 2 ] research. With (regression weight = 1.5, p 0.04), the results show that organizational culture has a direct positive and significant effect on employees' readiness for change.

The findings on the impact of organizational culture on employees' willingness to change are in line with the previous research. It has been reported that organizational culture has a positive impact on employees' willingness to change [ 27 ]. If a link between organizational change and employee readiness to change can be found, it is a win–win situation [ 2 ]. It is also discovered that organizational culture plays a role in enhancing employees' readiness to take on change initiatives. The role of organizational culture in increasing employees' readiness to change initiatives [ 44 ], and more specifically the role of organizational culture in boosting employees' motivation and commitment to participate in change implementation [ 40 , 44 ]

One important area of investigation was the role of culture as a mediator in the relationship between change leadership and employee readiness for change. The role of organizational culture as a mediator has been well documented in the literature [ 38 ]. The indirect beta value must be significantly reduced for mediation to occur. The direct effect of change leadership on employees' willingness to change is negative in this study (−  0.03). The indirect beta coefficient is 0.063, indicating the possibility of mediation, i.e., the path passing through organizational culture (0.42*0.15). When organizational culture was added as a mediator, the indirect coefficient increased in comparison with the direct coefficient.

The findings revealed that organizational culture has no bearing on the relationship between change leadership and employee readiness to change. The findings of this study differ from those of previous studies in that organizational culture does not mediate the relationship between change leadership and employee readiness to change. Previous research has found that organizational culture mediates the relationship between leader–member exchange and organizational change management [ 41 ], as well as the relationship between leadership style and employees' affective commitment to change [ 27 , 41 ], as well as the relationship between ethical leadership and employees' willingness to change [ 40 ]. The result also contradicts the findings of Adil's [ 2 ] research. His research discovered that organizational culture plays a role in mediating the relationship between change leadership and employee readiness to change. The findings of this study suggest that the role of organizational culture in mediating the relationship between other leadership styles and employees' willingness to change should be investigated further. Previous research has found that organizational culture plays a moderating role between leadership and employees' willingness to change, and it has also been suggested that organizational culture plays a moderating role between leadership and other outcome variables [ 27 , 41 ]. Leaders of a change process need to understand how to create and manage organizational culture that promotes openness to change. This requires them to have focus on ongoing basis. The role modeling behavior of change leaders must be practiced in public sector organizations.

During change times, employees may feel that they are vulnerable, and they require their leaders to provide the necessary psychological and resource support. This indicates change leaders create and maintain organizational culture with the crossover model of conservation theory. The model outlines how experiences, emotions, and resources are transferred within the social and organizational context [ 30 ]. The crossover of resources from the leader to the followers must exist. The leader–member exchange theory focuses on a two-way social exchange relationship between superiors and subordinates. Change leaders should provide vital resources like social support, control, and self-efficacy to followers. The existence of a positive and high-quality social exchange between change leaders and employees is a crucial factor. Change leaders' high engagement is found to have a better relationship with the followers, and this, in turn, benefits the followers' work engagement (Guterman et al. 2012). Leader–member exchange may play an important role in employees’ engagement. The mechanisms of resource exchange at the individual or organizational level may be fundamental to creating and maintaining engaged and resilient employees and organizations during change time [ 25 , 30 ]. To summarize, having good change leader and member exchange will create positive organizational culture, and through this change leader may boost the employees’ readiness to accept the change initiative and engage them to effectively implement it.

The main purpose of this study was to investigate the mediating impact of organizational culture on the relationship between the change leadership behavior of change leaders of selected public organizations in Ethiopia and their employees’ readiness to a specific change initiative. In addition to that, the direct impact of change leadership on employees’ readiness to change as well as the impact of organizational culture was examined. The study revealed a mixed result. Two of the hypotheses were found to be accepted, while the remaining two were not accepted. On the one hand, the impact of change leadership on organizational culture as well as the impact of organizational culture on employees’ willingness to change was discovered. On the other hand, neither the direct relationship between change leadership and employee readiness to change nor the mediating role of organizational culture in the relationship between change leadership and employee readiness to change is supported. The study concludes that change leadership does not have a direct impact on employees’ readiness to change and organizational culture does not mediate the relationship between change leadership and employees' readiness for change. This may indicate that future research should test the moderating role of organizational culture and possible mediation of other variables.

