Employee emotions during organizational change—Towards a new research agenda

A Cautionary Tale: Exploring Stakeholder Emotions During Curricular Change Using Group Concept Mapping

PhenomenonCurricular change is essential but challenging. Change efforts often struggle and some fail due to well-articulated challenges as well as other barriers less understood. The curricular change literature characterizes the organizational and operational features of successful change yet virtually ignores stakeholder emotions. A deeper understanding of these emotional responses during the change process could enhance participant and organizational well-being and support change success. Approach In 2019, data were collected at one large North American medical school using group concept mapping methodology, an asynchronous mixed methods approach. We sought to generate themes characterizing the emotional responses of faculty, administrative staff, and students across multiple stakeholder groups participating in the new and traditional (legacy) curricula 27 months after curricular change initiation. Participants brainstormed, sorted, and rated statements on emotional responses. Rating participants rated each statement using a Likert scale from 1 (does not resonate) to 4 (very strongly resonates) according to this prompt: "This emotional response resonates with my emotional experience during the curricular change." Multidimensional scaling and hierarchical cluster analyses were used to generate emotional profiles and compare them across stakeholders. Findings Of 335 stakeholders invited, 123 contributed to brainstorming (36.7%), 153 completed rating (45.7%) and 33 completed sorting (9.9%). Participants generated six themes of emotional responses to curricular change: enthusiastic, apprehensive, overwhelmed, missed opportunities, uncertain, and abandoned. The enthusiastic theme overall had the highest mean statement ratings while the abandoned theme had the lowest. Demographic subgroup analysis revealed new curriculum students (Class of 2021) were most enthusiastic while legacy curriculum students (Class of 2020) were more likely to feel abandoned. Overall, faculty and administrative staff were more enthusiastic than students whereas students rated the five other themes higher than faculty and administrative staff. InsightsCurricular change is emotionally taxing. Students in both curricula experienced greater uncertainty, apprehension, sense of missed opportunities, and feeling overwhelmed than did faculty and administrative staff. Legacy curriculum students rated statements in the abandoned cluster highest while new curriculum students rated statements in the enthusiastic cluster highest. Given the ubiquity of curricular change which often includes a legacy cohort, medical schools embarking on this journey must carefully attend to the varied emotional responses of their different stakeholder groups. The very activities recommended by organizational change models used in medical education, such as communicating wins early and often, could alienate legacy students, creating emotional polarization. These findings suggest that tailored communication strategies are necessary during change implementation to optimize success.

Job Insecurity and Intention to Quit: The Role of Psychological Distress and Resistance to Change in the UAE Hotel Industry

Hotel organizations today are in a state of constant change due to high competition, the emergence of pandemics, and cyclical economic crises. Hospitality employees are currently affected by job insecurity. The purpose of this research was to investigate the effect of job insecurity on intention to quit among hospitality workers, integrating the mediating effect of psychological distress and resistance to change and their mutual relationship. A total of 312 surveys were completed in four four- and five-star hotels in the UAE (Dubai and Sharjah). The SmartPLS 4 software was used to test the hypotheses in a mediation model with the bootstrapping method. The results showed that all of the direct links were positive and significant, and mediating relationships were confirmed. This study found that job insecurity predicts intention to quit through psychological distress and resistance to change acting as mediators, and these factors themselves also impact significantly on intention to quit. Resistance to change is impacted significantly by job insecurity and psychological distress, which suggests that a deeper approach to employees' resistance to change should be taken, especially when conducting performance appraisals in the hotel industry, by searching for its roots and aiming to minimize employees' intention to quit.

