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Implementing organizational change in a medical school

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Implementing organizational change in a medical school

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Content Running head: ORGANIZATIONAL CHANGE 1

Implementing Organizational Change in a Medical School
by
Andrea K. DiMattia

A Dissertation Presented to the
FACULTY OF THE USC ROSSIER SCHOOL OF EDUCATION
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF EDUCATION

December 2019

Copyright 2019 Andrea K. DiMattia
ORGANIZATIONAL CHANGE 2

Dedication
To my brother, Lonnie (1971–2010), for helping me to understand that a life without
challenges is a life that is not worth living. Overcoming the challenges and inspiring others was
the gift that you gave every day. The best parts of me are from loving and learning from you.

ORGANIZATIONAL CHANGE 3

Acknowledgements
On June 21, 2016, I received the letter from USC informing me that I had been admitted
to the doctoral program for Organizational Leadership and Change in the Rossier School of
Education. I knew professionally that pursing my degree was the right thing to do. I had no idea
how committing to do this would so deeply impact me on a personal level. This journey has had
a profound effect on me, and I am so grateful that I had the opportunity to grow in this way. I
could not have done it alone and without tons of support from my family, friends, and
colleagues.
Thank you to my parents, Lonnie and Kay Straw, and my sister, Shannon, for always
encouraging me to strive to be the best. I could not ask for better role models when it comes to
hard work, dedication, and passionately believing that what you do can make a difference. Thank
you for always cheering me on and providing me with much-needed reality checks and endless,
unconditional love.
To my classmates (Cohort 7) and the faculty and staff of the Rossier School of Education,
I did not think anything could be better than being a Clemson Tiger. Then I had the opportunity
to join all of you in the tradition of the University of Southern California as a Trojan, and I have
to say, I am honored to join your ranks. The love and support of the cohort is what got us all
through this process, and I share this accomplishment with all of you. To my sweet Lisa, my soul
sister, thank you, you will always be a lifelong friend. Regina and Bora, thank you for always
being the bright spot on cloudy days and ready with help whenever needed. To Dr. Phillips, Dr.
Ephriam, and Dr. Canny, thank you for taking an interest and being so supportive—the journey
was better, because you all were part of it.
ORGANIZATIONAL CHANGE 4

So many thanks to my dissertation committee: Dr. Kimberly Hirabayashi (my chair), Dr.
Lawrence Picus, and Dr. Ronni Ephriam. The guidance, feedback, and support that was offered
by all three of you, challenged and inspired me to continue and produce a dissertation that I can
be proud of. I learned a lot about the kind of leader and professional I want to strive to be by
working with all of you. Thank you for your time, it was—and is—so appreciated.
Thanks to my friends, family, and co-workers who encouraged me and helped me along
the way in myriad ways: giving my kids rides, proofing my papers, making me take breaks, and
telling me that I could do it. I could never have done this without all of your help. A special
thanks to my mother-in-law, Pauline DiMattia, who made sure that if my kids needed anything,
they had it!
To my husband and best friend, Tony, thank you for loving me and supporting my
growth and development as a professional and as a person. I am sure of one thing in life and it is
that you are the BEST person I know and that I am blessed that you are in my life. Finally, to my
four children, Mason, T.J., Torre, and Chase: no matter what I achieve in my life, you four will
always be the best thing that I have ever contributed to this world. The four of you are my
masterpiece, and I love you!

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Table of Contents
Dedication ........................................................................................................................................2
Acknowledgements ..........................................................................................................................3
List of Tables ...................................................................................................................................9
List of Figures ................................................................................................................................10
Abstract ..........................................................................................................................................11
Introduction to Problem of Practice ...............................................................................................12
Importance of Addressing the Problem .........................................................................................12
Organizational Context and Mission .............................................................................................12
Organizational Performance Goal ..................................................................................................14
Stakeholder Group of Focus and Stakeholder Goal .......................................................................15
Purpose of the Project and Questions ............................................................................................17
Review of the Literature ................................................................................................................18
History of Mergers in Health and Medical Education .......................................................18
Current Trends ...................................................................................................................19
Challenges to Mergers .......................................................................................................20
Navigating Uncertainty ..........................................................................................20
Mission and Vision ................................................................................................20
Communication ......................................................................................................21
Building Trust ........................................................................................................21
Consequences of Failure ....................................................................................................22
Organizational Culture .......................................................................................................22
The Clark and Estes Gap Analytical Conceptual Framework .......................................................23
ORGANIZATIONAL CHANGE 6

Stakeholder Knowledge, Motivation, and Organizational Influences ...............................24
Knowledge .............................................................................................................24
Leading Change .........................................................................................24
Self-Reflection ...........................................................................................25
Motivation ..............................................................................................................27
Self-Efficacy Theory ..................................................................................28
Individual and Collective Efficacy ........................................................................28
Organizational Culture ...........................................................................................30
Creating Vision ......................................................................................................31
Culture of Trust ......................................................................................................32
Communication ......................................................................................................32
Conceptual Framework: The Interaction of Academic Leaderships’ Knowledge and ..................34
Motivation with the School of Medicine’s Organizational Context
Qualitative Data Collection............................................................................................................36
Interviews ...........................................................................................................................37
Documents and Artifacts....................................................................................................38
Data Analysis .................................................................................................................................39
Findings..........................................................................................................................................40
Knowledge Findings ..........................................................................................................40
Leading Change .....................................................................................................40
Self-Reflection .......................................................................................................45
Motivation Findings ...........................................................................................................48
Individual Self-Efficacy .........................................................................................49
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Collective Efficacy .................................................................................................50
Organizational Findings .....................................................................................................52
Mission and Vision ................................................................................................52
Communication ......................................................................................................55
Culture of Trust ......................................................................................................57
Synthesis of Findings .........................................................................................................60
Solutions and Recommendations ........................................................................................................ 61
Motivation ............................................................................................................................... 62
Dynamics of Collective Self-Efficacy ...................................................................63
Organization ............................................................................................................................ 64
Mission and Vision..................................................................................................... 65
Creating a Culture of Trust ........................................................................................ 65
Communicating Effectively to Promote Change ...................................................... 67
Limitations ........................................................................................................................................... 68
Recommendations for Further Research ........................................................................................69
Conclusion .....................................................................................................................................69
References ........................................................................................................................................... 71
Appendix A: Participating Stakeholders with Sampling Criteria for Interview ............................79
Participating Stakeholders
Appendix B: Document Sampling and Protocol ............................................................................83
Appendix C: Credibility and Trustworthiness ..............................................................................85
Appendix D: Ethics ........................................................................................................................87
Appendix E: Integrated Implementation and Evaluation Plan ......................................................89
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Appendix F: Academic Leadership Session Evaluation ..............................................................108
Appendix G: Academic Leadership-Delayed Session Evaluation ...............................................110

ORGANIZATIONAL CHANGE 9

List of Tables
Table 1. Organizational Mission, Global Goal, and Stakeholder Performance Goals ..................16
Table 2. Knowledge Influences and Assessments for Knowledge Gap Analysis .........................27
Table 3. Motivational Influences and Assessments for Motivation Gap Analysis ........................30
Table 4. Organizational Influences and Organizational Influence Assessments ...........................34
Table 5. Participants Responses to Understanding Their Role in Leading the Integration ...........41
Table 6. Participants Understanding of the Mission and Vision of the School of Medicine .........53
Table 7. Recommendation for SoM Needs ........................................................................................ 62
Table F-1. Outcomes, Metrics, and Methods for External and Internal Outcomes .......................91
Table F-2. Critical Behaviors, Metrics, Methods, and Timing for Evaluation ..............................93
Table F-3. Required Drivers to Support Critical Behaviors ..........................................................95
Table F-4. Evaluation of the Components of Learning for the Program .......................................99
Table F-5. Components to Measure Reactions to the Program ...................................................100

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List of Figures

Figure 1. Interactive Conceptual Framework ................................................................................35
Figure F-1. External organizational goals: Increased employee community engagement ..........103
and collaborative publications between SoM and THS
Figure F-2. Internal organizational goals: Employee satisfaction ...............................................103
Figure F-3. Academic leaders delayed-session data ....................................................................104

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Abstract
Utilizing a modified gap analysis, this study evaluated the confidence of an academic leadership
team at a medical school in leading aspects of integrating with a health system. This study
looked at the knowledge and motivation of the academic leaders as individuals and as a team for
leading change. The study also considered influences in the organization that could be supporting
or hindering the academic leaders from achieving their goal of implementing the integration. The
organizational influences explored in the study were mission, organizational trust, and
communication. This qualitative study used document analysis and one-on-one interviews to
produce data for exploring the knowledge and motivation of the academic leadership team and
the organizational influences. The data indicated that the academic leaders had the knowledge to
lead organizational change. The academic leaders also possessed the individual self-efficacy
required to lead effective organizational change. However, I identified a gap in the collective
self-efficacy of the leadership team as well as gaps in the organizational support of the mission,
which intended to create a culture of trust and organizational communication. Based on the data,
I recommend that the academic leadership team hold mandated, focused discussions. These
discussions should be centered around the mission, organizational culture, and communication of
the SoM and the role that the team has in continuing to lead the integration process in these
areas. This work will support the team in its efforts to complete its stakeholder goal and,
ultimately, the organizational goal of implementing all aspects of the integration with the clinical
system by June 2020.
Keywords: Integration, organizational change, medical school

ORGANIZATIONAL CHANGE 12

Implementing Organizational Change in a Medical School
Introduction to Problem of Practice
Academic medicine is changing. The increased number of mergers and acquisitions in
healthcare over the last 15 years has more than doubled (Association of American Medical
Colleges [AAMC], 2017). A recent survey conducted by the American Hospital Association
(AHA), noted that three-quarters of hospital leaders reported planning to participate or
investigate a possible merger, acquisition, or affiliation (AHA, 2018). Kirch (2016) surmised that
challenges like the alignment of culture, governance, management systems, and mission will
continue to impact the success of such alliances. Leading sustainable organizational change in
educational and healthcare entities that have integrated is a growing challenge.
Importance of Addressing the Problem
Leading sustainable organizational change presents formidable challenges and warrants
consideration for a variety of reasons. With the changing landscape of healthcare, mergers to
increase market shares—producing a competitive edge and capitalizing on physician expertise—
are on the rise (Thier, Kelley, Pardes, Knight, & Wietecha, 2014). Across the United States,
hospitals, academic medical centers, medical schools, and healthcare systems are forming
relationships of all types. Reasons for these relationships vary; in many cases a consistent
intention behind forming these new organizational linkages is to drive down costs and address
the national physician shortage (Kirch, 2016). A recent study commissioned by the Association
of American Medical Colleges (AAMC) prepared by IHS Markit LTD (2018) stated that, by
2030, the growing demand for and limited supply of physicians will create a shortfall of 42,600–
121,300 physicians. In an evolving healthcare landscape, successfully implementing
ORGANIZATIONAL CHANGE 13

organizational change will be vital for the sustainability of new relationships being forged by
educational and healthcare entities.
Organizational Context and Mission
The School of Medicine (SoM) (a pseudonym) is part of the Town Health System (THS)
(a pseudonym) and is a fully accredited medical college. The mission of SoM is to educate future
doctors and scientists. To this end, the School of Medicine utilizes a community-based, patient-
centered model of education that incorporates innovation and interprofessional and evidence-
based inquiry, while being dedicated to inclusion. SoM has regional campuses that are utilized as
clinical site locations for third- and fourth-year medical students. The focus of admissions is
prioritized to the demographic area that the SoM serves as well as to the rest of the state in which
the SoM is located. As of this study, there are medical students in all 4 years of the medical
school curriculum.
SoM was originally incorporated as The Primary Medical School (TPMS) (a
pseudonym). From its inception until recently, TPMS was an independent medical college
founded by a group of community members with a vision of creating a medical school, in the
hopes of eventually re-populating the physician work force and improving the health of the
people living in their region of the country. TPMS admitted its first class of medical students and
graduate students in the early 2000s. TPMS operated with a small community board and an
independent president who was answerable to the board. As with many start-ups, there was little
regimentation, and early policy development focused on policies needed for accreditation.
Working in a start-up has fostered a strong sense of “ownership” among the early faculty and
administrators. The concept of “ownership” is supported by Kwiathowski (2016), who
articulated the differences between a start-up culture and a non-start-up culture in an
ORGANIZATIONAL CHANGE 14

organization. Kwiathoweshi specifically mentioned that in a start-up cuture all ideas— no matter
where they originate in the organization—have merit and are investigated as possibilities for the
organization to move forward. As it matures, the organization takes on more of an established
process for making decsions; every idea is challenged and vetted through a discussion process
that transistions to a more traditional hierarchy of the organization (Kwiathowski, 2016).
Recently TPMS was integrated with the Town Health System (THS) and was renamed
the School of Medicine. Established in the early 1900s, the Town Health System has grown to 12
hospital campuses and two research centers, serving almost all counties in the state in which it is
located, encompassing over three million people. Town Health System provides jobs for roughly
37,000 people and has a health plan with over 550,000 members. By Kwiathowski’s (2016)
standards, THS functions as a non-start-up culture; and while there is mission alignment between
THS and the SoM, there is culture difference as well. The mission of Town Health System is to
enhance the patient experience, providing integrated services that balance patient-centered care,
education, research, and service to community.
Organizational Performance Goal
By June 2020, School of Medicine will implement all aspects of the integration with
Town Health System. The dean and vice dean of the SoM established this goal in August of
2017, to focus the organization on the importance of the integration and the transformation of the
college and the clinical enterprise into an academic medical center. The integration consists of
several dimensions: financial, human resources, technology, marketing, research, compliance,
strategic initiatives, academic programs, and overall organizational culture. Achievement of
SoM’s integration goal will be measured by (a) creating a shared understanding of what it means
to be a newly formed academic health center, (b) establishing clearly defined roles and
ORGANIZATIONAL CHANGE 15