Limitations and suggestions for future studies

The study will have its own set of limitations, which future researchers can address. This study is one of the few studies conducted in the context of Ethiopian public organizations and centered on the role of change leadership in determining employee readiness for change, with organizational culture serving as a mediator. Thus, future studies should include many more variables to get a more comprehensive result. It is necessary to conduct a comparative analysis of the effects of different leadership styles on employees' readiness for change in private organizations. This study was conducted using cross-sectional data. Longitudinal studies to know the level of commitment (the behavioral component) employees require for successfully implementing a change initiative should be considered. Carefully designed studies that seek to investigate changes over time can aid in understanding the phenomenon and devising possible intervention mechanisms to improve employees' change readiness levels. Fourth, future research on the antecedents of change readiness and the potential moderating effects of organizational culture and other variables should be studied and reported. Fifth, the research focused on seven public organizations with 513 employees in one Ethiopian regional state. Taking a large sample size from private and public organizations would help to increase generalizability. Finally, the finding is from employees’ perceptions and self-reports, and to get a more comprehensive understanding of the variables, probing deeply into respondents' opinions and feelings may be beneficial.

Managerial and policy implications

Organizations that make a conscious decision to change their operations must also identify change agents responsible for leading and implementing the change effort. Organizations should formally identify change agents, which is beneficial in two ways. Firstly, it assigns responsibility in that certain organizational members are now accountable for the change implementation process. Secondly, change agents become a guiding force to support other organization members who may struggle with or question the change. The level to which change agents are personally involved with the change implementation is also crucial. They should have day-to-day (not a mere collection of reports at some point in time) involvement. It minimizes resistance because other organizational members sense that someone in a formally designated leadership role is present and supportive. The change also requires the engagement of the appropriate personnel.

The findings suggest that change leaders in public organizations in Ethiopia can use their change leadership behaviors and characters to enhance their employees 'readiness to change. Public organizations in Ethiopia must realize the contribution of change leadership's role in boosting their employees' willingness to change and look at intervention mechanisms in leadership development. They must design appropriate leadership training and development programs. They can get the required change leaders equipped with the essential ability and competence. IT is a crucial factor for employees to be willing to accept and implement a change initiative.

The result of the study will imply public institutions, their policymakers (change designers), and leaders who are in charge of implementation. Public organizations in Ethiopia know little about why change efforts fail to deliver their desired outcomes. The importance of change leadership toward effective formulation and implementation of changes has not gotten due attention. At the institutional level, policymakers and leaders will gain good insight into the change management practices of their institution and thereby determine where to intervene and decide what kind of intervention to deploy in the change management process to enhance their employees' level of readiness.

Availability of data and materials

The researchers want to assure you that the data we used for the analysis can be made available at any time requested.

Abbreviations

Adjusted goodness-of-fit index

Comparative fit index

Average variance explained

• Change leadership

Chi-square statistics to the degree of freedom

Composite reliability

Critical ratio

Employees’ readiness for change

Goodness-of-fit index

Kaiser–Meyer–Olkin

Non-normed fit index

Normed fit index

• Organizational culture

Root-mean-square error of approximation

Squared multiple correlation

Significance level

Standardized regression weight

Tucker–Lewis index

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Acknowledgements

We would like to thank Mr. Tesfaye Molla, Mr. Nebiyu Mesfin, and Mr. Yibeltal Elias for their support during the data collection process. Thanks are also due to the participants of the survey from all the selected seven public invitations.

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Engida, Z.M., Alemu, A.E. & Mulugeta, M.A. The effect of change leadership on employees’ readiness to change: the mediating role of organizational culture. Futur Bus J 8 , 31 (2022). https://doi.org/10.1186/s43093-022-00148-2

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Why change management is the most critical leadership skill.

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Nicole R. Braley is a marketing executive, servant leader, career coach, and a frequent speaker for business media. Connect today:  LinkedIn .

Over the past 20 months, it’s become clear why change management is one of the most essential leadership skills. Knowing how to lead and manage through tumultuous and unexpected changes can make or break a company. While the pandemic was an unexpected event that affected everyone, knowing how to manage change is also about traditional and routine events in the everyday business world. 