Psychosocial predictors of emotional labour among employees of merged and acquired banks in Ibadan, South-West, Nigeria

Mergers and acquisitions (M&As) are common among financial institutions. This process often exerts immense pressure on employees of these institutions. Hence, this study touches on the significant but neglected human angle aspect of M&A. Therefore, the study examined psychosocial predictors of emotional labour among employees of merged and acquired banks in Ibadan. The study design is cross-sectional, which involves using a quantitative data collection method to elicit responses from the participants. Furthermore, the convenience sampling method was used and selected four hundred, and twenty-two employees acquired or merged during the consolidation and post-consolidation eras in South-Western Nigeria. A structured questionnaire that measured job satisfaction, acculturation, attitude to M&A and emotional labour was used to collect data from the respondents. Data analysis was done using SPSS software window 10.0. The mean age of respondents was 32 years, with a standard deviation of 7.31. The results showed that attitude towards M&A (β = 0.39; p < .05) and acculturation (β = 0.36; p < .05) were significant independent predictors of emotional labour. Furthermore, attitude towards M&A (β = 0.32; P < .05) and acculturation (β = 0.28; p < .05) were also significant independent predictors of emotional labour per se, personal efficacy, and for false face, respectively. Therefore, it was concluded that employees' emotions and job satisfaction should be factored into the management's strategic plan during M&A because the success or failure of this undertaking rests on them. Therefore, it was recommended that bank managers pay adequate attention to acculturation and the attitude of employees during a major organisational change to enhance emotional labour performance.

On the contribution to the alignment during an organizational change: Measurement of job satisfaction with working conditions

INTRODUCTION

Modern approaches to Occupational Health and Safety have acknowledged the important contribution that continuous improvements to working conditions can make to the motivation of employees, their subsequent performance, and therefore to the competitiveness of the company. Despite this fact, organizational change initiatives represent a path less traveled by employees. Specialized literature has drawn on the fact that employees' satisfaction presents both the foundation and catalyst for effective implementation of improvements to working conditions.

METHOD

This paper conceptualizes the alignment of employees through measurement of job satisfaction and uses the Bayesian Network to assess the influence of human factors, particularly the cognitive, emotional, and behavioral aspects. Toward this aim, the Bayesian Network is evaluated through a cross-validation process, and a sensitivity analysis is then conducted for each influential dimension: emotional, cognitive, and behavioral.

RESULTS

The results reveal that these three dimensions are interrelated and have a direct influence on job satisfaction and employees' alignment during the organization change. Further, they suggest that the best strategy for enhanced alignment and smooth conduct of organizational changes is simultaneous enhancement of the three dimensions. Practical applications: This study shows the influence of emotional, cognitive, and behavioral dimensions on job satisfaction and employees' alignment during the organizational change. Furthermore, it elaborates the way to develop efficient and effective strategies for a successful change implementation and sustained alignment.

Institutional work through empathic engagement

A growing body of literature examines how actors engage with institutions and how they prompt institutional change and evolution. This article takes stock of this knowledge and contributes an affective dimension to the study of how institutional entrepreneurs achieve momentum and field-level impact. The article views institutional work as relational agency and conceptualises empathic engagement as a way for institutional entrepreneurs to relate affectively to other actors and induce cooperation. We demonstrate how empathic engagement by institutional entrepreneurs can nurture communities of practice that co-create change in institutional fields. Our argument hinges on the actors' affective investment and advances the less developed non-cognitive dimension of institutional work. By integrating empathic engagement into institutional entrepreneurship, we demonstrate how institutional entrepreneurs nurture their ability to engage and cooperate with others to diffuse particular values through institutional work. This integration focuses on the way of knowing generated through empathic engagement: the ability to bring about a consensus by creating frames of reference and identities that others are enchanted by and subscribe to, as opposed to using coercive mechanisms.

Anticipating the end: exploring future-oriented sensemaking of change through metaphors

Purpose

The purpose of this paper is to explore whether there is a link between retrospective and prospective sensemaking by analyzing metaphors of past and potential future changes.

Design/methodology/approach

The article draws on interview data from employees, team managers and middle managers at an IT department of a Nordic bank.