responsibilities, and (c) ensuring that members of both the THS and the SoM understand the new
structure of the medical school and the role that education serves within the clinical enterprise,
and beyond. At the time of this study, significant work has been conducted in all areas of the
integration. The most significant progress has been made in the areas of policy, procedure, and
processes that are directly related to finance, human resources, technology, research, compliance,
and marketing.
Stakeholder Group of Focus and Stakeholder Goal
Three of the stakeholder groups that will contribute to the integration of the medical
school with the clinical system are the SOM’s academic leadership team, the THS’s clinical
leadership team, and the THS’s executive leadership team. These teams consist of members of
the medical school and the clinical system. The academic leadership of the medical school will
lead the educational aspects of the integration. The academic leadership team is responsible for
ensuring that processes and procedures are streamlined and disseminated to all members of the
school of medicine. The academic leadership team consists of members from the vice dean/vice
president of academic affairs direct reports. Direct reports are department heads from student
affairs, regional campuses, faculty development, residency programs, medical education,
research, admissions, educational operations, and curriculum. The academic leadership team, in
cooperation with the clinical leadership of the health system, will work to create a vision of
collaboration that moves the two separate organizations into a cohesive academic medical center.
The clinical leadership includes the clinical department heads, the program directors and the
institute leaders. The executive leadership will articulate the vision for the academic medical
center so that the academic affairs leadership and clinical leadership will be able to move the
process forward to achieve the goal. The executive leadership team includes the president and
ORGANIZATIONAL CHANGE 16

chief executive officer (CEO) of Town Health System and the various executive vice presidents
(EVPs) that report to the president and CEO. The dean/president of the SoM is one of the EVPs
on the executive leadership team.
While the joint effort of all stakeholders will contribute to achieving the overall
organizational goal of implementing all aspects of the integration with Town Health System,
assess the impact of the organizational change on the academic leadership team remains
important. The performance of the academic leadership is vital to the achievement of the goal.
The stakeholder group of focus goal, to be completed by December 2019, is that 100% of the
academic leadership will feel confident in their ability to implement the integration with Town
Health Systems. If the team is not working to its potential, the institution will not be able to
sustain, thrive, and achieve the organizational goal of completing all aspects of the integration by
June 2020. Not achieving the stakeholder and then ultimately the organizational goal will have a
negative impact on the students, faculty, and staff of the medical school and of the clinical
system. Table 1, below, restates the organization’s mission, and the organization and stakeholder
goals of this study.
Table 1
Organizational Mission, Global Goal and Stakeholder Performance Goals
Organizational Mission
School of Medicine (SoM) educates aspiring physicians and scientists to serve society using a community-based,
patient-centered, inter-professional, and evidence-based model of education that is committed to inclusion, promotes
discovery, and utilizes innovative techniques.
Organizational Performance Goal
By June 2020, School of Medicine (SoM) will implement all aspects of the integration plan with Town Health
System (THS).
Stakeholder Goal
By December 2019, 100% of the academic leaderships will feel confident in their ability to implement the integration
with Town Health Systems (THS).
ORGANIZATIONAL CHANGE 17

Purpose of the Project and Questions
The purpose of this project is to evaluate the degree to which the organization is meeting
its goal of implementing all aspects of the integration with Town Health System by June 2020.
Analysis focuses on knowledge, motivation, and organizational influences related to achieving
the organizational goal, based on a gap analysis as presented by Clark and Estes (2008). While a
complete performance evaluation would focus on all stakeholders, for practical purposes the
stakeholder group to be focused on in this analysis is the academic leadership team of the
medical school.
The questions that guided this study are the following:
1. What are the academic leadership team’s knowledge and motivation related to their
confidence in their ability to implement the integration with Town Health Systems
(THS)?
2. What is the relationship between the School of Medicine’s culture and organizational
circumstances and the academic leadership team’s knowledge and motivation in
relation to their confidence in their ability to implement the integration with Town
Health Systems (THS)?
3. What are the recommendations for the School of Medicine’s organizational practice
in the areas of knowledge, motivation, and organizational resources in relationship to
the academic leadership team’s confidence in their ability to implement the
integration with Town Health Systems (THS)?

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Review of the Literature
This literature review examines the problem of implementing sustainable change in
organizations that have integrated. The review begins with the general literature on recent trends
in integrations and mergers occurring in higher education and healthcare. Next is an overview of
the literature that discusses the various challenges that emerge when organizations integrate. The
review then focuses on the consequences that can arise when change is not implemented
strategically. This section will include information on how change—in the case of an
organizational integration—can impact the economic bottom line of an organization. It will also
cover the impact that integrations can have on organizational culture. Following the general
research literature, the review will present the Clark and Estes (2008) Gap Analytical Conceptual
Framework and, specifically, knowledge, motivation, and organizational influences on an
academic leadership team’s ability to lead change in the face of an integration.
History of Mergers in Health and Medical Education
In the late 1980s and early 1990s, mergers and integrations in healthcare and medical
education were on the rise due to factors that influenced organizations to make the decision to
unite. Dranove and Shanley (1995) found that financial savings and the enhancement of
reputation played a major role in motivating healthcare organizations to merge. Pressure to
increase market share and market uncertainty also played a role in merger decisions (Dranove &
Shanley, 1995). This period also saw a dramatic increase in the number of medical schools. The
Association of American Medical Colleges (AAMC) Data Book (2001) shows that, from 1960–
1980, the number of medical schools grew from 85 to 126—an increase ascribed to data
indicating an impending physician shortage (Salsberg & Forte, 2002). Increases in the number of
medical students and international and osteopathic graduates and a static amount of available
ORGANIZATIONAL CHANGE 19

Graduate Medical Education (GME) slots has increased pressure for medical education reform
(Salsberg & Grovner, 2006). Healthcare and medical education during the 1960–1980 time
period were experiencing changes that precipitated the creation of partnerships. While this trend
dipped in the late 1990s into the early 2000s, the United States would see a rise again in the next
decade or so (Weiner, 2017).
Current Trends
In the second decade of the 21st century, mergers in healthcare are once again on the rise.
Brown, Werling, Walker, Burgdorfer, and Shields (2012) and Galloro (2011) stated that, with the
call for healthcare reform, healthcare entities will have to deal with decreased revenue and an
increase in costs and will be encouraged to operate in an integrated system model. Abelson
(2017), Brown et al. (2012), and Report (2013) all mentioned that part of the merger and
acquisition strategy is to increase the patient pool, which will also decrease the cost of
operations. The goal is to create healthcare organizations that can lower the cost of care without
sacrificing the quality of care (Berwick, Nolan, & Whittington, 2008).
Medical education has been undergoing challenges as well. The most recent report from
the Association of American Medical Colleges 2018 Medical School Graduate Questioner,
showed that the median debt carried by medical students at the time of graduation was $190,000,
an 8.3% increase from the median reported in 2017 (AAMC Graduate Questioner, 2018). Walsh
(2016) discussed the cost of medical education and the impact that it had on the cost of
healthcare in the country. Both education and clinical entities are looking for ways to leverage
their strengths and alleviate their weaknesses and part of this strategy is to merge, integrate, or
cultivate alliances (Mallon, 2003).

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Challenges to Mergers
Navigating uncertainty. In the best of circumstances, change in organizations is
difficult. The following section discusses a framework for the impact of change and areas to
monitor based on successful and failed mergers in academic medicine. Their et al. (2014)
discussed the concept of organizational uncertainty and how it can manifest and impact decisions
in a merger process. Their et al. (2014) pointed out that one of the highest rates of failure occurs
in mergers when the two organizations try to share authority. In this model, the constituents
spend time seeking guidance about where the final authority lies for various decisions. Such an
outcome does not promote confidence in the case of the academic, clinical, or research arenas of
an academic health center. A study conducted by Deloitte Center for Health Solutions (2017)
showed that the more time organizations devoted to the planning and execution of the merger,
the higher value the merger was perceived as having. The high value merger improved quality
and was cost effective (Deloitte Center for Health Solutions, 2017).
Mission and vision. To set the stage in any organization, there must be a mission and
vision. Articulating the vision and mission for a merged organization is an important part of
building a foundation of support for the combined entity. Kotter (1997) encouraged an
organization to have a clear purpose and vision. Thier et al. (2014) and Mallon (2003) reiterated
the importance of a clear mission and vision in the case of an organizational integration.
Understanding the vision for the new entity is an important step in ensuring that people
understand where the organization is headed (Kotter, 1997). Quality communication can be an
effective tool for disseminating and socializing the vision and mission of an organization.
Communication. The quality of organizational communication can impact change. In the
case of the change that occurs in an integration, the need for effective communication becomes
ORGANIZATIONAL CHANGE 21

even more apparent. Communication is more than just a tool for sharing information; it has the
power to set the tone for the entire organization. Coffey, Garrow, and Holbeche (2002) have
spoken at length about communication as a mechanism for building trust during an integration.
Using communication in a way that involves as many stakeholders as possible lends power to
your message (Coffey et al., 2002). As organizations undertake the integrating process, they
should put great thought into the most effective way of communicating (Bridges, 2016;
Mayfield, 2014). Results from the Deloitte Center for Health Solutions (2017) survey showed
that communication is key to the success of a merger process. VanVactor (2011), Sirkin, Keenan,
and Jackson (2005), and Muller (2006) also commented on the various ways in which
communication can impact sustainable change in organizations. Muller identified
communication as one of the most important factors in change, especially as it relates to a
merger or integration. Communication must be aligned with what the organization is saying and
doing, because this will build trust.
Building trust. Rafferty and Restubog (2010) have spoken to the importance of
considering context and relationships in an organization when attempting to build trust via
communication. Such deliberations are vital in the case of a merger or integration. Thier et al.
(2014) and Mallon (2003) have both eluded to the role that building trust can play in the outcome
of a merger, speaking specifically about mergers of health systems and academic entities.
Rafferty and Restubog have expounded upon the importance of understanding the perspectives
of employees as it pertains to trust in leadership. Mallon stated that some of the items that should
be considered when contemplating a merger are underlying organizational beliefs, organization
history, and the current trust environment before moving the integration forward. Part of creating
organizational trust is understanding the respective cultures of the pre-merged organizations.
ORGANIZATIONAL CHANGE 22

Consequences of Failure
Kirch et al. (2005) have discussed the implications of a failed integration attempt between
an academic institution and a clinical health system. The article describes key factors in the
dissolution of the relationship less than 3 years after inception. Some of these factors were
conflicts in the newly established governance, no support among the rank faculty for the
relationship, and not enough attention paid to the integration of two very distinct cultures. With
the dissolution of the relationship, both organizations found themselves reeling from the loss of
the time and energy, and the financial commitments that had gone unfulfilled. The organizational
cultures of the two organizations also incurred significant setbacks from the failure of the
integration (Kirch et al., 2005; Mallon 2003). Kastor (2010) discussed another failed integration
in academic medicine, citing that hospitals lost upward of 100 million when dissolving their
relationships with the academic entities, which of course did not include the time and human
resources lost in the 3-year integration process that ended in dissolution of the partnership
(Kastor 2010). With so much at stake—financial, operational, human resources, and the
catastrophic impact on organizational culture—failing organizational integration takes a toll. The
impact on the organizations’ abilities to realize their organizational goals and their abilities to
perform as high-functioning organizations can have ripple effects for years to come.
Organizational Culture
If integrations are to be successful, it is important to ensure that the original cultures of
the pre-integrated organizations can be combined to create a new culture. Kotter (2007)
discussed the concept of anchoring change in organizations. There are two components to
anchoring change: (a) the organization needs to demonstrate to the community how new
approaches, behaviors, and innovations will assist them, and (b) guiding people to understand
ORGANIZATIONAL CHANGE 23

how an improved or reworked process or new approach will benefit them individually can go a
long way in solidifying a culture-changing behavior. Kotter (2007) has asserted that the second
step to this process is ensuring that future generations of employees understand, and can
implement and sustain, the approach to the new culture. If these expectations are not implicitly
expressed as part of the expectations for employment, culture change can be difficult to sustain.
The impact of understanding organizational culture, and the influence that it can have on
organizations that have merged, cannot be discounted. Schein (2017) discussed the influences
that organizational culture had on the leadership and employees of an integrated organization.
Their et al. (2014), Mallon (2003), and Kirch et al. (2005) all stressed the importance of
understanding the individual cultures of organizations and planning to address how those
cultures will combine to create a new culture. Kirch et al. (2005) explained that recognizing and
appreciating the levels of culture that exist in an organization is an important insight into what an
organization values. Understanding what organizations value at the time of an integration assists
the transition of the two cultures into a new culture.
The Clark and Estes Gap Analytical Conceptual Framework
Clark and Estes (2008) gap analysis provides a conceptual framework for research by
identifying gaps in the areas of knowledge, motivation, and organizational influences (KMO).
Identifying these gaps can provide insight into why a stakeholder group is not performing at the
level that may be needed to achieve a goal (Clark & Estes, 2008).
Clark and Estes (2008) first highlighted the importance of using gap analysis to
understand where gaps in knowledge are for employees. Identifying the gaps in knowledge
creates an opportunity for the employees—or, in this case, the academic leadership—to work to
gain the knowledge necessary to improve performance. Identifying knowledge gaps in academic
ORGANIZATIONAL CHANGE 24

leadership will be important for SoM to achieve its goal of integration. Second, Clark and Estes
identified motivation as an influence. If gaps in motivation are identified, then the organization
can plan to close those gaps to achieve the organizational goal (Clark & Estes, 2008). The third
area identified by Clark and Estes (2008) is organizational influences, which can include
resources, policy, procedures, and culture. The remainder of this section examines in depth
assumed influences in the areas of knowledge, motivation, and organizational influences.
Stakeholder Knowledge, Motivation, and Organizational Influences
Knowledge. Research indicates that individuals and groups need to be able to build on
existing knowledge and properly employ learning so that organizations can be successful
(Rueda, 2011). Knowledge dimensions, as discussed by Rueda (2011) and Krathwohl (2002),
can be divided into four categories: factual, conceptual, procedural, and metacognitive. Factual
knowledge is the basic knowledge of a discipline (Krathwohl, 2002). Conceptual knowledge is
the more complex, organized process that promotes using factual knowledge to create new
theories (Krathwohl, 2002). Procedural and metacognitive knowledge will be discussed in detail
later as they are linked to the knowledge influences of the academic leadership.
Leading change. Academic leaders need to know how to lead change in their
organization. Bridges (2016) presented a list of skills that leaders need so that they can
implement sustainable change. A few areas discussed are clarification and articulation of
organizational purpose, rebuilding trust, unpacking organizational history, and communicating
that change is about continuous quality improvement (Bridges, 2016). These areas require that
leaders understand the skills and knowledge that are necessary to lead during times of transition
and change. Gill (2003) supported the assertions made by Bridges in his dimensions of leading
ORGANIZATIONAL CHANGE 25