Mergers and acquisitions happen all the time. If a business and its leaders are not prepared to effectively manage through these major events, it can lead to low morale among employees and poor customer experience. 

Change management needs to happen at all levels of an organization. As Harvard Business states, “In today’s uncertain climate, leaders at all levels in the organization are involved in managing change. While senior executives set the organizational tone, those in middle management, leaders on the frontlines, and team leaders also play critical roles.”

Change, expected or unexpected, has left companies out of business － and made others come out stronger. Think about Kodak, Atari, Blockbuster, Netscape, and Nokia － all favorite brands with significant success stories until they doubled down on outdated business practices. “That’s the way we’ve always done it” doesn’t allow businesses to reinvent themselves to meet the market where it is, or where it’s going. Because of this, change management is a skill regularly discussed in business schools and within corporations. 

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But in the healthcare industry, change management takes on a whole new spin. Leaders, in many cases, are the physicians and doctors on the frontline dealing with both their staff and patients. Though medical school teaches physicians about the many facets of practicing medicine, it is mostly absent on business leadership training, specifically, leading and managing change within an organization.  

It certainly raises the question: Why isn’t the education of business acumen, organization and development skills, like change management, prioritized for physicians, when their daily leadership has such a direct effect on both employee and patient experience? 

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As fellow business leaders and industry professionals, we need to be empathetic and encouraging to our physician colleagues during times of change. We need to help physicians understand their roles as leaders within their organizations. Because of their education, knowledge, and experience, they will inherently be seen as leaders in the community and at their workplace. Helping them understand their positions of authority and arming them with tools, training, and support will result in organizations that can withstand and prevail through times of change.

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1. Recognize you're going through change.

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2. Communicate accurately about the change. 

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The best leaders are very self-aware and lead with introspection, not authority. Navigating change isn’t easy, and those who lead through it best are people who understand their power and use it to help others feel safe. Physicians often aren’t aware of their innate, implied authority; thus, the leadership aspect of change management and leading with introspection is important. 

Being skilled at change management is something all leaders and organizations need to take seriously and prioritize. With regular mergers, acquisitions, and other organizational changes, it is a standard part of the business world. The more prepared your leaders are to lead through change, the better the experiences your employees, customers, and patients will have.

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Successful change management strategies for improving diabetes care delivery among high-performing practices, kevin a. peterson.

1 Department of Family Medicine and Community Health, UMN Medical School, University of Minnesota, Minneapolis, Minnesota

Leif I. Solberg

2 HealthPartners Institute, Minneapolis, Minnesota

Caroline S. Carlin

Helen n. fu.

3 Public & Population Health Informatics, Regenstrief Institute, Center for Biomedical Informatics, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana

Rachel Jacobsen

Milton eder, associated data.

To learn how the highest-performing primary care practices manage change when implementing improvements to diabetes care delivery.

We ranked a total of 330 primary care practices submitting practice management assessments and diabetes reports to the Understanding Infrastructure Transformation Effects on Diabetes study in 2017 and 2019 by Optimal Diabetes Care performance. We ranked practices from the top quartile by greatest annual improvement to capture dynamic change. Starting with the top performers, we interviewed practice leaders to identify their most effective strategies for managing change. Interview transcripts were qualitatively analyzed to identify change management strategies. Saturation occurred when no new strategies were identified over 2 consecutive interviews.

Ten of the top 13 practices agreed to interviews. We identified 199 key comments representing 48 key care management concepts. We also categorized concepts into 6 care management themes and 37 strategic approaches. We categorized strategic approaches into 13 distinct change management strategies. The most common strategies identified were (1) standardizing the care process, (2) performance awareness, (3) enhancing care teams, (4) health care organization participation, (5) improving reporting systems, (6) engaging staff and clinicians, (7) accountability for tasks, (8) engaging leadership, and (9) tracking change. Care management themes identified by most practices included proactive care, improving patient relationships, and previsit planning.

CONCLUSIONS

Top-performing primary care practices identify a similar group of strategies as important for managing change during quality improvement activities. Practices involved in diabetes improvement activities, and perhaps other chronic conditions, should consider adopting these change management strategies.

