Navigating multiple contexts to integrate system transformation programs

• Published in: International journal of project management Vol. 40; no. 3; pp. 290 - 311
• Main Authors: Bos-de Vos, Marina, Deken, Fleur, Kleinsmann, Maaike
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01-04-2022
• Subjects: Healthcare transformation; Interorganizational collaboration; Program embeddedness; Program–parent integration; Transformation programs; Healthcare transformation; Transformation programs; Program embeddedness; Interorganizational collaboration; Program–parent integration
• ISSN: 0263-7863; 1873-4634
• DOI: 10.1016/j.ijproman.2022.03.003

•System transformation programs need to be integrated into multiple organizational, interorganizational and system-level contexts.•Such contexts may have conflicting demands for integration.•An iterative pattern of context navigation practices was found in a multiparty healthcare transformation program: aligning contexts, prioritizing contexts and adding previously uninvolved, “new” contexts.•The pattern shows a fanning out of the program through multiple parallel collaborative paths, which enabled progress and integration with multiple organizations.•Breakdowns and decoupled collaborative paths add novel understanding to the management of transformation programs in relation to the multiple contexts they take place in.
This paper unpacks how actors navigate the multiple organizational, interorganizational and industry contexts that are associated with system transformation programs for addressing wicked, societal problems. Because system transformation programs can only succeed when changes are implemented by multiple organizations, an increased understanding of integrating programs in multiple contexts is needed. We draw on a qualitative field study of an interorganizational program designed to help transform the Dutch healthcare system. We identified three practices of context navigation that actors used to integrate the program into multiple parent organizations and address emerging incongruencies among contexts. These are aligning contexts, prioritizing contexts, and adding contexts. Over time, these navigating practices promoted progress towards program objectives via multiple parallel collaborative paths. Our findings shed new light on the role of breakdowns and decoupled collaborative paths in programs oriented at contributing to system transformation.