change. Leaders need to have knowledge to establish vision, values, strategy, empowerment, and
motivation, and to create and sustain organizational change (Gill, 2002).
Adding to the complexity of the skills needed to lead change is understanding how
leaders engage stakeholders in conversations about change that will evolve into the
implementation of the organizational goals (Karp & Helgo, 2009; Mayfield, 2014). In a situation
as complex as integrating education into a clinical delivery system to create sustainable change,
knowing how to engage stakeholders is vital to the success of the transformation. Mayfield
suggested that most of a leader’s unrestricted time be dedicated to engaging stakeholders and
listening to stakeholders’ thoughts and concerns regarding the organizational change. Clark and
Estes (2008) discussed the importance of using gap analysis to understand where gaps in
knowledge exist for employees. Identifying the gaps in knowledge creates an opportunity for the
employees or, in this case, the academic leadership to work and gain the knowledge necessary to
improve performance. Identifying areas where the academic leadership team has knowledge gaps
will be important for the SoM to achieve its goal of integration. Krathwohl (2002) described
procedural knowledge as the knowledge and skills that are required to understand how to do
something. Procedural knowledge that focuses on how to successfully lead change could assist in
strengthening the academic leadership teams’ skills, if that intervention would be required based
on the gap analysis. The research indicates that leading change requires specific knowledge and
skills. Understanding what the academic leadership already knows about leading change and
where gaps in their knowledge might occur could be a useful tool for ensuring organization
success.
Self-reflection. Krathwohl (2002) identified his fourth category of knowledge as
metacognitive. Metacognitive knowledge is a person’s ability to reflect upon what they know
ORGANIZATIONAL CHANGE 26

and what they need to know. Metacognitive knowledge is also deliberating on one’s own
learning and thinking. Edgelow (2011) discussed the concept of change as an event, and
transition as the experience of the change. During the transition, leaders need to reflect on their
role in leading change and their impact on the experience of others facing transition. Leaders
must understand how their ability to lead change can impact the experience of other people in the
organization. Utilizing self-reflection as a tool for building relationships and engaging
stakeholders is a concept that requires leaders to understand the goals of the organization
(Bridges, 2016; Kotter, 2007). Communicating goals effectively to stakeholders so that they can
provide feedback takes effective communication skills and an ability to build trusting
relationships (Mayfield, 2016). Moorman and Grover (2009) encouraged leaders to reflect on
their skills for building trust in an organization during times of change. Leaders need to be able
to identify areas where they need improvement so that they can build the skills necessary for
leading change. The theory of authentic leadership as discussed by Northouse (2016) describes in
detail a leader that is self-aware. A self-aware leader understands their strengths and weaknesses
and their relationships with others. Authentic leadership also includes self-regulatory processes
and procedures. For example, authentic leadership includes a person’s ability to view a situation
from an objective lens and being honest and transparent with other people in the organization
(Northouse, 2016). The theory of authentic leadership goes hand in hand with the ability to
reflect on leadership abilities and areas for improvement. When leaders can reflect on their own
skills and abilities, they can assist the organization in achieving goals. Table 2 details the
knowledge influences and assessments for identifying gaps.

ORGANIZATIONAL CHANGE 27

Table 2

Knowledge Influences and Assessments for Knowledge Gap Analysis
Organizational Mission
School of Medicine (SoM) educates aspiring physicians and scientists to serve society using a
community-based, patient-centered, inter-professional, and evidence-based model of education
that is committed to inclusion, promotes discovery, and utilizes innovative techniques.
Organizational Performance Goal
By June 2020, School of Medicine (SoM) will implement all aspects of the integration plan with
Town Health System (THS).

Stakeholder Goal
By December 2019, 100% of the academic leaders will feel confident in their ability to
implement the integration with Town Health Systems (THS).

Motivation. Mayer (2011) defined motivation as “an internal state that initiates and
maintains goal directed behavior” (p. 39). Clark and Estes (2008) discussed three motivational
processes: active choice, persistence, and mental effort. Active choice is about a person making
the choice to do or not do something. Persistence is the act of continuing with a process once it is
started. Mental effort is how much work or thought a person is willing to invest in completing a
task (Clark & Estes, 2008). In any situation, active choice, persistence, and mental effort can be
the difference in achieving or not achieving a goal. Rueda (2011) discussed various variables that
characterize motivation: self-efficacy, control beliefs, values, goals, and goal orientation. Control
beliefs center on the reasons people must explain the success and or failure of achieving goals

Assumed Knowledge Influences

Knowledge Influence Assessments
Knowledge (Procedural): Academic leaders
need to know how to lead change in an
organization.
Interviews. Questions focused to solicit
information on the academic leader’s knowledge
about how to lead change.
Knowledge (Metacognitive): Academic
leaders need to reflect upon their leadership,
demonstrate person-centered skills, values,
and attitudes.
Interviews. Questions focused to solicit
information on the academic leader’s ability to
reflect upon their ability to lead change.
ORGANIZATIONAL CHANGE 28

and their perceptions about the amount of control they had over the result (Rueda, 2011). Values
are predicated on the person’s desire to achieve or the importance subscribed to a task. Goals are
focused on whether a person wants to achieve the stated goal (Rueda, 2011). The areas of self-
efficacy and collective efficacy will be the focus of this study. It is important to understand if
there are assets and gaps in motivation for the academic leadership team. If gaps are identified,
then the organization can plan to close those gaps to achieve organizational goals (Clark & Estes,
2008).
Self-efficacy theory. Self-efficacy, as defined by Bandura (2000), is a judgment a person
makes regarding their ability to complete a task. Self-efficacy has roots in Bandura’s Social
Cognitive Theory. Social Cognitive Theory maintains that individuals can shape their
environments and plan their own course (Bandura, 2000). Self-efficacy is important to the Social
Cognitive Theory, because self-efficacy is what prompts a person to believe that they can
accomplish goals. Research indicates that the more self-efficacy a person has, the more likely
they are to sustain activity in challenging situations (Grossman & Salas, 2011; Robbins & Judge,
2009). Bandura (2000) also discusses the concept of collective efficacy, defined as “people’s
shared beliefs in their collective power to produce desired results” (p.75). For the purposes of
this dissertation, individual self-efficacy and collective efficacy are considered separate topics
for gap analysis; however, they will be discussed in the construct of self-efficacy theory.
Collective efficacy can be assessed using a two-pronged approach, which first gauges the
individual beliefs about their ability to achieve a goal and then asking the individual to consider
the group’s ability to reach the goal as a unit (Bandura, 2000).
Individual and collective efficacy. Academic leaders should be confident in their ability
to lead change and in their academic leadership group’s ability to lead change. Shin, Seo,
ORGANIZATIONAL CHANGE 29

Shapiro, and Taylor (2015) considered the topic of leading change from the perspective of the
employees in the organization. In times of organizational change, employees are looking to
leadership to determine the direction of the organization, how the direction is communicated, and
how they, the employees, perceive the leadership’s ability to move the organizations forward
(Shin et al., 2015). Cerne, Dimovski, Maric, Penger, and Skerlavaj (2013) approached the same
topics of organizational direction and communication and focused on the leader’s perceptions of
their own abilities or their team’s ability to implement change. Two studies supported the
correlation between the level of team collective efficacy and performance outcomes. Tasa, Taggar,
and Seijts (2007) and Lent, Schmidt, and Schmidt (2006) agreed that the higher the team
collective efficacy the more efficient and successful the team will be in achieving their goals.
While the literature indicates that being confident in your abilities as a leader can have a
positive impact on your organization, there is also a growing body of literature that discusses the
impact that overconfidence can have on leaders and their teams. Shipman and Mumford (2011)
conducted a study that maintains that at times leaders may permit confidence to blind them to
problems, obstacles or errors. Moores and Chang (2008) stipulate based on the results of their
study that, high self-efficacy can have an incapacitating effect on organizational performance.
This is especially true in situations where the leader or team is not receiving immediate feedback
on performance (Moores & Chang, 2008). Shipman and Mumford (2011) suggest that
organizations may want to consider requiring leaders to have performance measures that call for
rigorous self-evaluation and revisions of work based on potential identified problems.
Table 3 shows the motivational influences and assessments to identify the gaps in self and
collective efficacy.

ORGANIZATIONAL CHANGE 30

Table 3

Motivational Influences and Assessments for Motivation Gap Analysis
Organizational Mission
School of Medicine (SoM) educates aspiring physicians and scientists to serve society using a
community-based, patient-centered, inter-professional, and evidence-based model of education
that is committed to inclusion, promotes discovery, and utilizes innovative techniques.
Organizational Performance Goal
By June 2020, School of Medicine (SoM) will implement all aspects of the integration plan with
Town Health System (THS).
Stakeholder Goal
By December 2019, 100% of the academic leaders will feel confident in their ability to
implement the integration with Town Health Systems (THS).

Organizational culture. Schein (2017) discussed the importance of understanding an
organization’s culture. Schein (2017) described organizational culture as a labyrinth of
processes, procedures, and shared learning that has occurred overtime and has been adopted by
the members of the organization as an accepted way to function within that organization. Trying
to understand where shared learning, processes, and procedures evolved from in an organization
can assist an observer in understanding the cultural model of the organization (Rueda, 2011).
Gallimore and Goldenberg’s (2001) explanation of cultural models focused on the individual and
how the individual understands or makes sense of their experiences. Transferring this idea to
organizations explains how organizations function in ways that are unique to their circumstances.
Rueda (2011) elaborated on the concept of organizational culture by exploring the influence that

Assumed Motivational Influences

Motivational Influence Assessment
Motivation (Self-efficacy):
Academic leaders should be confident in their
ability to lead change.
Interviews. Questions focused to solicit
information on the academic leader’s confidence
in their ability to lead change.
Motivation (Collective efficacy): Academic
leaders should be confident in their team’s
ability lead change.
Interviews. Questions focused to solicit
information on the academic leader’s confidence
in the academic leadership team’s ability to lead
change.
ORGANIZATIONAL CHANGE 31

cultural setting has on the organization. Rueda described cultural setting as the physical place,
location, resources, people, and visible parts of the organization that interact with the invisible
cultural model of an organization. The challenge for SoM leadership is to both understand the
culture of SoM and gain an understanding of the culture of THS. Navigating the cultural models
of two organizations as part of leading a change intended to transform those two organizations
into one is a complex matter.
Creating vision. Kotter (1997) explained that an organization needs to have a clear
vision. Kotter elaborated that organizations typically have plans and programs but lack a clear
vision to assist in propelling an organization forward. The academic leadership at SoM should
know what the vision is and have the confidence to move the vision forward. Gill (2002)
supported the assertions made by Kotter (1997). A study by Kakabadse (2002) found that in a
survey of 12,000 organizations, one third of managers provided an explanation of their
organizations’ vision that was different from other managers in the same organization. Bridges
(2016) explained that the organization must have a clear vision so that members of the
organization know where they are heading as well as how the vision will impact them
individually and as a part of an organization. As they explore the future, organizations need to
support their employees; doing so will help employees move toward a new vision (Bridges,
2016). Organizations must develop the skills of the leadership to establish vision, values,
strategy, empowerment, and motivation as well as create and sustain organizational change (Gill,
2002). To support the academic leadership in the change process, the literature suggests that,
THS and the SoM should make efforts to ensure that leadership across the system understands
the vision for moving forward.
ORGANIZATIONAL CHANGE 32

Culture of trust. In a study by Rafferty and Restubog (2010), data focused on
organizational trust indicated that an employee’s change history within the organization can
impact their willingness to trust the organization during a change process. These data are of
interest to the study of organizational trust at the SoM because of the challenging history of SoM
prior to and including the integration with the THS. Prior to integration with THS, SoM was an
independent medical school that was struggling financially. The literature supports that
understanding the history of the organization can inform how the organization considers building
a culture of trust in times of change. The Rafferty and Restubog study also produced data
indicating that the level of trust an employee has in the organizational leadership impacted their
willingness to engage in organizational change processes. Linking organizational history and
trust could be vital to SoM academic leadership in achieving the organizational goal of
integration with THS.
Norman, Avolio, and Luthans (2010) conducted a study that investigated organizational
trust. The study showed that organizations that were transparent with information regarding the
change process earned the increased trust of the employees (Norman et. al., 2010). The literature
suggests that organizational trust can impact the overall success of an organizational change
process (Kotter, 1997; Mayfield, 2016; Norman et al., 2010; Rafferty & Restubog, 2010).
Building trusting relationships is closely linked in the literature with organizational
communication (Mayfield, 2016). For the purposes of this study, the importance of effective
organizational communication was connected to building trust.
Communication. Schweiger and Denisi (1991) conducted a longitudinal study looking at
the effects of mergers. Schweiger and Denisi found that organizations that communicated
realistically and regularly saw an increase in employees’ willingness to adapt to the integration
ORGANIZATIONAL CHANGE 33

and increased the level of trust that employees had in the organization leadership. This finding
was echoed in a study of the literature done by Cartwright and Schoenberg in 2006. Cartwright
and Schoenberg stated that organizations that have effectively communicated with employees in
times of change have cultivated support for the integration and created a culture of inclusion for
the organization’s employees. If change occurs during a merger or integration, the need for
effective communication becomes even more apparent (Muller, 2006). Muller contended that
communication has been identified as one of the most important factors in change, especially as
it relates to a merger or integration. Communication can have an impact on creating and
promoting employee behavior change, building relationships within the organization, promoting
organizational trust and demonstrating caring and compassion for employees (Coffey et al.,
2002). Table 4 summarizes the organizational influences and assessments that will assist in
identifying gaps in the organization’s performance.