INTRODUCTION

Although the need to improve diabetes outcomes in primary care is evident, exactly how a practice successfully manages change in care delivery in the midst of a busy clinical environment is much less clear. 1 , 2 Conceptual models for improving care delivery often identify foundational principles and highlight thematic and strategic approaches based on those principles. 3 - 5 The National Demonstration Project organizes change around core principles of primary care, whereas the National Committee for Quality Assurance structures strategic guidelines around 6 transformational themes supporting team-based care. 6 , 7 Changing existing care management processes is essential for successful quality improvement; however, introducing new processes into a busy practice environment can often be disruptive. Many local factors, such as problems with clinician engagement, staff education, or leadership, can contribute to incomplete or ineffective adoption of care management change and compromise anticipated improvements in clinical outcomes. 8 - 12

Improving diabetes care delivery is a common focus of quality improvement activities in primary care. 13 As a model for chronic disease management, successful strategies for diabetes care delivery can inform on how to best implement effective care management processes (CMPs) across a variety of chronic diseases in primary care settings. 14 A CMP is a specific activity performed in a clinical practice with the goal of providing high-quality care. 15 Quantitative improvement in diabetes performance has been associated with multiple CMPs. 15 - 18 We previously reported that CMPs used by high-performing practices differ from those used by low-performing practices. 17 The ability to effectively adopt a CMP and manage potentially disruptive change in a demanding care setting might be another differentiating characteristic of high-performing practices. The 7-year Understanding Infrastructure Transformation Effects on Diabetes (UNITED) study combined the efforts of experienced investigators from the University of Minnesota Center of Excellence in Primary Care and HealthPartners Institute to identify the CMPs most effectively improving primary diabetes care across Minnesota and surrounding regions. 19 In this qualitative study, we explored strategies used by the highest-performing primary care practices to determine how they managed change.

Practice Selection

We surveyed practices participating in the Physician Practice Connections Readiness Survey (PPC-RS) to determine the presence of CMPs from all 585 primary care practices reporting to the Minnesota Statewide Quality Reporting and Measurement System in 2017 and 626 practices reporting in 2019. Response rates were 71% in 2017 and 72% in 2019. Respondents and nonrespondents were comparable in rurality and health system size. Details about the survey process can be found elsewhere. 15 A total of 477 practices completed the PPC-RS survey in either 2017 or 2019. For this study, we selected practices for interviews from the 330 practices completing the PPC-RS survey and submitting annual diabetes performance data in both 2017 and 2019. Submission of performance data is mandatory for Minnesota practices seeing >30 patients aged 18 to 75 years with diabetes per year. A patient is considered to have received optimal care if they achieve concurrent blood glucose control and blood pressure control, have guideline-based use of a statin and an antiplatelet drug, and are a nonsmoker. These participating practices provide care to 191,513 patients with type 1 or type 2 diabetes. To control for variation in practice populations and settings, we matched performance data with American Community Survey data to capture zip code–level descriptors of each patient’s neighborhood including measures of racial distribution, income/education, and wealth. The wealth and income/education measures were computed from a factor analysis of income, housing, education, and family composition measures retrieved from 5-year American Community Survey data for 2015. We measured practice performance using the National Quality Forum (NQF)-Endorsed Maintenance Standard Optimal Diabetes Care (ODC) (NQF#0729). The methods used to determine the measurement of practice performance by population characteristics have been described in more detail previously. 14 Average Optimal Diabetes Care (ODC) performance in Minnesota increased from 12% to 45% during the period 2004 to 2017. The national average was 23% during the period 2013 to 2016. 20

We identified practices in the upper quartile of ODC performance in both 2017 and 2019 and then ranked the practices by annual percentage improvement in ODC score to capture those that are continuing to improve. Beginning with the highest-performing practice, we contacted practice leaders by telephone and e-mail and explained why they were selected. We asked practices to identify the individual(s) completing the PPC-RS survey to participate in a 20-minute onsite interview with study investigators.

Qualitative analysis of interviews was performed by 5 investigators (K.A.P., L.I.S., M.E., R.J., H.N.F.) after every set of 2 interviews. 21 , 22 The investigators determined saturation to occur when 2 practices were interviewed sequentially with no new identified strategies.