Findings

The study found that organizational members' sensemaking of changes in the past were characterized by trivializing metaphors. In contrast, future-oriented sensemaking of potential changes were characterized by emotionally charged metaphors of uncertainty, war and the End, indicating that the organizational members anticipating a gloomier future.

Research limitations/implications

These findings might be limited to the organizational context of an IT department of a bank with IT professionals having an urge for control and sharing a history of a financial sector changing dramatically the last decade.

Originality/value

This article contributes to the emerging field of future-oriented sensemaking by showing what characterize past and future-oriented sensemaking of changes at a bank. Further, the paper contributes with an empirical study unpacking how organizational members anticipate an undesired future which might not be grounded in retrospective sensemaking.

The Effect of Organizational Changes on the Psychosocial Work Environment: Changes in Psychological and Social Working Conditions Following Organizational Changes

Purpose: The present study aimed to clarify the prospective effects of various types and frequencies of organizational changes on aspects in the psychosocial work environment. Methods: The study had a prospective, full-panel, repeated measures design. Data were collected by self-administered, online questionnaires, with a 2-year interval between measurement occasions. Five types of organizational change were assessed - company restructuring, downsizing, layoffs, partial closure, and partial outsourcing. The effects of change on eleven, specific work factors were measured utilizing QPS Nordic. At baseline, 12652 employees participated, while 8965 responded at follow-up. Generalized estimating equations were utilized to estimate the effects of change taking place within the last 12 months or more than 24 months prior. Results: Cross-sectional analyses, i.e., changes occurring within the last 12 months, showed all 11 work factors to be statistically significantly associated with the organizational changes restructuring, downsizing, and partial closure (coefficients ranging -0.28 to 0.04). In the prospective analyses, i.e., the effects of change taking place more than 24 months prior, associations were no longer significant for a number of work factors, although all types of organizational change remained significantly associated with at least three work factors (coefficients ranging -0.14 to 0.05). Following repeated organizational changes, statistically significant associations were shown for all 11 work factors (coefficients ranging from 0.39 to -0.04). Conclusion: Following both separate and repeated organizational change, various psychological and social work factors were altered, with the most pronounced effects following repeated change. These results suggest the implementing organizational change, especially repeated change, may have an adverse effect on various parts of the psychosocial work environment. The negative effects of a company's psychosocial working conditions may contribute to the adverse health effects often observed following such changes and help explain why many change initiatives fail to reach its intended results.

Leading transitions in traumatically experienced change – a question of doing or being?

Purpose

The purpose of this paper is to explore change leadership in the context of traumatically experienced change. “Being-centeredness” is proposed as a change leadership paradigm, with the leader becoming a facilitative instrument who assists restoration of a healthy working environment, healed emotions and change transitioning.

Design/methodology/approach

This paper is a conceptual research paper. Conceptualizations of being-centeredness are developed by building on the discourse of change emotions in organizations and research on change leadership.

Findings

Change interventions are experienced more traumatic than often believed. Healing of these emotions is essential to avoid stuckness. Becoming an instrument of change enables being-centered leaders to assist the emotional healings of victims and survivors when change is experienced as traumatic, promoting individual transitioning, restricting resistance to enhance change readiness and resilience.

Research limitations/implications

Although conceptualizations are supported by an abundance of research and practical experience, as with any conceptual research, it lacks direct empirical evidence to support the conceptualizations.

Practical implications

Being-centeredness is an untapped inner capacity in many change leaders and change interventions. Explicitly normalizing and promoting being-centeredness and the further development of this capacity in leaders will allow this latent capacity to surface from its suppressed state, to be applied overtly.

Originality/value

The paper provides a new paradigm on leaders can and should deal with acute emotions that are often experienced from change, which focus more on the way of being of leaders, than competencies or change activities that must be done. This is likely to further emotional healing, change transitioning, resilience and ultimately change success.

Measuring change attitudes in health care organizations

PURPOSE

Measuring attitudes of healthcare providers and managers toward change in health care organizations (HCOs) has been of widespread interest. The purpose of this paper is to evaluate the psychometric characteristics and usability of an abbreviated German version of the Change Attitude Scale.