ORGANIZATIONAL CHANGE 34

Table 4

Organizational Influences and Organizational Influence Assessments
Organizational Mission
School of Medicine (SoM) educates aspiring physicians and scientists to serve society using a
community-based, patient-centered, inter-professional, and evidence-based model of education
that is committed to inclusion, promotes discovery, and utilizes innovative techniques.
Organizational Performance Goal
By June 2020, School of Medicine (SoM) will implement all aspects of the integration with Town
Health System (THS).
Stakeholder Goal
By December 2019, 100% of the academic leaders will feel confident in their ability to
implement the integration with Town Health Systems (THS).

Conceptual Framework: The Interaction of Academic Leaderships’ Knowledge and
Motivation with the School of Medicine’s Organizational Context
Maxwell (2013) explained that a conceptual framework is a model for researchers to
describe what they will be studying and how what they are examining relates to other elements in
the research. Clark and Estes (2008) provided a gap analysis model that examines the
knowledge, motivation, and organizational influences that can impact goal achievement. While

Assumed Organizational Influences

Organizational Influence Assessments
Organization (Cultural setting): The
organization needs to have clear vision.
Interviews and Document Analysis. Questions
focused to solicit information on the
organization mission. Documents focused on
the organizational mission and vision.
Organization (Cultural model): The
organization needs to have a culture of trust
Interviews and Document Analysis. Questions
focused to solicit information on the academic
leader’s perception of organizational trust.
Documents focused on organizational
perceptions of trust.
Organization (Cultural setting): The
organization needs to communicate
effectively with stakeholders
Interviews and Document Analysis. Questions
focused to solicit information on the academic
leader’s perception of organizational
communication. Documents focused on
organizational communication.
ORGANIZATIONAL CHANGE 35

knowledge, motivation, and organizational influences are independent of each other, Merriam
and Tisdell (2016) suggested that part of building a conceptual framework is theorizing how
independent influences interact with one another. Figure 1 shows how the independent
influences of knowledge, motivation, and organization culture interact with one another to either
preclude or encourage the academic leadership team in achieving the organizational goal of
integration.

Figure 1. Interactive Conceptual Framework.

Academic Leadership
Knowledge:
Academic leaders need to know how to
build trust in an organization, academic leaders need
to reflect
upon their leadership strengths and weakness
Motivation:
Academic leaders should be confident in their ability
to lead change, academic leaders should be confident
that their team’s ability lead change
School of Medicine (SoM)
Cultural Settings: SoM should have clear
goals and communicate clearly
Cultural Models: SoM should promote
trust and support change as vital to create
an integrated cultural identity
By December of 2019, 100% of
the academic leaders will feel
confident in their ability to
implement the integration with
Town Health Systems
ORGANIZATIONAL CHANGE 36

Qualitative Data Collection
In order to develop detailed descriptions of the academic leaders’ understanding of the
role they had in leading organizational change, I chose to use qualitative research methods for
this study. By conducting individual interviews and document review, I collected a tremendous
amount of data, which provided answers to the study’s research questions. The sample selected
for this study included members of the academic leadership team at the SoM. This team was
comprised of associate deans, department chairs, and senior directors with responsibilities
focused on the creation, oversight, and delivery of the school’s medical degree–granting
program. This team’s reporting structure was accountable to the vice dean of the SoM. This
group had been charged to lead change in the SoM. Fourteen people fit the described stakeholder
group at the time of the study, and there was 100% participation. I chose interviews as a strategy
for data collection because I wanted to understand the experience of the academic leaders while
they were in the process of leading change. Merriam and Tisdell (2016) explained that
interviewing allows a researcher to acquire first-hand information about how a person is
experiencing a situation. In these interviews, I was seeking information on the participants’
motivation, knowledge, and thoughts on organizational influences. The interviews provided
considerable data on their experiences in leading change. The data collected offered significant
insights into the organization, team efficacy, and the knowledge and experience of the team
tasked to lead change.
Merriam and Tisdell (2016) also noted the merits of using artifacts and documents in
qualitative research, because documents can speak to the researcher in much the same way that
interviews can. Document collection and review was another strategy of data collection for this
ORGANIZATIONAL CHANGE 37

study. The document review helped me gather information about organizational influences and
culture. The following sections describe the qualitative methods in more detail.
Interviews
The interviews for this study were semistructured. A semistructured interview format
allows the researcher to discuss specific topics with the participant in a more organic way
(Merriam & Tisdell, 2016). For the purposes of this study, I acknowledge that I have an existing
relationship with the participants. For the interviews to flow naturally and for me to utilize
probes for further information, a semistructured format worked best. A semistructured format
acknowledges that the interviewer and interviewee are familiar with one another; but it was also
understood that specific topics had to be covered for the purposes of this research study. Using
the semistructured format, I remained mindful that identified topics of motivation, knowledge,
and thoughts on organizational influences had to be discussed. During the interviews, the topics
of the participants’ knowledge and motivation as related to leading the integration were covered.
The interview questions sought to uncover the participants’ thoughts on the efficacy of the
leadership team. Another important area for exploration was the participants’ understanding of
how the organization had influenced the change process. The questions were structured to delve
into the participants’ lived experience of leading change. Merriam and Tisdell (2016) have
described interviews that lead to uncovering lived experiences of participants as
phenomenological interviews.
Interviews were held from February 11, 2019, through March 8, 2019. Each interview
was held with one participant at a time and was scheduled for 45 minutes. The interviews
averaged 35 minutes in length and took roughly 8 hours and 30 minutes total to complete. The
interviews were scheduled over 4 weeks and four interviews a week were held during week one
ORGANIZATIONAL CHANGE 38

and week two of the study. The remaining six interviews were held during weeks three and four,
with three interviews occurring each week. Interviews were held in the participants’ office or in a
conference room in the SoM main campus building. Having participants select the location for
their interview made it convenient for them to participate. The interviews were scheduled based
on the participants’ availability. Prior to commencing the interviews, I sought verbal consent
from each participant to record the session. All interview sessions were recorded. I took some
basic notes during the interview, which helped me remember important points that I then
followed-up on while reviewing the transcribed audio recordings. The interview recordings were
transcribed by an outsourced service, Rev.com. Due to my relationship to the participants and the
organization, it was vital that after each interview I spent time recording my thoughts and
reflecting on biases about the participants’ perspectives in order to prevent my own perspectives
from influencing the findings of the study.
Documents and Artifacts
I collected documents that speak to the influences of the organization on the study
participants. These documents were collected and reviewed from February 11, 2019, through
March 8, 2019, the same 4 weeks in which I conducted the individual interviews. These
documents included satisfaction survey results of faculty and staff of the SOM and provided a
comparison to satisfaction rates of employees working in THS. The documents also included the
2016 Faculty Satisfaction Survey, 2017 Staff Satisfaction Survey, a recommendations document
from an independent organizational satisfaction survey, the State of the College Address 2019-
2020, the SoM website, and the initial shared vision document that was circulated with the
organizational notice of the integration. Creswell and Creswell (2018) and Merriam and Tisdell
(2016) agreed that some of the merits of using documents in qualitative research include
ORGANIZATIONAL CHANGE 39

understanding the language of the organization. Documents are written information that informs
the participants’ experience and documents are a convenient source of information for the
researcher. These documents were used to understand the context for which the study
participants were functioning and to gather a perspective on the overall organizational culture,
mission, and vision.
Data Analysis

Interviews and document analysis were performed simultaneously. I wrote analytic
memos after each interview and each document review. I documented my thoughts, concerns,
and initial conclusions about the data in relation to my conceptual framework and research
questions. Once I left the field, interviews were sent to an outside service, Rev.com, to be
transcribed. I then reviewed and coded the transcripts. In the first phase of analysis, I used open
coding, looking for empirical codes and then applying a priori codes from the conceptual
framework. During the second phase of analysis, the empirical and a priori codes were
aggregated into analytic/axial codes. In the third phase of data analysis, I identified pattern codes
and themes that emerged in relation to the conceptual framework and study questions. I also
analyzed the acquired documents for evidence consistent with the concepts in the conceptual
framework.
Validity strategies are identified in Appendix C, “Credibility and Trustworthiness” and
all data were obtained and reviewed using the ethical practices described in Appendix D,
“Ethics.” Prior to finalizing the findings section, I met with a peer reviewer to discuss my
findings and to work through any biases I had with regard to them. The peer reviewer was a
former colleague who now works at a different institution of higher education. Through our
conversations, it was clear that the findings of the study represented the collective response of
ORGANIZATIONAL CHANGE 40

the participants and the documents reviewed. The data collected and analyzed were guided by
the research questions and informed by the conceptual framework for the study.
Findings
The document and interview findings for this study are detailed below. To further protect
the participants of the study, gender neutral pseudonyms were assigned to the 14 participants.
Nine of the 14 participants were female and the remaining five were male. Ten of the 14
participants had 11 of more years of experience in the field of medical education and the three
remaining had at least six years of experience in the field of medical education. The findings for
the study were organized using the conceptual framework, leading with knowledge, followed by
motivation and concluding with organizational influences (KMO).
Knowledge Findings
Rueda (2011) and Krathwohl (2002) discussed the categories of knowledge: factual,
conceptual, procedural, and metacognitive. Based on the stakeholder goal, this study focused on
two of the four categories: procedural and metacognitive knowledge. The stakeholder goal that,
by December of 2019, 100% of the academic leadership team will be confident in leading the
integration with THS requires procedural understanding of leading change and the metacognitive
knowledge of reflection. These two areas of knowledge impact the achievement of the
stakeholder goal.
Leading change. All 14 participants were asked what their understanding of their role
was in leading the integration, and all 14 participants discussed their role in the integration
process from the perspective of their individual departments or responsibilities. Many of the
academic leaders—12 of the 14— focused on their role as building relationships and providing a
context for their role in SoM. Two participants described their roles in the integration process
ORGANIZATIONAL CHANGE 41

from a different perspective. The responses by participants to their understanding of their role in
leading the integration is detailed in table 5.
Table 5
Participants Responses to Understanding Their Role in Leading the Integration

Participants

Theme

Responses
Jamie Building Relationships “My role really had more to do with
bridging the gap between where we were
at in education in the clinical system and
where the medical school was at in their
educational initiatives.”
Frankie Building Relationship “I have made several personal contacts
within the clinic system and that has
expedited being able to get things done.”
Jayden Building Relationships “I work as a representative to the
administration, and I work to assist
people in their understanding of
operations of the SOM as a whole.”
Mickey Building Relationships “I see myself somewhat as a bridge. I can
be on the ground here and making people
aware of education.”
Cameron Building Relationships “I have worked with a lot of physicians
over the years, so part of my role is being
a liaison between the school and the
providers.”
Adrian Building Relationships “I am kind of like an advanced guard,
getting to know the system and the people
involved in education, how the clinic
system is organized and beginning to
make relationships.”
Finely Building Relationships “I think they have been very supportive of
it on the clinical side and helped us to
understand what their needs are and
challenges, and they tried to understand
what goes on at the school because it is
different than what they do.”
Jesse “The mission is the same since the school
was founded.”
Quinn Building Relationships “I know the needs of my area, so I had to
build the connections so that my
ORGANIZATIONAL CHANGE 42

Participants commented about working to ensure that all levels of the organization were
involved in the process in some way. Making an integration process a “grass roots effort” or
“engaging the ground level” is a theme that arose throughout the interviews. Mickey explained,
“If you really want the integration to occur, it has to happen at the ground level, where people
from the school are interacting with the various clinical departments.” Jayden shared Mickey’s
observations when he/she said,
If you involve more people at a ground or a grassroots level early, even if you just asked
them what their thought was, positive or negative and then lead them down the road of a
process, you could get more buy in.
Adrian also had some insights on getting participants engaged, “I work to encourage everybody
to be reaching across what was perceived as a divide, usually the results of that have been
unbelievably positive.” Based on the interviews, engaging the “ground level” had not been
department could continue to meet
objectives.”
Robin “We still have the mission we always
had.”
Jordan Building Relationships “I am able to help people understand
education in both areas, school and
clinic.”
Blair Building Relationships “I believe that I have some really positive
relationships and clinicians have asked
me to collaborate on projects.”
Alex Building Relationships “I work to help people understand the
role of my department in the larger
context of education.”
Taylor Building Relationships I see my role as sort of an advisor, to my
department and to the system.”
Jesse Consolidating Service “It became clear to me that my role was
about merging and consolidating
services.”
Robin Ensure Education “My role is to ensure the education of
students, providing the resources needed,
is my focus.”
ORGANIZATIONAL CHANGE 43

accomplished as effectively as it could have been. Individuals in the academic leadership had
been working to engage the different stakeholders in the organization is different ways, however
a streamlined, planned approach for this type of engagement, was yet to be effectively executed.
When asked about the role of the academic leadership team in the integration process, all
participants implied that the team is important; however, 10 participants intimated that team
integration had not occurred in a formalized fashion. This finding is based on the various
descriptions of the team interactions by the participants. Four participants did not answer the
question from the perspective of the team’s approach; they discussed overall team leadership.
Jesse stated, “My recollection is we haven’t sat down as a team and said, these are the major
issues, and this is how we’re tackling them.” Quinn asserted, “I don’t feel like the team was
intimately involved in the integration, at least from my perspective. I haven’t been engaged in
that team, at least from my vantage point, discussing the integration.” Alex expressed that “The
leadership team meetings are probably our most organizing cohesive way that we have
approached it, but I think there is a lot of informal efforts I think happens in that too.” Robin
commented, “I think that parts of the team have worked together but are disconnected from other
members.” Adrian remarked about the role of the team,
I feel like people can be in their own jobs and from the outside it may have looked a little
messy, we maybe could have collaborated and anticipated stuff more, but we kept the
ship afloat and we will keep improving.
Finley suggested, “I think the team could have been engaged more with the overall roll out of the
integration, at times I felt the team didn’t have enough information on the status of various
processes.” Blair stated, “I know who on the team I can talk to and get the information that I
need to understand the process.” Cameron commented, “I think different members of the team
ORGANIZATIONAL CHANGE 44