Qualitative Interview

Semistructured interviews were conducted by the study investigators (K.A.P., L.I.S., M.E.) in 2020. Nine interviews were conducted onsite. One interview was conducted by videoconference, owing to concerns regarding the coronavirus disease 2019 pandemic. The number of practice participants in each interview ranged from 1 to 5. We used a grounded theory approach for the interviews, which focused on the management of diabetes care improvements in the practice over the prior 3 years. 23 Interviews began with brief unscripted personal introductions and a recognition of each practice’s achievement of high-quality diabetes outcomes. After obtaining oral consent for audio recording, interviewers read the following script using scripted probes to promote further discussion:

• (Probe if this is unclear.) Consider changes in structure or process of care. For example, some clinics have implemented reminders or outreach to patients.
• (Continue to ask the question until they have identified everything that might have contributed.) Is there anything else you’d like to add?
• Was there a change in personnel or resources that made the changes possible?
• What aspects of your clinic or its relationship with the larger medical group contributed to making the change possible?
• Were there any other factors that contributed to your improvement?

Interviews were transcribed by an external professional transcription service and evaluated qualitatively using conventional content analysis. Practices did not review transcripts. All practice comments identifying a specific CMP, or a specific method of change implementation, were identified using NVivo 12 software (QSR International). Comments were derived directly from the text data. We constructed an initial coding framework as a directed content analysis after review and discussion of the first 2 interviews by all 5 investigators. 21 During subsequent review, we coded comments into distinct concepts. The framework and individual concept codes were modified by consensus as we discussed each interview. We used a combination of individual reviews followed by group discussion to clarify and standardize concept codes across all interviews. Any changes in the coding that resulted from subsequent reviews resulted in rereview of previous interviews and recoding to reflect the change. This was followed by assigning concepts into 1 of 3 distinct categories: (1) process of care (what was being implemented), (2) strategy for managing change (how a process was implemented), and (3) obstacles to care delivery. Data saturation was determined to occur when no additional strategies were identified in the 9 th or 10 th interviews. We then conducted a summative analysis of themes, combining frequency counts with observations in a constant-comparative approach. 22

All interviews were performed with informed consent. The study, all data handling procedures, and all study processes were approved and overseen by the University of Minnesota Institutional Review Board.

The UNITED study measured ODC in 330 primary care practices in 2019. Thirteen practices were approached, and 10 were interviewed and analyzed before saturation occurred. The selected practices belonged to different health care organizations. Each practice was managed by an administrative clinic manager and a clinician leader. None of the practices had worked together on a common quality improvement initiative. Selected practices included small rural, large rural, and urban settings. All practices belonged to health care systems of ≥2 practices. The average ODC performance of the 330 practices participating in the UNITED study was 48.4% in 2019. 19 The average ODC performance for the 10 high-performing practices interviewed in the present study was 56%. This included any patient aged 18 to 75 years with type 1 or type 2 diabetes seen over the course of the year. The selected practices had increased ODC performance by an average of 2.9 percentage points (range, 1.6-4.0 percentage points) per year from 2017 to 2019, showing that dynamic active improvement was still occurring in the practice at the time of the interview. Practice characteristics are listed in Table 1 .

Performance Characteristics of Selected Practices

ODC = optimal diabetes care.

The investigators wrote notes on 199 key comments over the course of the 10 interviews. Analysis of comments identified 48 distinct concepts ( Supplemental Table 1 ). Using interpretive analysis, we categorized the concepts into 6 care management themes, 37 strategic approaches, and 4 obstacles. Five investigators (K.A.P., L.I.S., H.N.F., R.J., M.E.) categorized the strategic approaches into 13 distinct change management strategies.

Change Management Strategies

Change management strategies are shown in Table 2 . Selected quotes are shown in Supplemental Table 2 . (All strategic approaches are available in supplemental information.) Nine change management strategies from a total of 13 identified were recognized as important by ≥5 practices and are presented below.

Code Counts Extracted During Interviews That Identified Change Management Strategies Important for Improving Diabetes Care

QI = quality improvement.

1. Standardizing the Care Process

Every practice identified the principles of change management during quality improvement activities using descriptors such as standardization, individualization of standardization, clear priorities, keeping it simple, and providing consistent messages. Developing a standard process for diabetes care simplified the complexity of diabetes care management. Some practice leaders considered standardizing roles and responsibilities to be important for accountability of the care team. Standardized tasks also simplified covering for staff absences by clarifying expectations for replacement staff.