DESIGN/METHODOLOGY/APPROACH

The Change Attitude Scale was used in a survey of healthcare providers and managers in German hospitals after the implementation of a breast cancer center concept. Reliability analysis, confirmatory factor analysis, structural equation modeling and bivariate analysis were conducted.

FINDINGS

Data from 191 key persons in 82 hospitals were analyzed. The item-scale structure produced an acceptable model fit. Convergent validity was shown by significant correlations with measures of individuals' general opinions of the breast center concept. A non-significant correlation with a scale measuring the hospital's hierarchical structure of leadership verified discriminant validity. The interaction of key persons' change attitude and hospitals' change performance through change culture as a mediator supported the predictive validity.

RESEARCH LIMITATIONS/IMPLICATIONS

The study found general support for the validity and usability of a short version of the German Change Attitude Scale.

PRACTICAL IMPLICATIONS

Since attitudes toward change influence successful implementation, the survey may be used to tailor the design of implementation programs and to create a sustainable culture of high readiness for change.

ORIGINALITY/VALUE

This is the first study finding that a short instrument can be used to measure attitudes toward change among healthcare providers and managers in HCOs.

Inside the Onion: Understanding What Enhances and Inhibits Organizational Resilience

Organizational resilience refers to an organizations’ capacity to withstand changes over time. Most existing models of organizational resilience have not been empirically tested and/or tend to focus on “what resilience is” and little attempt has been made to investigate factors that enhance and/or diminish an organization’s resilience. This qualitative research study, therefore, seeks to advance theorizing about organizational resilience by identifying and exploring both the enablers and inhibitors of organizational resilience. Longitudinal interview data are analyzed to explore employees’ perceptions about what has impacted their organization’s ability to cope with change. A conceptual model of organizational resilience is proposed. The contributions of this model are that it is the first, to our knowledge, to (1) propose a multilevel conceptualization of organizational resilience, and (2) include within the model the idea that earlier changes can both enhance and inhibit the organizations’ current ability to cope with change.

Emotions during executive succession in a public board

Purpose

The purpose of this paper is to address a significant gap in the literature as it explores challenging emotions in the context of forced executive succession in a public sector board by re(conceptualizing) executive succession as a change process.

Design/methodology/approach

This study is empirical in nature and uses a combination of an ethnographic case study and narratives to understand emotions in the context.

Findings

The authors show that the emotional complexities emerged when executive succession was enforced from outside due to multiple interpretations of the emergent situations. It further shows how shame, guilt and embarrassment were produced when actors realized that they had failed to deliver responsibility; issues of trust and betrayal emerged when actors were not taken into confidence whilst taking certain actions; and the way actors manipulated situations and managed unwanted emotions by finding excuses and shifting blame.

Research limitations/implications

Future research can explore the political nature of emotions and can take into account the emotions of other stakeholders, such as staff and general public during forced succession in public sector organizations.

Originality/value

The re(conceptualizing) of executive succession as an emotive change process is an important contribution, since the current literature concentrates mainly on the changes and subsequent emotions triggered by new executive in the public sector. Through the lens of emotions, multiple interpretations of the situated emotions are revealed that influences board members relationships and interactions. This will help to create a better understanding of what happens inside public boards when executive succession is enforced from outside.

Evaluation of how a real time pre-registration health care curricula was managed through the application of a newly designed Change Management Model: A qualitative case study

BACKGROUND

Curricula change in nurse education is of international importance. The pace of such change has been continuous and has triggered criticisms of inadequate preparation of practitioners. There are no change formulae for managing curricula change and despite a raft of change methods, globally change success remains low. A lack of a unified voice, undue focus on cognition, and arguably no existing models for academia and a literature gap contribute to change challenge. A new Change Management Model designed from research with emotion as its underpinning philosophy is evaluated.