are more involved with task specific to the integration, but not all of us are as involved, so we
discuss it, maybe we should talk about it more.” Mickey suggested, “Now that we are
integrating, I think the roles on the academic leadership team are going to become more defined
and I think we need to start talking about that.” Jayden remarked, “I think the team has talked a
little more recently about the integration process, hopefully that will continue” Taylor, Frankie,
and Jordan discussed the team in the context of leader. Taylor stated, “I think the leadership of
the team is strong and works hard to keep us focused.” Frankie commented, “I think our leader
keeps us involved and shares with the group, what can be shared in regard to the integration
process.” Jordan remarked about the team leader, “The team leader, helped us to understand the
process, from there we did what was needed in our area.” Jamie replied, “I have had a different
role on the team through the integration process, so my involvement has varied throughout the
process.” Finley made an additional comment about the role of team:
I wish that at one of the meetings we would have said, okay this is the change we are
trying to lead, how are people feeling about it and so forth. I think more of our meetings
were just leadership. It would be helpful because it could give people the tools for
helping with their teams and to help keep morale high during the change.
The participants seemed to understand that part of their responsibility in the integration process
was to promote understanding of what the SoM does and, in turn, to begin exploring and
understanding what the clinical enterprise is responsible for. Each member of the team made this
observation from an individual perspective and, as such, each member gained their own insight
into the integration process in these early relationship-building experiences.
Although individual members of the team commented on the importance of team
meetings and expressed an understanding for the purpose of those meetings, the interviews
ORGANIZATIONAL CHANGE 45

indicated that some members of the team did not have a clear grasp on the team’s role in the
integration process. Other members of the team thought that some members of the team had a
better understanding because of their involvement with the process. Not all members of the team
had a shared understanding of the integration process. Information gathered during the interview
process indicated that, while individually the academic leaders understood their specific roles in
the integration process, as they pertained to their work responsibilities, the academic leaders did
not have a collective understanding of the role of the team in the integration process. Leveraging
their collective procedural knowledge for leading change and applying that a comprehensive
team approach would better position the team for achievement of the stakeholder goal, 100% of
the academic leadership team will be confident in leading the integration with THS, by
December of 2019.
Self-reflection. When asked what advice they would have for an individual or team
charged with leading this type of organizational change, all members of the academic leadership
team responded with thoughtful, reflective answers. Blair and Quinn discussed not being able to
explain changes to their teams, which made them feel out of touch with how the integration was
progressing. Blair provided an example regarding trainings:
When I think back about the experience, there were obviously some things we had to adjust
to and learn, which did cause some angst with some people, because there were so many
trainings that needed to occur in a very short amount of time, while we were also doing our
normal jobs, that did put some stress on people throughout the organization, who were also
dealing with their normal job and integration, into the clinical venue.
Quinn made this comment regarding benefits:
ORGANIZATIONAL CHANGE 46

Having to take sick leave and annual leave together, those things matter. Suddenly, we can't
wear jeans. I mean you would think they're small things on the big scale of things, but
they're things that matter to the staff, I know I didn’t think enough about the impact.
The concept of resistance to change and making assumptions or judgments in the context of
organizational change was an area in which the academic leaders provided reflective advice.
Academic leaders commented on knowing people are resistant to change but still being surprised
by exactly how resistant people could be. The integration had been announced roughly 2 years
previously, and the integration process has been moving forward in different ways over that time
period. At this point in time, based on the comments of the academic leadership team, there was
still resistance from the various stakeholder groups depending on the topic, process, or procedure
being discussed. A few of the interviewees talked about resistance from staff members dealing
with change, resistance from team members about evolving programs, and general resistance about
things that impacted organizational culture. Jordan provided her thoughts on change resistance:
I don't know if this is a new thing, I think it has emphasized how resistant we all are to
change. I don't think this is necessarily a novel feature, but it's just reinforced. We can see
this and talk about it intellectually, but once we're in the midst of it, we still go through the
same processes of denial and all the rest, anger, bargaining, all the other phases of grieving
that others have gone through. I think that we've gone through this as an organization, I
think we've come to the point now of acceptance and starting to be more positive and to
look forward. But I think it is, despite all our training and all our conversations about the
challenges of change, it did not make it less difficult when we had to go through it
ourselves.
Alex had this to say about people in the context of organizational change:
ORGANIZATIONAL CHANGE 47

At the end of the day, most people come to work to do the right thing and they want
positive outcomes. I think it's very easy when you're not closely affiliated with somebody,
to make a fair amount of assumptions. And I think those are often wrong.
Jamie echoed Alex’s thoughts, “You need to give people a chance. You need to get to know
people, because you and the other people around you can easily create stories about what exists on
the other side.” Jesse had this to say about people in the organization, “People are resilient, and
people all cope in a different way. It's very clear that some people can handle change much better
than others, and I think, at the higher levels, at the organizational level, it is hard to bring people
together.” Adrian reflected upon reaching out to breach resistance, “One of my insights is that you
need to encourage everybody to be reaching across what was perceived as a divide, usually to
results of that are unbelievable positive.” Finley had this reflection about change:
I think it’s a tricky thing, trying to take the temperature of how much change people can
take and in what doses it is really a tricky thing. I don’t know how that can be done in an
expert fashion. I think if people understand that, yes, it is okay to be feeling this way
because we are trying to get to the next point on the continuum. You might be able to start
to anticipate that these things are going to be okay and then we start to think about the next
thing that needs to happen collectively.
Mickey reflected on his/her experience with resistance by stating, “This experience has reinforced
my thinking, you don’t try to change people, it isn’t a good use of your time. You need to figure
out what people want and work with them to get it.” Jayden observed, “I realized that we all could
do a little bit better job of empathizing with others.”
The academic leaders also reflected on various things they learned about themselves during
the integration process. Robin commented on evolving teaching styles, “I didn’t know the efficient
ORGANIZATIONAL CHANGE 48

ways of teaching students. I taught in a different fashion than I am teaching in today.” Cameron
commented, “I think on a personal level, it just really reminded me that of the fact that you can
make anything work. You have to praise the effort.” Frankie focused on taking action, “My
personal insights are that sometimes it is easier to go directly to the source for the answer rather
than going through some of the steps that we have internally.” Taylor commented on what he/she
had learned from the integration:
So, I’ve learned that people never stop surprising me. Just when I think I can call what
you’re gonna do nine out of ten times, there is that one that you just can’t. Sometimes it is a
pleasant surprise, sometimes it’s not a pleasant surprise, sometimes it’s genuine, sometimes
it’s not genuine, but as a leader you have to roll with it.”
Based on the team’s insightful comments, the data are clear that the academic leaders were
adept at self-reflection, which equates to metacognitive knowledge. The gap existed because the
team’s collective knowledge was not being utilized in a way that moved the integration process
forward in a cohesive, interconnected way. Document analysis was not utilized to determine
stakeholder gaps in procedural or metacognitive knowledge.
Motivation Findings
I also explored motivation as part of the conceptual framework in order to understand the
barriers that may impede the stakeholders from achieving their goal. To achieve the stakeholder
goal, academic leaders must believe they are equipped with the right skills and abilities. In this
case, the academic leaders also need to believe that the academic leadership team can reach the
goal. The participants’ persistence, mental effort, and choice in achieving the goal are all part of
their individual and collective self- efficacy (Bandura, 2000; Clark & Estes, 2008; Rueda, 2011).
ORGANIZATIONAL CHANGE 49

Individual self-efficacy. Overall, the academic leadership team members had a very
strong sense of individual self-efficacy. One might anticipate this based on the amount of
experience these leaders had in their professional fields. All the academic leaders held significant
leadership posts within the SoM and had established themselves as leaders in the field. They all
spoke eloquently about their individual motivation and commitment to the integration and the
organization overall. Taylor had this to say about his/her role in the integration, “Here’s how we
formed collaborations in leadership, here’s what the leader before did and the one before that. I
am able to provide a steady hand on the tiller, because I have been here doing the work.” Quinn
remarked about his/her experience, “I have personally found that I couldn’t wait for anybody
else to do anything. That if things were going to happen, then we needed to do them ourselves.”
Jesse had this to say about getting the work done, “When the demands go up, what do they say?
That is when the cream rises to the top.” Frankie remarked, “Personally I don’t think the
experience has changed me, I have always been a person that is able to work in the gray.” Jayden
commented, “I like to problem solve and I am good at it, that is important in change.” Mickey
stated, “I am a big picture person, I think strategically, and I am always thinking five or six steps
down the road.” Finley said, “As long as I know what the vision is, I can figure out how to get
there.” Adrian explained, “I have felt like the integration has been a good moment for me to use
my experience and skills to assist the organization in a new way.” Robin commented on his/her
abilities, “You have to be able to work with people knowing you don’t have all of the answers
and then work with people to get them.” Jesse commented on professional impact, “When I teach
or mentor students, when I am sitting with them, talking to them, that’s when I feel I have the
biggest impact.” Blair talked about the ability of being an agent for change, “I believe we all
need to be change agents and the leaders of change, and I have personally seen the value in that
ORGANIZATIONAL CHANGE 50

individually and as a member of a team.” Jordan remarked about the change, “I just keep
thinking about the benefits of the change for the organization and how my areas have improved
from our work with our clinical partners.” Alex commented, “I understand the role of the clinical
system in education and I can help them to understand the role of undergraduate medical
education.” Jamie had this to say about his/her confidence in the process, “I feel better about
where we are now, then were we were six months ago, each day I am more confident in where
we are headed and my role in that.”
Analysis of the interview transcripts show that the individuals on the academic leadership
team were dynamic, engaged self-starters. They all talked about how they individually
approached the integration process, and provided examples of their individual successes. All of
the members of the team were confident about their abilities to lead change and about carrying
out their responsibilities to the SoM.
Collective efficacy. A review of the data shows, there is a gap in the academic leadership
team’s collective efficacy. Nuances of concern appear in 12 of the interviews, manifesting in
various ways and voiced in different forms from the participants. When asked about the role of
the team or how confident the participant was in the team’s abilities, participants made clear that
the team was lacking confidence in its collective ability to lead this change. A few of the
academic leaders shared concerns about the level of engagement of other members of the team.
The overall sentiment on engagement was that some members of the team could more easily
step-up and be self-directed in moving projects forward, while others would sit back and wait to
see how things evolve. This impression suggests that some of team members were seen as
effective team participants, while others were perceived as not being as engaged or involved with
ORGANIZATIONAL CHANGE 51

the team. Cameron made this statement regarding the team, alluding to what the underlying cause
of the team’s struggles could be:
From my view, everybody is working hard I'm not sure all-together we have a true high-
functioning team. It is no criticism of individuals. Everyone is working very hard. I see
that, but maybe there is some trust that's lacking.
Adrian made this comment regarding the team, “Some members of the team have gotten more
engaged than others, learning about and sharing information about their role and reaching out.”
Frankie remarked, “I don’t think that sometimes the academic leadership team, especially when
going through a change or a process, doesn’t always share the same information.” Jamie
commented on his/her location and building relationships, “I feel like my location impacts my
interactions with the team, I don’t have the face time with people. I don’t have the ability to have
hallway conversations or to build rapport and trust.” Taylor made this comment about the team, “I
think there are good examples of individuals that are on the leadership team and I think there are
maybe some less than good examples, when it comes to sharing information and communicating.”
Jordan added his/her perspective on the team:
I think that there has been so much change and so rapidly that some of the leadership team
have had problem themselves grappling with the change. So, it has been difficult for them
to lead because they are trying to come to terms with the change.
Jayden stated, “I think there may need to be a little more coordination of all of the academic
leadership team to get them on the same page, especially when we are going through this rapid
change.” Mickey made this comment about the academic leadership team, “I think the role of the
team is evolving and we need to figure out what that means as a team.” Finley said, “As a team I
think we could do a better job at supporting one another, I think the change sometimes make this
ORGANIZATIONAL CHANGE 52

difficult, but we have to try harder.” Robin said, “Our team needs to work harder to communicate
with one another, we are all located at different sites, so we can’t communicate enough.” Jesse
made this comment about the team, “I don’t think we sit as a group enough and think strategically
about what we are doing as a team, which makes me think that we don’t really have as much of a
collaborative approach as I would like.” Quinn commented, “I think we need to look at our
stakeholders and clearly define what is involved in the integration process. I think this is one of the
team’s missteps. We never really called it out.”
With most of the academic leaders voicing some concerns about the cohesion, function,
and effectiveness of the team, this gap in motivation will certainly need to be addressed.
Interviews were the most effective way of ascertaining the group’s perceptions on collective
efficacy. Document analysis was not utilized to assess this portion of the KMO framework.
Organizational Findings
Rueda (2011) described cultural setting as a visible part of the organization that interacts
with the invisible cultural model of an organization. For the academic leadership team to achieve
its stakeholder goal of 100% confidence in leading the integration, it is important to understand
how the organizational cultural setting and cultural model may impede or support performance.
This study specifically looked at the cultural settings of mission and vision along with
communication and the cultural model of trust, as these are important elements for success in
leading successful, sustainable change (Bridges 2016; Gill 2002; Kotter, 1997; Muller, 2006;
Rafferty & Restubog, 2010).
Mission and vision. Data collected from the 14 interviews indicated that all 14 members
of the academic leadership team understood and could articulate the mission and vision of the
SoM. A recurring theme in the interviews was that the mission and vision had not changed.
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Table 6 details the participants responses regarding their understanding of the mission and vision
of SoM.
Table 6

Participants Understanding of the Mission and Vision of the School of Medicine

These statements are supported by document analysis. The current State of the College
document, the website, and the Shared Vision document all underscore that the mission of the
SoM has not changed. However, when I began to delve deeper into the question “What is the
organization’s understanding of the mission and vision of the School of Medicine?”, a few