2. Performance Awareness

Nine of the 10 practices identified the importance of performance awareness and commitment to quality that was regularly nurtured across the entire clinic staff. Beginning with the hiring and onboarding process, and included as a part of staff meetings, leaders emphasized the importance of delivering high-quality care as reflected by performance measures. Some practices encouraged a feeling of competition between providers or with other practices. Several made a point of celebrating good scores or improvement in scores with recognition or awards for high-performing teams.

3. Care Teams

Nine of the 10 practices reported expanded roles for care team members or increased size of the teams as key to improving diabetes performance. Expansion of the teams provided capacity for additional support for patient outreach and enhanced patient relationships. Three practices had care teams comprising clinician-medical assistant pairs, whereas 6 practices described expanded care teams beyond those roles. Some practices modified physical space to improve care team interactions.

4. Support From Health Care Organization

Participation with the health care organization (HCO) was identified by 8 practices as important in contributing to better performance. The 2 practices that did not identify this support belonged to 2 different large HCOs. Practices used the HCO for additional information and expertise. Support included improving patient registries, expanding quality improvement meetings, improving access to expert opinion, assisting with standardizing workflow, and enhancing staff training.

5. Population-Based Reporting

Eight practices identified the importance of better reporting systems for improving diabetes care. Six practices identified the need for reliable, up-to-date reports, whereas 5 practices additionally identified the need to dedicate time for actively working on those reports. Reports needed to be easy to use and focused on actionable information that supported outreach and previsit care. One practice hired an assistant (shared between 3 clinics) with the sole responsibility of evaluating reports.

6. Engagement

Seven practices identified clinician engagement, and 5 identified staff engagement in the improvement process as important for success. Practices engaged clinicians and staff in multiple ways including competition and celebration of success. Leaders promoted clinician and staff engagement by emphasizing shared goals regarding improved clinical outcomes.

7. Accountability

Seven practices identified management of staff accountability for completing processes as important. Five practices required staff to meet process targets. Four practices monitored staff performance of processes. Accountable processes included evaluation of registry reports, monitoring clinical performance scores, and checking that patient behavior change was sustained over time.

8. Leadership

Five practices identified local and/or organizational leadership or diabetes champions as important. Leadership was noted to play an important role in enhancing clinician and staff engagement, setting priorities, and promoting awareness and accountability.

9. Quality-improvement activities

Five practices identified organizational structures responsible for managing the change process. Three practices relied on quality improvement meetings to track change, whereas others used huddles or small teams.

Care Management Themes

All care management themes identified as important for improving diabetes care are shown in Table 3 . Selected quotes are shown in Supplemental Table 3 . The 3 themes recognized by more than half of the practices are described below.

Code Counts Extracted During Interviews That Identified Care Management Themes Considered Most Important for Improving Diabetes Care

1. Proactive Outreach

Proactive outreach was defined as any approach initiating care outside of a diabetes care visit. Proactive care was identified by 10/10 high-performing practices as important for improving diabetes care delivery. It was mentioned more often than any other CMP and was commented on an average of 2 to 3 times during each interview. Proactive outreach included actively contacting patients who needed testing, medication changes, or appointments. Most practices (8/10) reported evaluating diabetes registry reports to identify when to reach out and inform patients of care needs and/or deficiencies in current targets. Outreach included contact by telephone, mail, e-mail, and web-portal messages to individual patients who were missing a targeted diabetes performance goal.

2. Enhancing the Patient Relationship

Eight practices focused on enhancing the patient relationship primarily by increasing the frequency and quality of interactions using telephone calls, letters, or electronic communication. Practices characterized the practice relationship with patients as particularly involving the clinicians (2/8), the care team (4/8), or both the clinician and the care team (2/8). A better relationship with the patient was perceived as essential in establishing the patient trust necessary to promote adherence to behavioral change recommendations. Long-standing relationships with patients were seen as particularly important for improving diabetes performance measures.

3. Previsit Planning

Six practices identified previsit planning as important. A form of proactive care, previsit planning was defined as planning to use an upcoming appointment as an opportunity to address needed diabetes care. Previsit planning usually involved generation of a physician or staff reminder to ensure that diabetes care requirements were addressed during a patient visit for another reason.