OBJECTIVE

Evaluation of a newly designed Change Management Model through a real time pre-registration health care curricula change.

DESIGN

A qualitative case study was adopted. The single case study was the new pre-registration health care curricula.

SETTING

This study took place in a Faculty of Health and Social care in one HEI in the UK.

PARTICIPANTS

Four senior academics and fifteen academics across professions and specialisms involved in the curricula change took part in the study.

RESULTS

The findings suggested that leadership operated differently throughout the organisation. Distributive and collective leadership created a critical mass of people to help deliver the new curricula but academics felt excluded at the strategic level. Emotion at the strategic level inhibited innovation but boosted engagement, emotional relationships and creativity at the operational level. Face to face communication was favoured for its emotional connection. A top down approach created an emotional disconnect and impacted inclusiveness, engagement, empowerment, vision and readiness for change.

CONCLUSION

Testing the new model widely not only in organisations, practice and team changes but personal change in improving health and wellbeing could be beneficial. The continuing gap in knowledge on the link between emotion and curricula change, practice and organisational change and therapeutic value of the model also warrants further research.

Impact of psychological capital on the resistance to change during post-merger integration

Purpose

Mergers and acquisitions (M&As) are major corporate changes and are among the most stressful for employees. Employee resistance is a well-recognised reason for high failure rates of post-merger integration (PMI). The contemporary concept of psychological capital (PsyCap) is a promising approach for dealing with the issue. To date, relatively little research has been conducted on the relationship between PsyCap and resistance. The purpose of this paper is to examine the possible positive impacts of PsyCap on employee resistance during PMI, based on a review of the existing literature and selected interviewers with a panel of experts, and offer a theoretical model for decreasing the resistance.

Design/methodology/approach

This paper builds on the literature on M&A, PMI, and employee resistance by focusing on the contribution of PsyCap. Apart from formulating propositions and answering pre-determined research questions, the findings are the basis for a theoretical model that was validated by a panel of experts.

Findings

This research documents the negative emotions that are triggers for resistance during PMI under the influence of PsyCap. By measuring and assessing the PsyCap needs of employees, resistant employees were revealed, and their PsyCap was developed using tailored interventions. The research findings indicate this to be a feasible approach for reducing resistance during PMI.

Research limitations/implications

All of the findings rely on empirical testing and operationalisation. Cultural differences may influence the PsyCap dimensions.

Practical implications

M&A deals often fail due to unsuccessful PMI implementation because leaders fail to consider the psychological impacts when trying to overcome resistance. The model proposes a possible solution.

Originality/value

The offered theoretical approach is original and provides new insights for researchers and practitioners who evaluate M&A strategies.

Excessive change and coping in the working population

Purpose

– Two complementary objectives are addressed in this paper. First, several studies are introduced based on the assumption that organizational change is now excessive. The purpose of this paper is to propose an operational definition to change excessiveness, and the authors assess whether it is a generalized phenomenon at a societal level. Second, these studies are habitually mobilizing coping theories to address their purpose. However, an integrated model of coping, including appraisals and coping reactions towards change is still to be tested. Thus, the assessment is anchored in an application of the Stimulus-Response Theory of Coping (SRTC).

Design/methodology/approach

– A quantitative study is conducted by administering questionnaires to a nationwide representative sample (n=1,002). Anderson and Gerbing (1991) two-step approach is used to validate the study and tests its hypothesized model. Change excessiveness is measured in order to observe if it is a generalized phenomenon in the working population. Its effects on coping are modelled through the fully mediated SRTC. Therefore, the hypothetical model predicted that the relationships between the perception of excessive change contexts and negative coping reactions is fully mediated by negative appraisals towards change contexts.

Findings

– Perceptions of excessive change is a normally distributed and a statistically centralized phenomenon. As hypothesized, an structural equation modelling test of the SRTC shows a full mediation effect of negative appraisal between change intensity and negative coping to change.