Participants

Responses
Taylor “I know them verbatim”
Frankie “The vision and mission of the school, even with the integration, have not
changed.”
Jayden “I could recite the mission and vision word for word.”
Mickey “I don’t think we just speak the words of the mission and vision we live it.”
Cameron “I am not going to recite the mission; I have a really good understanding of
what it means.”
Adrian “We still have the same stated mission”
Finely “The mission hasn’t changed”
Jesse “The mission is the same since the school was founded.”
Quinn “The mission has not changed one bit.”
Robin “We still have the mission we always had.”
Jordan “The mission has not changed that much”
Blair “This is an easy question; the mission and vision of the school have not
changed.”
Alex “We are saying the mission and the vision of the school has not changed and I
think fundamentally it hasn’t.”
Jamie “The mission and vision of the school has not changed since the integration.”
ORGANIZATIONAL CHANGE 54

noteworthy responses emerged. When Finley was asked about the mission, she referenced a
conversation that occurred when discussing curriculum:
As far as we got was, we don't know if this is still really a legitimate mission, and should
we spend time rethinking the mission or figuring out a way that as a result of the ongoing
integration, is it really a shared mission? Can we really say that this, Is the answer, yes,
everybody should embrace this because it's embraced by the entire system, including the
School of Medicine and all of the programs associated with it? We left it as a question
mark.
Quinn made this comment about the mission, “I don’t know from where I sit, what the mission and
vision are right now.” Adrian remarked, “It's like the values are there but the actual work that
supports the part of what I consider to be very core to our mission, I feel like is not getting that
much attention anymore.” Jesse made this statement, “I don’t feel like we embody it collectively. I
think it’s been told to us.” Taylor offered the following about the mission, which echoed
statements made by others:
If the mission and the vision don’t bring that into action and make that concrete and
definable and objectified, for lack of a better word, then you’re just parroting nice things. If
the mission and vision don’t hit the road, the tracks don’t grab, don’t move and get traction
then you’re really falling short. I think we fall short a little bit on that. Not that it isn’t nice
and aspirational, but talk is cheap, the actual actions must match it.
Interviews and document review indicate that the mission and vision were clearly stated, and that
the academic leadership did not understand the mission and vision as written. Most of the
academic leadership firmly stated that the mission and vision had not changed and offered support
for those assertions. However, some members of team suggested that, while the mission was
ORGANIZATIONAL CHANGE 55

clearly stated, from their perspectives there was a disconnect from the stated mission and what was
occurring in the organization.
Communication. The SoM needs to communicate effectively with all stakeholders in the
organization, as this will support not only the stakeholder goal, but also the achievement of the
overall organizational goal of completing all aspects of the integration with THS by June 2020.
Communication came up as a recurring theme in the interviews. When asked how the mission was
communicated in the organization, responses ranged from written, talked about in community
meetings, presented at admissions presentations, and circulated in broadcast e-mails.
Communication was also discussed by the academic leaders in response to the question “What
advice would you have for an individual or team that is charged to lead this type of organizational
change?” Eleven of the fourteen academic leaders had responses that included “communicating
effectively.” The theme of communication arose most often in the interviews and was connected
to comments on organizational trust, building relationships, understanding and executing the
mission as areas of improvement for the organization. Jesse commented about the need to
communicate with staff:
In terms of managing people, if they don't know what's going on, then things can kind of
spin out of control. And sharing as much information and knowledge as I can with them so
that they don't get worried about things.
Jayden also had some insights regarding advice for others trying to lead this change:
I think the transition could have been thought out a little more at the detail level as far as
communicating the various processes, timetables. Very specifically, communicating who
the contact people are in certain areas that you're to call to find out information.
ORGANIZATIONAL CHANGE 56

Finley also shared some insights on communication, “I think it helps people to know what the next
steps are so that they can anticipate where they are going to go next. I think it helps people tolerate
change a little bit more.” Frankie made a similar comment, “Some of the territoriality that exists in
every organization has become more robust since the integration, with this the communication has
not been enhanced.” Cameron commented that, “Communication has not occurred to the extent
that we need it to across the organization.” Taylor talked about communication from the
perspective of not just saying the words, “I think actual communication is, do it, show it, prove it.
Don’t just tell me, live through the action.” Robin discussed the communication flow, “We have to
get information out there, we have to get better at ensuring everyone knows what is going on.”
Jordan said, “I don’t know if it is because the SOM is a smaller organization, that we just assume
people know what is happing, now that we are part of bigger organization we need to really think
about communication.” Alex made the comment “Better communication is something we need to
think about.” Blair offered, “How we communicate as a team and with the organization, needs to
be talked about.” Jamie talked about the different languages used by the SoM and THS, “The
communication challenge is that we speak different languages. In the sense of how we title things
to how we talk about culture, or how our culture shapes us in the way we talk about things.”
One of the documents reviewed was a Recommendations Document, last updated in
September of 2018. This Recommendations Document was based on various surveys that the SoM
faculty and staff had completed. I had the opportunity to review the 2016 Faculty Satisfaction and
the 2017 Staff Satisfaction data; however I did not have access to written comments. The
Recommendations Document had eight recommendation in the area of communication. These
recommendations were (a) commit to better utilization of existing communication forums, (b)
close the loop on information in community meetings, (c) host town hall meetings that are run by
ORGANIZATIONAL CHANGE 57

different managers, (d) make community meetings a two-way flow of information, (e) identify task
force membership for organizational initiatives and have them provide updates at meetings, (f)
update the intranet for posting meeting minutes to enhance information sharing, (g) enhance
manager training on communication and information sharing, and (h) provide conflict resolution
training for all staff, faculty, and administrators.
At the time of this writing, some of these recommendations are in the process of being
implemented and others are under consideration by the senior leadership. In the January 2018
Student Learning Environment Study, first- and third-year medical students commented on the
“lack of communication to students from medical school faculty and staff.” In a 2016 survey of the
faculty of the medical school, two of the 10 lowest scoring items were “Senior leadership do a
good job of explaining medical school finances to the faculty and there are sufficient opportunities
for faculty to participate in the governance of the medical school.” These were also the two of the
10 lowest items in a staff survey that was completed in 2017. These items are directly connected
with the organization’s ability to communicate effectively with stakeholders and engage them in
the decision-making processes.
Data from the individual interviews and the document analyses evince a gap in the
organization’s support of effective communication. The academic leadership team needs to work
with other leaders in the organization to support a cultural setting that promotes communication.
Culture of trust. In the most recent employee engagement survey, initiated by THS for all
employees, the staff and faculty of the SoM were less engaged than the staff of the clinical system.
The lowest scoring items on the survey for the SoM were, “I can’t imagine working for another
organization,” and “SoM employees treat each other with respect.” The Recommendations
Document, that was last updated in September of 2018 had six recommendations that were focused
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on improving organizational trust. Those recommendations were: (a) create a committee that is
committed to addressing culture change, implement a manager training that focuses on fostering
trust, (b) create a personal time off exchange to promote equity and concerns for others, (c) commit
to kindness and recognition for the accomplishments and efforts of faculty, staff, and students, (d)
make an effort to build a better understanding of job responsibilities and matrixed reporting
structures, and (e) offer emotional intelligence training to all faculty, staff, and students of the
organization. Some recommendations are currently being implemented and others are under
consideration by the senior leadership. These items support some of the comments gathered from
the interview process as well. Cameron talked about the team dynamic and building trust:
One thing I would say is there were periods of time where I felt that we were sort of
coming together, and then I felt that it wouldn't last, and it didn’t. More genuine
teambuilding would have helped, and I think we can still do it. You know, there's an effort,
but I don't feel it's consistent. I think what is lacking organizationally is communication in a
very deep sense and trust. Genuine trust amongst the people, is not as much as it needs to
be.
Blair talked about how lack of communication impacted others in the organization: “Expecting
people to go to training sessions in a week, utilize something when there wasn't a proper
educational process embedded for people to understand it. That occurred time after time after time
after time.” Finley suggested that, in a time of change:
I think what sometimes happens is that everyone is just trying to power-grab because there
not sure what the change is going to mean if they don’t. It can create a lot of unnecessary
stress and strain between people that had been working collaboratively.
ORGANIZATIONAL CHANGE 59

Frankie provided some insights on people’s willingness to change and the impact that can have on
trust:
People who have been here at the institution for longer periods of time than others were
less acceptable to the change than those who were relatively new, being ingrained in how
things are done, can cause you not to trust change.
An interesting trust-based theme that emerged from the interview process was the concept of
strategically understanding how to create a new integrated culture. Various academic leaders
alluded to trying to merge the cultures of the SoM and the clinical system or working to make the
clinical system “understand the culture of education.” Jamie discussed trying to understand the
cultural differences:
Because I know it's been hard for simple things, just policies, or the way we approach the
dress code, or just all different kinds of things that really are kind of tough for the school to
have to kind of . . . I mean, they're not even really being asked to evolve. You're just being
told you will change to this culture. And people talked a lot about when THS had attempted
to integrate years ago with another educational entity and how, it was really culture that
made that integration not work. I think that's also, to some degree, true of this integration
now, the difference with the failed integration, was that you were bringing two sorts of
equally-sized entities together. So, with the school it's a little different, because they're not
equal size, and at the end of the day, the clinical system is driving the financial viability of
everything. So, even though the cultures didn't mash, it's almost like, I feel like the big
system will just consume any preexisting culture.
Robin talked about THS and what he perceived as part of the challenge to building trust:
ORGANIZATIONAL CHANGE 60

There is a perception that THS only does what THS wants to do. We try to teach new
pathways to doctors, but the rule of thumb in general is, well if it worked for me in the past,
why do I have to change?
Blair had these words of advice about working to engage a culture of trust between the two
organizations:
Transparency, honesty, effective communication, ability to work with both camps, and try
to bring along the camp that doesn't believe it's a positive, and to educate them. Maybe
they'll never be at the same level as those who love the Kool-Aid, but it may keep coming
back to the cooler.
Data from the interviews and document analysis indicate a gap in the organization’s supporting a
culture of trust for the stakeholders. Addressing this gap and the gaps in organizational
communication and mission will be important next steps to the achievement of the academic
leadership stakeholder goal and of the organizational stakeholder goal.
Synthesis of Findings
The review of the findings of this study indicate that the SoM is on the path to achieving
the stakeholder goal that 100% of the academic leadership team will be confident in its ability to
lead the integration with THS by December 2019. Some areas need attention and, with focus, can
better support the academic leadership team in achieving this goal. Data from the study indicate
that the academic leaders individually have the procedural and metacognitive knowledge and skills
to understand and reflect on their role in leading change.
Individual self-efficacy was high among the academic leaders. The individual team
members aware confident in their own abilities to lead change. The gap appeared in the collective
ORGANIZATIONAL CHANGE 61

efficacy of the team. The team needs to work on developing its collective efficacy in order to
produce a more cohesive and comprehensive approach to the integration process.
The SoM needs to make strides to support the organizational setting for mission and vision.
While all 14 of the academic leaders could recite the mission, and the documents clearly stated the
mission and vision of the organization, interview data uncovered a gap between the stated mission
and their current experience in the SoM. The disconnect must be resolved so that the academic
leadership team can move forward with the remainder of the integration process. The data also
indicated a gap in the cultural setting of communication and the cultural model of organizational
trust. Both gaps were supported through individual interview data and documents analysis. The
SoM needs to address these gaps as well to achieve the stakeholder and organizational goals for the
integration.
Solutions and Recommendations
This evaluation study identified assets and areas of improvement for the SoM. The
following sections will highlight the assets of the SoM and offer recommendations for the areas
upon which the organization could improve to achieve the stakeholder goal. Recommendations and
tenets to support the improvements are shown in Table 7.

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Table 7

Recommendation for SoM Needs

Motivation
Bandura (2000) explained that self-efficacy is a judgment that a person makes regarding
his or her own ability to complete a task. Bandura defined individual self-efficacy as a person’s
belief that they can complete a specific task. Bandura also stated that collective self-efficacy is
two pronged and looks at each member of a team or group and that member’s judgement

Assumed influences

Principle Citation

Context-Specific
recommendation
Academic leaders should be
confident in their team’s
ability to lead change.
(Collective Efficacy)
Learning and motivation are
enhanced when learners have
positive expectancies for
success (Pajares, 2010).
Academic leaders need to
participate in a series of
experiences that promote team
building, communication, and
trust.
The organization needs to
have a clear mission/vision
(Cultural Setting)
Organizational effectiveness
increases when leaders help
the organization set clear,
concrete and measurable
goals, aligned with the
organization’s mission
(Kotter, 2007).
Reinforcement of the vision
and mission and how
departmental goals and
outcomes support the vision
and mission should be utilized
to continue the understanding
of this process by the
community.
The organization needs to
communicate effectively
with stakeholders
(Cultural Setting)
Effective leaders know how to
use effective communication
during the time of
organizational change
(Hattaway & Henson, 2013).
Create a comprehensive
communication plan that
identifies progress of the
integration plan and includes
strategies for enhancing
organizational communication
overall.
The organization needs to
have a culture of trust
(Cultural Model)
Effective change begins by
addressing motivation
influencers; it ensures that the
group knows why it needs to
change. It then addresses
organizational barriers and
then knowledge, skills, and
needs (Clark and Estes, 2008).
Leaders will discuss with the
community and devise a plan
that articulates a standard of
ethical behavior and process
of accountability that includes
the leaders. This plan will be
shared broadly with the
community and monitored
regularly to ensure it is
achieving the desired
outcome.
ORGANIZATIONAL CHANGE 63

regarding how well the group can collectively achieve a goal or task. In both cases, individual
and collective self-efficacy can either support or hinder the motivation of the individual or a
group to complete a task. The more efficacious an individual or group is directly correlates to the
individual’s or group’s willingness to persist and succeed at a task (Rueda, 2011). Table 7 has
recommendations from theoretical principles that will support the academic leadership’s efforts
to address needs.
Dynamics of collective self-efficacy. The data showed that the academic leaders were
not confident in the academic leadership team’s ability to lead change. A strategy rooted in self-
efficacy theory has been selected to close this motivation gap. Pajares (2006) stated that learning
and motivation are enhanced when learners have positive expectations for success. By the vice
dean requiring the academic leaders participate in focused discussions that center on the vision
and mission, organizational culture, and communication of the SoM and on the role that the team
has in continuing to lead the integration process could assist in bolstering the collective self-
efficacy of the team. In addition, utilizing self-reflection as a tool for building relationships and
engaging stakeholders is a skill that is important for leaders to have (Bridges, 2016; Kotter,
2007). The focused discussions should include time for the academic leadership team to reflect
on its performance as a team to better understand the impact that it can have on leading the
organization. It should also reflect on the progress of the integration to this point and utilize
those reflections to inform the decisions that it will make moving forward as a team. The
recommendation would be to provide the academic leaders a group forum to collectively discuss
individual perspectives about change and the future direction of the SoM. The goal of these
sessions is to address individual concerns while utilizing already- successful milestones of the
ORGANIZATIONAL CHANGE 64

integration to develop a unified voice about an efficient and effective change management plan
moving forward.
A study conducted by Donohoo, Hattie, and Eells (2018) looking at collective teacher
self-efficacy found productive behaviors, improvement in leadership, and increases in work
satisfaction when collective self-efficacy was strong. Donohoo et al. imparted that collective
self-efficacy can play a role in how efficiently and effectively a team can function to achieve
goals. Committing time and resources to increasing the collective-efficacy of a team can
positively influence the academic leadership team's ability to create an efficient and effective
change management plan.
Organization
Table 5 shows the influences—and level of impact these influences have—on the
stakeholders’ ability to meet the goal of confidently leading integration with THS. Van den
Akker, Heres, Lasthulzen, and Six (2009) have discussed the importance of understanding how
perceived ethical or unethical behavior can impact trust in an organization. Hattaway and Henson
(2013) focused on the importance of communicating effectively, especially in times of
organizational change. Communicating realistically and regularly can also impact the success of
organizational change, which is especially important in the case of an integration (Schweiger &
Denisi, 1991). Ensuring that the organization is monitoring the effectiveness of communication
and the level of trust could assist in successfully implementing the change process. It is
important to note that because the stakeholder goal of focus for the study is narrow, the
researcher understands that there is a larger context of organizational cultural integration that
should be explored and addressed. While Appendix E: “Integrated Implementation and
Evaluation Plan” alludes to this issue, the following sections do not explicitly addressed it.
ORGANIZATIONAL CHANGE 65