Barriers to Performance Improvement

Barriers were infrequently identified by these high-performing practices. No single barrier was noted by >4 practices. The identified barriers are shown in Table 4 . Four practices identified staff and clinician turnover as a barrier by diminishing the relationship with patients and compromising the experience and training of the care team. This ultimately decreased the practice’s ability to provide outreach and motivate behavioral change. Three practices identified the challenge of providing high-quality care to patients with economic or social barriers. These practices identified the value of integrating community resources, but no practice reported having a good system for systematically identifying social or economic needs or integrating community resources.

Code Counts Extracted During Interviews That Identified Barriers to Improving Diabetes Care

This qualitative study provides evidence that high-performing primary care practices share a similar perception of the change management strategies that are important for success during performance-improvement activities for diabetes. All selected practices shared outstanding performance. Despite never working together, 9 change management strategies were independently identified by more than half of the practices as important for successful implementation of practice change. Although the same strategies were commonly identified, no single practice identified all 9 strategies.

The strategies represent methods of managing core elements of a practice as described in the National Demonstration Project. 24 This includes the management of resources, organizational structure, and functional processes. Other strategies identified provide methods of managing leadership and engagement and more closely address constructs defining adaptive reserve. 25

Variation in the core elements of practice could be expected to contribute to implementation differences. Change management strategies that address core practices around resources, organizational structure, functional processes, and adaptive reserve offer a plausible pathway for enhancing adoption of practice improvement initiatives. Because the strategies identified by these practices were not developed from a particular approach to improvement, they suggest an approach to change management that potentially has broader applicability beyond diabetes improvement. The strategies highlighted by the practices were successful across a variety of improvement approaches.

The identified change management strategies are not goals to accomplish and do not lend themselves to establishment of simple metrics; however, together they provide a perspective for how successful practices manage change during performance improvement. A review of these perspectives might help practices identify strengths and weaknesses in their own approach to change management during practice improvement activities. Quality improvement initiatives might consider further evaluation of change management strategies that are commonly considered important for successful performance improvement.

Standardization of diabetes care management processes was the only strategy identified by all practices. All practices defined a uniform process to address the challenges of managing complex disease in a busy clinical setting. Standardization has been credited with providing a pathway for quality care improvement. 26 , 27 Standardized work was noted to clarify roles and simplify interactions between staff. It also provided greater flexibility and efficiency in staffing a group practice. Staff absences were noted to be more easily managed when roles and tasks were well defined and accountability was clarified. Performance awareness, staff and clinician engagement, and accountability are 3 themes that have been recognized in the Harvard Business Review as counteracting a disconnection between personal and organizational performance. 28 Most practices identified each of these as important for supporting practice performance improvement. Quality improvement activities were identified as providing an organizational approach to track implementation of change. Although quality improvement teams were not always identified, most practices implemented organizational activities to manage the change process.

Additional important strategies provided direct support for providing proactive care. Providing an expanded care team and the creation of better reporting systems were seen by practices as important for expanding the capability of the practice to reach out to patients who needed additional support. Expanding the care team might include task delegation or increasing personel. 29 , 30 A 2020 study in 4 states (24 health care systems) demonstrated the necessity of using health information technology to improve performance. 31 In the present study, practices described using reports to implement a review of systematically collected data that resulted in targeted telephone calls, e-mails, web-portal notifications, or letters to patients. Nearly all practices used reporting systems to support previsit planning, ensuring that recommended care was offered when a patient visited the practice for another reason. Although a better reporting system was seen as necessary for care delivery, it was not considered sufficient. Good reporting systems still required someone on the care team to spend time working with the reports to initiate proactive care activities. Expanded care teams were used to review reports, and organizational improvement teams tracked performance. Engaged leadership and the health care organization were identified as providing valuable administrative direction. Leadership contributed primarily by increasing awareness of performance measures, promoting engagement, providing accountability, supporting education, and engaging additional organizational resources and expertise.

