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Drivers of change

In this step, we outline some of the drivers of change in complex healthcare systems.
© Coventry University. CC BY-NC 4.0

Considering the challenging process and issues of system mapping, some may ask, why all the fuss?

Usually, in mapping out healthcare systems, we seek to make a change and improve the quality of service delivery and outcome for the patient/users and population. Hence, it’s important to end this short course by briefly highlighting the drivers of change in complex healthcare systems.

In their rapid review to determine the evidence for critical enablers of, and barriers to, successful and sustainable large-scale change in complex health systems, Atkinson et al. (2013) categorised multiple key factors into three essential change components: the antecedents of change; the process of change; and maintenance and evolution.

Let’s look at what each of these change components includes.

Antecedents of change

  • Leadership structures and management support
  • Microsystem capacity: sufficient staff, training, and resources
  • Infrastructure
  • Alignment between initiative goals and organisational priorities
  • Systems perspective and broad engagement of stakeholders
  • The credibility of evidence-based initiatives

Process of change

  • Engagement and peer support
  • Attention to changing organisational culture
  • Approach to the rollout of initiatives
  • Intervention fidelity with implementation flexibility
  • Equipping frontline staff with tools for problem-solving
  • Monitoring and evaluation of progress

Maintenance and evolution

  • Integration of the change into routine practice

We’ll be exploring some of these factors in more detail over subsequent short courses – specifically, how they relate to, or could be considered and applied in, leading innovation and improvement in complex healthcare systems.


Atkinson J., Patel C., Wilson A., Mittman B., Dominello A., Brown B. (2013) Drivers of Large-scale Change in Complex Health Systems: An Evidence Check Rapid Review. [online] available from [23 April 2020]

© Coventry University. CC BY-NC 4.0
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Understanding Systems Thinking in Healthcare

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