Mission and vision. Based on the evidence obtained from interviews with the academic
leaders, all 14 of them could clearly articulate the mission and vision of the SoM. However, it
also became apparent that while they could state the mission and vision, there was a disconnect
with some members of the team about whether the organization is subscribing to or living the
mission. I selected a strategy rooted in organizational change theory to close this gap. Kotter
(2007) maintained that organizational effectiveness increases when leaders help the organization
set clear, concrete, measurable goals aligned with the organization’s mission. Tasking the
academic leadership team with taking the currently stated mission and vision of the SoM and
discussing how, in the context of the integration, it applies or does not apply to the organization
is an important step for the team’s collective understanding. It will be important for the team to
see how the realities of the integration impact the mission and vision of the school. The team will
also need to discuss this issue with stakeholders, so that organization can move forward with a
united understanding of the mission and vision in the current context of the organizational
culture.
Bridges (2016) and Kotter (2007) have conducted research on organizational mission and
vision during times of change. The organization must frequently check in with the mission and
vision for continued alignment during times of change (Bridges, 2016; Kotter, 2007). Schein
(2017) discussed the importance of alignment of the mission and vision, especially as a tool for
providing effective leadership. If the mission and vision are saying one thing, and the perception
by stakeholders is that the leaders are not living the mission, a strain can be placed on the
organizational culture (Schein, 2017).
Creating a culture of trust. Based on the evidence compiled from participant
interviews, the academic leaders did not think that the school of medicine had a culture of trust.
ORGANIZATIONAL CHANGE 66

This understanding was supported by data in documents highlighting faculty, staff, and student
satisfaction. A strategy rooted in organizational change theory was selected to close this gap.
Clark and Estes (2008) stated that effective change begins by addressing motivation influencers;
it ensures that the group knows why it needs to change and then addresses the organizational
barriers and the knowledge and skills needed to accomplish change. Encouraging the academic
leaders to have a meeting with the community to discuss the organization’s current culture is a
strategy that could uncover organizational barriers to trust. The recommendation would be to
have a community conversation around creating a culture of trust. An example would be to
create a plan that articulates a standard of ethical behavior and process of accountability that
includes the academic leaders. This plan will be shared broadly with the community and
monitored regularly to ensure it is achieving the desired, agreed-upon outcomes.
Clark and Estes (2008) supported engaging all stakeholders’ perspectives to inform the
design and decision-making processes leading to change. Norman et al. (2010) highlighted the
importance of being transparent during change, which is documented in the study they executed on
organizational trust. Understanding the thoughts of the community as they pertain to the overall
culture will assist the academic leaders in designing a process that will promote transparency and
support a culture of trust. Accountability is increased when individual roles and expectations are
aligned with organizational goals, and incentives and rewards need to reflect that relationship
(Elmore, 2002). Ensuring that the community and the academic leaders have a shared
understanding of accountability will strengthen the plan for increasing organizational trust. This
two-pronged approach was enforced in a study by Chughtai, Bryne, and Flood (2014, which
found that building trust-based relationship with subordinates increased worker engagement,
accountability, and an overall healthier workforce.
ORGANIZATIONAL CHANGE 67

Communicating effectively to promote change. Interview data showed that the lack of
effective communication had complicated the change effort. This finding was supported by
faculty, staff, and student satisfaction surveys that were reviewed as part of document analysis. A
strategy that evolves from organizational communication theory can be utilized to improve
organizational communication. Effective leaders know how to use effective communication
during the time of organizational change (Hattaway & Henson, 2013). Approaching
organizational communication strategy by utilizing information gained during the community
discussion led by the academic leaders supports research presented by Gilley, Gilley, and
McMillan (2009). Effective leaders are aware of the influence of motivation as it relates to
communication and organizational change (Gilley et al., 2009). An example would be for the
academic leaders to utilize information that they gathered in the meeting with the community to
discuss organizational culture and plot a communication strategy. The communication strategy
would be informative for stakeholders and could be part of the strategy for cultivating a more
trusting culture.
Using communication in a way that involves as many stakeholders as possible lends
power to your message (Coffey et al., 2002). This notion enforces the thoughts of Hattaway and
Henson (2013). Rafferty and Restubog (2010) stated that it is important to consider context and
relationships in an organization when attempting to build trust via communication. Merging the
concepts of communication and trust could be a strategy for the academic leadership team.
Holding the community meeting to gather information from stakeholders on the overall
organizational culture as it pertains to trust and communication will inform the plans for building
trust and enhancing organizational communication. The plan should include an overview of
goals already obtained, an update on the current status of the integration, and next steps. The
ORGANIZATIONAL CHANGE 68

next steps should include specifics on goals, timelines, and responsible parties that is monitored
by the vice dean.
An implementation and evaluation plan are included as Appendix E. The plans are based
on the New World Kirkpatrick Model (Kirkpatrick & Kirkpatrick, 2016), which revisits the
recommendations presented in the solution section of this study and includes critical behaviors,
required drivers, and the identified outcomes that the SoM will need to attend to while
implementing these recommendations. Appendix F contains a post-training assessment for the
academic leadership team’s teambuilding trainings.
Limitations
Limitations identified for this study include: possible researcher biases, forthrightness of
the research participants, and timing of the participant interviews. As I disclosed earlier in the
study, I am a member of the academic leadership team being studied. With this knowledge in
mind, I took as many precautions as possible to ensure that my own biases did not play a role in
the final analysis or interpretation or recommendations for the study. Interviews with the
participants were held in the weeks leading up to various organizational accreditation processes,
so it was a busy, high-stress time for participants, which could have impacted their responses to
the interview questions.
The organizational performance goal for this study is broad and multi-faceted. The
stakeholder group of focus goal is narrow. These two goals are aligned and, while the
recommendations for the academic leadership team stakeholder group are the focus of this study,
recommendations made for this group should be considered as they apply to the broader context
of the organizational performance goal. Selecting the academic leadership team as the
stakeholder group of focus does not negate the importance of the organization’s understanding of
ORGANIZATIONAL CHANGE 69

the impact of the integration on other stakeholder groups. The effects of the organizational
integration with THS and SoM to create a mutual understanding of organizational culture and
mission alignment will be of vital importance to the overall success of the integration and is not
limited to, nor can it be accomplished by, just the academic leadership team.
It is also of note that at the time of the study there were 14 members on the academic
leadership team. At the time of this write-up, the SoM had undergone an organization change
that resulted in three members of the team being reassigned to other supervisors in the
organization and an additional member of the team leaving the SoM. In the reorganization, new
members were added to the academic leadership team. The SoM and THS continues to be in
transition as it navigates the remainder of the integration process coupled with the normal ebbs
and flows of day-to-day business.
Recommendations for Further Research
A future study could focus on the impact of organizational change on other stakeholder
groups within the SOM and THS. Future research could include additional research into the
impact of culture and what steps or processes could be implemented to drive specific cultural
expectations as the SoM matures into the THS cultural context. Further study of the mission and
vision and the impact an integration can have on an organizational mission and vision could also
be explored.
Conclusion
The Clark and Estes (2008) KMO Framework provided strong guiding principles for
understanding the gaps in knowledge, motivation, and organizational influences that could be
preventing the academic leaders from achieving their stakeholder goal. This is an exciting time
for the SOM and THS. The integration is moving ahead and has reached a point where both
ORGANIZATIONAL CHANGE 70

organizations have an opportunity to reflect on progress and contemplate the next steps. The
stakeholders in both organizations are committed to creating a partnership that builds on all of
the expertise and success of THS, evolving education to a more comprehensive level with the
addition of the SOM. The recommendations are designed to assist the academic leaders in
achieving their stakeholder goal, which will ultimately assist in achieving the organizational
goal.

ORGANIZATIONAL CHANGE 71

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Appendix A: Participating Stakeholders with Sampling Criteria for Interview
Participating Stakeholders
Merriam and Tisdell (2016) defined purposeful sampling for qualitative research as a
group of people that represents the situation or phenomenon the researcher is trying to explore.
This specific group of people is uniquely qualified to provide insight to the research questions
(Merriam & Tisdell, 2016). For this study, the stakeholders from which the sample was pulled
were all members of the academic leadership team of the SoM. This team was comprised of
associate deans, department, chairs and senior directors whose responsibilities were focused on
the creation, oversight, and delivery of the school’s medical degree granting program. This team
also had a reporting structure that was accountable to the vice dean of the SoM. This is the group
that has been charged to lead change in the SoM. At the time of the study, there were 14
members of this team.
Interview Criteria and Rationale
Criterion 1. Participants have a reporting structure that requires them to report to the
vice dean of the SoM.
Criterion 2. Participants have responsibility and oversight for a department of the SoM
that is related to creation, delivery and administration of the medical school educational program.
Interview Sampling and Recruitment Strategy
The sampling strategy for this study was a census sample because it was targeting all the
members of the academic leadership team, as defined for the purposes of this study. In the case
of the academic leadership team, this researcher had access to the entire team, which facilitated
the groups participation. There were 14 members of the academic leadership team. All 14 of
these members served on the Council of Chairs and Deans. All 14 members of the team were
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asked to participate in the interview process for this study. Participants could choose to opt out of
the interview process. Creswell (2014) recommended having eight to 10 participants for a
phenomenological research study. Phenomenological studies examine the lived experiences of
the participants (Creswell, 2014); this study examined the experience that implementing change
has had on this academic leadership team. By interviewing the willing participants of the
academic leadership team, the researcher gained an understanding of how implementing change
impacted the individual and the team. The researcher also gained insight into what support is
needed from an organizational perspective to achieve the goal of the SoM integration with Town
Health System (THS).
Interview Guide

Thank you for agreeing to participate in this study. By interviewing you and some of our
other colleagues I hope to gain some valuable knowledge on how leaders experience leading
change in the organization. I am interested in your perceptions of your role in leading the
integration with the health system. I also would like to gain some insight into your perspectives
on how the integration is going and how our academic leadership team is performing at this stage
of the integration process. As you know I am conducting this study as a part of my doctoral work
with the University of Southern California. I am bound to abide by the processes and procedures
as set forth by the University’s Institutional Review Board (IRB). I would like to take this
opportunity to remind you that your participation in this study is voluntary and that you can
withdraw your participation at any time. You are also free to answer or not answers any of the
questions that are posed to you during the interview. I will use a pseudonym when recording and
reporting any data to further protect your identity. I would like your permission to record this
session and take notes during the session. Do I have your permission? After the interview is
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transcribed I will delete the recordings of the sessions. All notes, recordings and transcripts of
our interview will be secured in a lock box in my home office. Do you have any questions before
we begin?
1. Tell me a little bit about how you got into the field of medical education.
2. Talk to me about your experience thus far with the integration.

3. What is your understanding of your role in leading the integration? (probes: What about
the role of the academic leadership team?)
4. With the integration in mind, what challenges have you encountered since the integration
as a department head or leader? (probes: What insights have you gained from this
experience?) (probes: How might you have approached the challenge differently?)
5. Regarding the academic leadership team, from your perspective how has the team
approached leading this change? (probes: What may have enhanced their performance as
a team? What may have hampered their performance?)
6. How confident are you right now about the integration process? How has your
confidence changed over time? What has influenced that confidence over time (both
positively and negatively)?
7. How confident are you as a leadership team about the integration process? What has
influenced that confidence over time (both positively and negatively).
8. What is your understanding of the current vision and mission of the SoM. (probes: What
is the organizations current understanding of the mission, how does the organization
communicate that vision and mission to you and to the leadership team)?
9. How do you think the culture of the organization is influencing the integration process or
vice versa?
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10. What advice would you have for an individual or team that is charged to lead this type of
organizational change?
11. What advice would you have for a team that is charged to lead this type of organizational
change?
12. What have you learned in this integration process about yourself, or others, or organization?
13. Thank you for your time. I appreciate your candidness and your thoughtful observations.
Before we end the session, is there anything that we have not covered that you would like
to share?