In addition to similar perspectives on how to manage change, the practices shared perspectives on what processes should be targeted. Three main care management themes were identified, suggesting a similar focus between the practices on what was necessary. The delivery of proactive care was identified by all practices as essential for improving diabetes care. Proactive patient outreach has previously been identified as the most important approach for achieving and maintaining high-quality diabetes outcomes by high-performing practices. 17 Previsit planning is a form of proactive care that allows for opportunistic care to be provided when the patient visits the practice for another reason. Practices implemented previsit planning by reviewing upcoming appointments to flag care that might otherwise be missed during the visit. The importance of proactive care is consistent with previously published work identifying care management processes that distinguish high- from low-performing practices. 15 , 17 Improving the patient relationship was the third care management theme identified by most practices. A strong patient relationship has previously been identified as important for patient-centric diabetes care. 32 , 33 The common focus on improving patient relationships underscores the perception in the practices that good patient relationships contribute directly to better diabetes outcomes. Establishing a strong relationship was acknowledged as important for enhancing patient adherence to recommendations and promoting behavioral change. The identification of the above themes supports the findings of previous work identifying differences between high- and low-performing primary care practices in the provision of diabetes care. 17

This qualitative study has several limitations. Although high-performing practices report change management strategies as important, whether the strategies identified are necessary or sufficient in any particular practice was not addressed by the analysis. All practices wanted to increase proactive care, and interpretation should be limited to practices with this goal. Although the sample was geographically limited to practices serving Minnesota, substantial variation in performance exists across Minnesota. Minnesota practices use the same delivery models adopted across the county. Given that practice performance was statistically controlled for race, ethnicity, and income, it is unlikely that these known barriers would be identified during the analysis. Because only high-performing practices were selected, common barriers to care delivery that influence performance were unlikely to be identified.

High-performing primary care practices share a common perspective regarding the change management strategies they consider important for successful implementation of change during diabetes performance improvement activities. These strategies focus on the management of core elements of the practice including resources, organizational structure, functional processes, and adaptive reserve. Implementing a standardized process of care during patient-initiated encounters helped to address the complexity of diabetes care, whereas staff engagement, performance awareness, and accountability promoted alignment of personal and organizational performance. Engaged leadership and organizational support increased awareness, engagement, and accountability. High-performing practices also shared a similar approach to diabetes care delivery, focusing on proactive outreach to patients not in clinic and opportunistic care delivery for patients in clinic, to deliver recommended clinical services. Finally, high-performing practices focused on improving patient relationships to improve adherence to recommendations and promote behavioral change.

Supplementary Material

Annals Journal Club selection

Conflicts of interest: authors report none.

Read or post commentaries in response to this article.

Funding support: Research reported in this publication was supported by the National Institute of Diabetes, Digestive, and Kidney Diseases of the National Institutes of Health (R18DK110732). Helen N. Fu is presently funded as a postdoctoral research fellow in Public and Population Health Informatics at the Fairbanks School of Public Health and the Regenstrief Institute, supported by the National Library of Medicine of the National Institutes of Health (T15LM012502).

Disclaimer: This content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Change Is Hard. Here’s How to Make It Less Painful.

• Erika Andersen

Four strategies to help you shift your mindset.

When an organizational change is first proposed, most people immediately want to know three things: what does this change mean to me, why is it happening, and what will it look like when the change has been made? People only begin to be open to accepting, embracing, and making this change when their mindset starts to shift from “this change is going to be difficult, costly, and weird” to “this change could be easy, rewarding, and normal.” The author offers four straightforward approaches for leaders to support their people through this necessary mindset shift, resulting in a critical mass of people who will understand, accept, and adopt the change reasonably quickly.

Every leader has had the experience of unveiling an organizational change — a new system or process, a corporate restructure, a shift in the business model — and getting a less-than positive response from their team. Sometimes the reaction is subtle: lowered eyes, tightened lips, silence. With a more confident or vocal team, you might get questions about whether the change is necessary, complaints about “yet another thing to do,” and lots of reasons why this just isn’t a good time for a big shift.

• Erika Andersen  is the founding partner of Proteus International , a coaching, consulting, and training firm that focuses on leader readiness. In addition to her latest book, Change From the Inside Out: Making You, Your Team, and Your Organization Change-Capable , she is the author and host of  The Proteus Leader Show   podcast and the author of four previous books:  Growing Great Employees , Being Strategic , Leading So People Will Follow , and Be Bad First .

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