Originality/value

– This paper empirically tests a nationwide sample where organizational change may be too excessive for individuals’ positive coping. It is the first to generalize the observation of change excessiveness as perceived by employees to a nationwide level. Moreover, it addresses the gap between change excessiveness and coping theories in modelling the SRTC through its three components: event, appraisals, and coping reactions. Finally, it presents managerial discussions towards the strategic necessity for organizational change and its potential “too-much-of-a-good-thing” effects.

Evolving emotional experiences following organizational change: a longitudinal qualitative study

Purpose

– There is a lack of qualitative longitudinal studies in the literature exploring the complexity and dynamism of affective experience during phases of organizational change. The purpose of this paper is to explore the nature and intensity of emotional reactions to change and the contextual triggers that made them vary.

Design/methodology/approach

– In total, 11 nurses in a Norwegian public hospital were interviewed at three points in time about a change in technology, one month prior to implementation, three months after implementation and one year after implementation. They were asked to reflect “forwards” and “backwards” about their emotional experiences to the technical change in particular and to other changes occurring at work.

Findings

– The informants reported mixed emotional experiences to change at all three interviews. Emotion terms such as “uncertainty”, “joy” and “resignation” were reported at all times, “anxiety and “excitement” were only reported at Times 1 and 2 whereas “frustration” and “cynicism” were only reported at Times 2 and 3.

Research limitations/implications

– A larger group of informants would have produced greater insight into the evolving emotional change experiences. Further research could explore other contexts and a wider range of data collection methods.

Originality/value

– This is a rare qualitative study of emotional change experiences where the informants were interviewed three times.

Emotions in sensemaking: a change management perspective

Purpose

– Following various calls for research, the purpose of this paper is to adopt theories of emotion and action to understand the affective dimension of sensemaking processes in organizational change endeavors.

Design/methodology/approach

– This paper is conceptual in nature, introducing theories from psychology, in particular dual processing theory and the somatic marker hypothesis, to the field of intra- and inter-personal sensemaking in change processes.

Findings

– The author discusses how emotions shape sensemaking and thus the perception of change events and how four discrete emotions (anger, fear, anxiety, hope) shape content and motivational strength of sensemaking accounts, influence the likelihood that a person will engage in sensegiving activities and will be willing to accept inter-personal sensemaking outcomes. The author proposes that emotions are an input to as well as an outcome of sensemaking processes.

Research limitations/implications

– Although this research builds on a strong empirical basis, is conceptual in nature. Future research might test the relationships suggested in this paper empirically.

Practical implications

– The findings suggest that the management of affective reactions of people subjected to change processes might be a field currently not sufficiently accounted for in change management. Active emotion management might be a way to steer change processes in a positive way for all the stakeholders involved.

Originality/value

– The conceptualization presented here contributes to the often requested development of a conceptual model integrating emotions into the sensemaking perspective. The introduction of distinct emotions and the grounding in multi-disciplinary theory as well as the strong implications for change management theory and practice make this contribution valuable.

Introduction of vincristine mini-bags and an assessment of the subsequent risk of extravasation

INTRODUCTION

Numerous international organisations have advocated the preparation of vincristine in small volume intravenous bags in order to eliminate inadvertent intrathecal administration. However, the risk of extravasation is a significant deterrent, and adoption of this practice has been variable and only hesitantly accepted in the clinical setting.

PURPOSE

We carried out a study with the aims of establishing the incidence of reported extravasation of vincristine administration to paediatric and adult patients in mini-bags; here we describe motivating factors and barriers faced by clinical staff. The secondary aim was to support the need for change and implementation of the international recommendations.

METHODS

Chemotherapy-certified nurses completed a survey spanning August 2009 to August 2011, to ascertain the incidence of extravasation associated with the administration of vincristine in mini-bags.

