Friday, 21 April 2017

Commentary on: Leading change: a concept analysis

Commentary on Nelson-Brantley H.V., and Ford D.J. (2017) Leading change: a concept analysis. Journal of Advanced Nursing 73(4), 834-846.

Dr Mark Hughes
University of Brighton, UK

As a management and organization studies academic with a strong interest in leading change, I read Nelson-Brantley and Ford’s (2017) recent paper with interest and I will certainly be referring to this informative paper in my future work. I share their desire for greater conceptual clarity around change leadership. Ford and Ford (2012) raised similar concerns, although not nursing specific, in their review of the leadership of organizational change literature published in peer-reviewed journals between 1990 and 2010.

As the authors rightly remind us, the focus of their concept analysis potentially has life or death consequences, so I do hope that their paper provokes much-needed debate, as the debate often appears to myself and others to be trapped in the past (see By et al, 2016). I want to fuel this debate through raising four challenges which could be directed at the paper and more generally at leading change theories and their implications for nursing practices.

1. Do aggregate success/failure rates inform or misinform nursing change practices?

A shift away from management towards leadership was prefaced by claims of change failure. In essence, change management failed, with an implication that change leadership was going to succeed. However, the evidence base for these highly publicized aggregate failure rates was non-existent (Hughes, 2011). Intuitively we appreciate that a success/failure rate for transforming a hospital will differ from the rate for improving nursing education given that they are completely different activities and that there will be considerable contextual variations even within nursing.

2. Are the prescriptions of Kotter really applicable to nursing change practices?

Professor John Kotter’s 1996 book features very prominently in the paper, potentially reflecting his contribution to leadership studies. Even assuming that Kotter’s business cases are applicable to healthcare settings, I have generic concerns about this model of leading change (Hughes, 2016). Over the past two decades, we have witnessed academic advances in understanding ethics, power and politics, processes, agency and discourses in relation to organizational change, which appear to be missing from Kotter’s account of leading change. It was disappointing that the conceptual analysis did not reveal ethics as one of the attributes for leading change or make any reference to ethics.

3. Do we need nurses to lead or manage change or both?

The call for nurses to lead change has been echoed in the UK. But as a patient of the UK National Health Service, rather than a practitioner, I fear we may underestimate management in delivering high-quality healthcare. As a patient more mundane aspects such as hospital cleanliness, available appointments, maintaining effective medical records and effective hospital communications with myself really do matter. My fear is that organizations have become seduced by notions of leading change at the expense of other crucial activities. The paper rightly touches upon dualities and paradox, but potentially misses an opportunity to encourage a dualities aware approach.
Effective change leadership means appreciating how dualistic forces can shape and enable change. By adopting a dualities aware perspective, leaders can come to terms with the intuitive desire to resolve contradiction by instead managing the complementarities within contradictory forces. (Sutherland and Smith, 2013: 220)
The implication is that rather than nurses leading or managing and dealing with change or continuity, they will typically be involved in managing and leading changes and continuities. In any effectively run hospital continuities may prove to be as important as changes and we may find managing those continuities is as important as leading changes.

4. Does associating leading with changing really inform nursing change practices?

The authors rightly tend to make associations between leading and changing, rather than asserting that leaders influence organizational change. Whilst institutional rhetoric of nurses leading change may be strong, I have reservations about the empirical reality of leaders influencing organizational change. Parry (2011:57) is cited in the concept analysis, but what I took away from his short review of leadership and organizational change was that ‘there are many more books and articles on practitioner or conceptual scholarship than on theoretical or empirical scholarship. Much of the practitioner work is case study-based, and anecdotal and not rigorous in its conduct.’ This concern could be levelled at some citations in the content analysis. I personally found Ford and Ford’s (2012:22) review of the leadership of organizational change literature persuasive:
There is simply too little empirical research that specifically addresses the leadership of change to warrant a prescription for what works…we find, the available research equivocal and incomplete regarding both what constitutes effective leadership and the impact of change leaders approaches, behaviors, and activities on change outcomes of any type.

I welcome the publication of this concept analysis in clarifying the concept of leading change and situating this analysis in the context of nursing and healthcare. I am personally still not convinced that we have the empirical evidence to satiate the institutional desires for leading change in healthcare or any other sector.

Dr Mark Hughes
Reader in Organizational Change
University of Brighton
Brighton Business School
Brighton, UK


By R.T., Hughes M & Ford, J. (2016) Change leadership: Oxymoron and myths. Journal of Change Management 16 (1), 8-17.

Ford, J.D. & Ford L.W. (2012) The leadership of change: A view from recent empirical evidence. In Research in Organization Change and Development (Pasmore W., Woodman, R and Shani, A. eds) 20: (1-36).

Hughes, M. (2011) Do 70 per cent of all organizational change initiatives really fail? Journal of Change Management 11(4), 451-464.

Hughes, M., (2016) Leading changes: Why transformation explanations fail. Leadership 12(4), 449-469.

Nelson-Brantley H.V. & Ford D.J. (2017) Leading change: a concept analysis. Journal of Advanced Nursing 73(4), 834–846. doi: 10.1111/jan.13223

Parry K.W. (2011) Leadership and Organization Theory. In The SAGE Handbook of Leadership (Bryman A., Collinson D., Grint K., Jackson, B. & Uhl-Bien, M. eds), SAGE Publications Ltd., London EC1Y 1SP, pp. 53.70.

Sutherland, F. & Smith, A.C.T. (2013) Leadership for the age of sustainability: A dualities approach to organizational change”. In Organizational Change, Leadership and Ethics: Leading Organizations Towards Sustainability (By R.T. & Burnes B. eds), Routledge, London, pp. 216-239.

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