RESULTS

This period captured 421 occasions of vincristine administration in 25-ml or 50-ml mini-bags (in 0.9% sodium chloride). The median age of patients was 13 years (range 2.5 months to 99 years). Vincristine was administered through peripheral lines (26.4%), portacath (52.0%), PICC line (15.9%) and Hickman line (5.7%). The majority of infusions were over at least 10 minutes (50.1%). There were no cases of extravasation reported.

CONCLUSIONS

The administration of vincristine in small volume intravenous bags was safe, practical, and feasible in all patient groups. The successful implementation of the international recommendations for vincristine administration in mini-bags to eliminate potential inadvertent intrathecal administration was dependent on stakeholder buy-in.

Exploring types of individual unlearning by local health-care managers: an original empirical approach

Background

The ability of health-care managers or organisations to adapt and respond to change is vital if they are to succeed in the contemporary health-care environment. Change involves the learning of new behaviours and giving up, or abandoning, some established ones – more formally defined as unlearning. However, research on unlearning is lacking. This original exploratory study investigates UK NHS health-care managers' engagement with behavioural unlearning and cognitive unlearning, and also considers the related concept of fading. The study also investigates the impact of individual unlearning on participating health-care managers' decision-making.

Research questions

(1) To what extent do health-care managers engage with the process of unlearning and what impact does the engagement with this process have on health-care managers' decision-making? (2) What are the barriers and enablers that influence the engagement of health-care managers with the process of unlearning? (3) To what extent does the health-care setting affect the level of engagement with the process of unlearning by health-care managers?

Methods

The study investigated these questions through an examination of the academic literature. Several management (Business Source Complete, Emerald), psychological (PsycINFO), health (MEDLINE) and education [Education Resources Information Center (ERIC)] electronic databases were searched for English-language articles that were published between January 2000 and March 2012. The literature provided the basis for original exploratory research that investigated local health-care managers' experiences of unlearning. A case study approach was adopted for empirical data collection, using qualitative interviews to investigate experiences of unlearning in two secondary care NHS trusts (an acute trust and a mental health trust). A total of 85 episodes of unlearning were identified from a purposive sample of 29 health-care managers. The sample participants varied in terms of clinical/non-clinical background, type of department/unit and length of time as a manager.

Results

The findings show that the health-care managers who participated in this study engaged with unlearning and fading. The engagement is triggered through either an individual experience or a change event. There was little evidence to indicate that health-care setting or professional background had a strong influence over health-care managers' engagement with unlearning, although this finding is limited by the exploratory nature of the study, sample size and range of settings examined. Participants identified a variety of barriers to individual unlearning including personal behaviour and staff resistance to change. Enablers such as personal skills, attitudes and relationships were more commonly cited than organisational enablers such as policies, procedures and work circumstances. The findings also suggest that unlearning does influence the decision-making of health-care managers, encouraging a more discovery-orientated approach.

Limitations

This study has a number of limitations. It is an exploratory study involving a small number of participants drawn from two NHS trusts, which limits the depth of insight that it can provide regarding specific aspects of unlearning processes. Further, because of the relatively low numbers of participants in our study, the findings provide limited insights regarding theextentto which managers engage with processes of unlearning across different health-care settings and theimpacton their decision-making. Finally, the study is able to provide only a limited interpretation of the nature of fading, although the empirical data do provide evidence that fading should not be conceptualised as a type of individual unlearning.

Conclusions

The study has enhanced the theory of individual unlearning by reconceptualising existing unlearning models and developing a new typology that distinguishes between four separate types of individual unlearning. The findings demonstrate that health-care managers who participated in this study engaged with unlearning processes and that this engagement impacted on their decision-making processes. After engaging with individual unlearning, several managers moved away from idea imposition approaches to decision-making in favour of more discovery-focused approaches, which have been reported in academic literature to be more successful. Future work that investigates a greater number of health-care managers' experiences of unlearning in a wider range of settings is necessary to establish the significance of health-care setting to individual unlearning experiences and provide greater generalisability to the findings of this study.

Funding

The National Institute for Health Services and Delivery Research programme.