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Appendix B: Document Sampling and Protocol
Document Sampling
Documents and artifacts of an organization can provide context and depth to a
researcher’s understanding of the organization (Merriam & Tisdell, 2016). As part of the study,
the researcher conducted a review of documents that provided insights into the progress of the
organizational change and satisfaction of other stakeholders (Creswell, 2014).
Document Access Strategy and Rationale
The SoM’s Dean granted permission for access to SoM documents that served to answer
the research questions. The researcher reviewed and analyzed those documents for use in this
study. None of the documents reviewed was confidential.
Document Analysis Protocol
Date:
Start Time of Analysis:
End Time of Analysis:
Location:
Observer:
Document(s) Reviewed:

Conceptual Framework/KMO

Evidence of Procedural Knowledge
Leading Change

Evidence of Cultural Setting:
Organizational Vision
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Evidence of Cultural Model:
Culture of Trust

Other Influences:

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Appendix C: Credibility and Trustworthiness
Merriam and Tisdell (2016) have discussed at length the need for researchers to examine
their own biases about the phenomenon of interest prior to interviewing participants. It is crucial
to keep the researcher’s bias from impacting the data collection and interpretation of the meaning
derived from the study. This was an important step for consideration in the data collection
process for this study, as the academic institution where the participants worked was the same
organization in which the researcher worked. Merriam and Tisdell go as far as to assert that the
researcher may want to consider writing about their own experiences with the phenomenon being
studied to better understand their own perspective. I spent time after each interview to write
down my thoughts about the comments of the participants. I took time to explore my
understanding of their experiences, compared to my own experiences in the organization. At
times, I struggled with some of the comments or concepts that were discussed by participants,
because I had a different viewpoint. At those times, I utilized a peer debrief to get to the root of
my concerns and to assure that I was representing the data as it had been presented to me.
Creswell (2014) expounded upon the responsibility of the researcher to ensure that
participants are protected, and that the credibility of the data is confirmed. This is especially true
in a situation in which the researcher is conducting research in their place of employment
(Creswell, 2014). To ensure the participants’ anonymity, I gave them gender-neutral pseudonyms
and desegregated their demographic data to grant them more protection. I also employed member
checking, a strategy that ensures that participants’ conversations are not being misinterpreted by
the researcher (Maxwell, 2013). As various themes emerged, I took the opportunity to discuss
and confirm them with participants—another part of member checking known as “respondent
validation” (Creswell & Creswell, 2018).
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Triangulation was also employed in this study. Triangulation is the process of using
multiple sources and individuals to decrease the chances that a conclusion is identified and
varied from only one source (Merriam & Tisdell, 2016). By interviewing all 14 members of the
academic leadership team and reviewing organizational documents, triangulation ensured that
the data presented to make conclusions came from multiple sources. By collecting rich data from
interviews, utilizing member checking, peer debrief, and triangulation all contributed to the
credibility and trustworthiness of this study.

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Appendix D: Ethics
As the researcher for this study it is my responsibility to ensure that the study was
conducted with integrity and maintained ethical standards (Merriam & Tisdell, 2016). As
intended by Merriam and Tisdell, this researcher upheld ethical practices, as described below as
all aspects of the study were conducted.
This study was conducted at the SoM, where the researcher currently works. The
academic leadership team members who served as the participants of the study were my peers.
We were all members of the same team and we all had a reporting relationship to the vice dean
of the SoM. I made it known to all the potential contributors that their participation in the study
was optional. I also made it clear that participants’ interviews would remain confidential and that
participants had the option to withdraw from the study at any time. Participants were also aware
that pseudonyms were being assigned to them to further protect their personal identities.
As a member of this leadership team, I have had my own experiences leading change. I
was interested in hearing about the various perspectives of my colleagues on their experience and
their perspectives on being part of the team. I acknowledge that I had assumptions and biases as I
worked through the data analysis, collection, and writing my findings. As a researcher, it was my
responsibility to acknowledge those bias and assumptions and approach the study with an
objective perspective. I made every effort to prevent my biases and assumptions from clouding
the analysis, data collection or reporting of my findings. I used triangulation and external
reviewers to ensure that my findings were interpreted in a way that was consistent with others
who would be viewing the data.
As a graduate student of the University of Southern California, I complied with all the
rules and regulations set forth by the University’s Institutional Review Board (IRB). I sought and
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received informed consent before conducting any interviews. Krueger and Casey (2009) and
Rubin and Rubin (2012) have explained that informed consent includes assuring participants that
partaking in the study is voluntary, that they can withdraw from the study at any time, and that
they are made aware of any risks involved by participating in the study. I asked participants for
their permission to record the interviews and to take notes during the sessions. All recordings and
notes from the interviews were kept in a lock box in my home office.

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Appendix E: Integrated Implementation and Evaluation Plan
Implementation and Evaluation Framework
This study used the New World Kirkpatrick Model as the premise for implementing and
evaluating organizational change. The New World Kirkpatrick Model expands on the four levels
for evaluating training programs introduced by Don Kirkpatrick: Level 1, Reaction; Level 2,
Learning; Level 3, Behavior; and Level 4, Results (Kirkpatrick & Kirkpatrick, 2016). In the
Kirkpatrick model, planning begins at Level 4, Results and works backward to level one.
Starting with the desired results encourages participants to consider their internal and external
outcomes and how those outcomes can be measured and achieved (Kirkpatrick & Kirkpatrick,
2016). Level 3 consists of applying what was learned at the training to the task at hand. Level 2
focuses on presenting the skills and knowledge that the participants need to perform effectively,
and Level 1 is centered on the satisfaction of the participants with the more superficial aspects of
the training event.
Organizational Purpose, Need, and Expectations
The School of Medicine (SoM) (a pseudonym) was part of the Town Health System
(THS) (a pseudonym) and was a fully accredited allopathic medical college. The mission of SoM
was to educate future doctors and scientists. SoM did so by utilizing a community-based, patient-
centered model of education that incorporated innovation, interprofessional, and evidence-based
inquiry, while also being dedicated to inclusion. SoM was originally incorporated as The
Primary Medical School (TPMS) (a pseudonym). From inception until recently, TPMS was an
independent medical college founded by a group of community members that had the vision of
creating a medical school in hopes of eventually re-populating the physician workforce and
ORGANIZATIONAL CHANGE 90

improving the health of the people who lived in their region of the country. TPMS admitted the
first class of medical students and graduate students in the early 2000s.
Around the time of this study, TPMS had been integrated with the Town Health System
and was renamed the School of Medicine. The SoM had an organizational goal of completing all
aspects of the integration by June 2020. The stakeholder group of focus was the academic
leadership team of the SoM. The aim was that, by December 2019, 100% of the academic
leaderships would feel confident in their ability to implement the integration with Town Health
Systems (THS). When the integration is realized, the SoM will be able to achieve the vision of
being regionally engaged and nationally relevant, and, internally, employees will be more
engaged and satisfied with organizational accountability and communication.
Level 4: Results and Leading Indicators
Table F-1 lists the Level 4 internal and external outcomes, organized by outcome, metric,
and method. If the academic leaders understand their roles in leading the organizational change,
then it is highly likely that the SoM will achieve the organizational goal of completing the
integration with THS by the designated date. If the recommendations provided in Table F-1 are
put into practice, then the academic leadership team should be on course to achieve their goal.
The critical behaviors identified above, along with metrics, methods, and timing recommended
for each is outlined in Table F-1, below.

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Table F-1

Outcomes, Metrics, and Methods for External and Internal Outcomes

Outcome Metric(s) Method(s)
External Outcomes
1.SoM will be
regionally
engaged and
nationally
relevant
1a. Increase in the amount of
community engagement by
employees in the name of the
SoM by 10% each year with the
baseline year of January 2019.

1b. Increase in the number of
publications and presentations at
national and regionally
conferences generated by the
SoM focusing on educational
innovations and the
collaborations with THS, with an
increase of 10% each year with
the baseline year of January
2019.
1a. Track the number of events in
which the SoM sponsors and
employees are engaged in giving
back to the community. Count events
in which employees are giving back
to the community as representatives
of the SoM.

1b. Track the number of publications
and conferences attended by SoM
employees that pertain to educational
innovations and collaboration with
THS.
Internal Outcomes
Increased
organizational
accountability
measures
1a. Steady increase in employee
satisfaction with the
accountability processes.

1b. Steady increase in employee
satisfaction with ethical
behaviors within the
organization.
1a & 1b. Employee
satisfaction/engagement survey
monitoring employee satisfaction
with accountability and ethical
behaviors, every 6 months for 18
months and then moving to yearly.
Increased
organizational
satisfaction with
communication
Steady increase in employee
satisfaction with organizational
communication.
Employee satisfaction/engagement
survey monitoring employee
satisfaction with communication
every 6 months for the 18 months
then moving to yearly.

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Level 3: Behavior
Critical behaviors. Critical behaviors, as discussed by Kirkpatrick and Kirkpatrick
(2016), are the most important behaviors an employee must master to achieve a stated goal. The
stakeholder group of focus for this study was academic leaders. This study identified three
critical behaviors that academic leaders need to demonstrate so that the organizational goal can
be achieved. The three critical behaviors are (a) understanding their role and responsibilities in
leading the integration, (b) collaboration, and (c) accountability. Bridges (2016) and Kotter
(2007) surmised that self-reflection is a tool for building relationships and engaging
stakeholders. If the academic leaders understand the integration process and their continued role
and responsibility for the process, the organizational goal can be achieved. The second critical
driver is collaboration. Academic leaders need to understand how to leverage and utilize
collaboration in a way that assists them in achieving goals as individuals and as a team.
Understanding collaboration will also support the academic leaders in their goals of engaging all
stakeholders in the integration processes. The third critical driver is accountability. When the
academic leaders can become accountable for their role in the integration and understand how
they can ensure that a culture of accountability is established in the organization, the level of
organizational trust and communication should increase. Table F-2 shows the critical behaviors
identified above, along with metrics, methods, and timing recommended for each.

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Table F-2
Critical Behaviors, Metrics, Methods, and Timing for Evaluation
Critical Behavior Metric(s)
Method(s)
Timing
1. Academic leaders
demonstrate that they
clearly understand
their role in leading the
integration.
Goals established for the
remainder of the integration
process should be monitored
with specific responsible
parties identified and clear
deadlines established and
monitored by the vice dean.
Academic leaders need to be
provided with specific
expectations for their role in
leading the integration process;
these expectations should be
individual and team based. and
should be discussed with the
individual academic leaders and
with the team by the vice dean
and revisited at the team’s
meetings.
Bi-
weekly
2. Academic leaders
reflect on the
integration process to
date and use that
reflection to inform the
process moving
forward.
Academic leaders actively
contribute to revisions in the
integration plan and timeline.
As a team, the academic
leadership should discuss goals
that have been accomplished to
this point and the progress of
goals that remain. They should
use this information to set a
revised plan in place. This should
be monitored by the vice dean.
Weekly
3. The academic
leadership team
participates in team-
building activities that
promote trust and
understanding of their
roles on the team.
The academic leadership
team will be more effective
as a team and have gained
skills that will promote
communication,
collaboration, and trust
among the team members and
the organization; 100%
participation by the team is
required.
The academic leadership team
participates in team-building
activities that focus on trust,
collaboration, and
communication that are led by an
outside consultant. Attendance
will be monitored by the vice
dean.
Monthly
4. Academic leaders
create a plan that
promotes and models
organizational trust.
Steady increase in employee
satisfaction with the
accountability, ethical
behaviors, and trust within
the organization.

An organizational satisfaction
survey will be implemented to
determine if employee
satisfaction with accountability,
ethical behaviors, and trust
within the organization is
increasing; data will be
monitored by the academic
leadership team and the vice
dean.
Monthly
5. Academic leaders
collaborate with senior
leadership on the
creation and execution
of a formal
communication plan
for the organization.
Steady increase in employee
satisfaction with the overall
communication in the
organization.
An organizational satisfaction
survey will be implemented to
determine if employee
satisfaction with organizational
communication is increasing;
data will be monitored by the
Monthly
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academic leadership team and the
vice dean.
Required drivers. The academic leadership team will need the support and guidance of
the vice dean to stay on track to achieve the organizational goal of integration with THS. Having
the vice dean monitor the progress of the integration and the development of the academic
leadership team should increase the team’s motivation and understanding of their roles in the
integration process. In turn, monitoring employee satisfaction in the areas of communication,
trust, accountability, and ethical behavior will engage the community and motivate the academic
leadership team to ensure that the changes occur. Table F-3 shows recommended drivers that
will reinforce, encourage, reward, and monitor the critical behaviors previously identified.

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Table F-3

Required Drivers to Support Critical Behaviors
Method(s) Timing
Critical
Behaviors
Supported
1, 2, 3, etc.
Reinforcing

The vice dean will send the academic leadership teams’ emails to
remind them of upcoming team training activities
Monthly 3
At the meetings of the academic leadership team, the topic of
integration progress will be a standing agenda item for all members to
report on.
Bi-weekly 1,2
The academic leadership team will send reminders to encourage staff to
participate in the satisfaction surveys and the focus groups.
Monthly 4, 5
Encouraging
The vice dean will provide community updates on the integration
process.
Monthly 2, 4, 5
Rewarding
The vice dean will announce via broadcast emails and at community
meetings when goals/milestones of the integration process are reached.
Ongoing 2, 4, 5
The vice dean will announce quarterly the results of the employee
satisfaction survey that is monitoring organizational communication
and trust, ethical behavior and accountability.
Quarterly 4, 5
Monitoring
The academic leadership team will be conducting a monthly survey to
ensure that employee satisfaction is increasing in the areas of
accountability, organizational trust and communication and ethical
behavior.
Monthly 4, 5
The academic leadership team will be holding staff focus groups to
better understand the quantitative data gathered from the employee
satisfaction surveys.
Biannually 4, 5
The academic leaders will have formative and summative evaluations
of their progress with their specific responsibilities for the integration.
This formative and summative evaluation will be performed by the vice
dean.
Biannually 1, 2
The academic leadership team will participate in an assessment that
measures their skills as a team and evaluates the level of trust,
communication, and collaboration of the team members.
Annually 3

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Organizational support. It is vital that the organization support the critical behaviors
and the required drivers that have been identified in this study to achieve the organizational goal
of the integration with THS. For the organization to implement the integration, the critical
behaviors and the required drivers must be shared with the members of the community in a way
that energizes the stakeholders across the organization to promote excitement about the
integration. The dean and the vice dean will be important to this process, as they will set the tone
of the process. Ensuring that the staff understands that the critical behaviors and required drivers
will not only bolster the organization's ability to achieve the integration, but also improve overall
organizational culture in the areas of communication, trust, accountability, and ethical behavior
reinforces the organizations commitment to all stakeholders. A communication plan for ensuring
dissemination and sharing of information will be vital to the success of these efforts.
Level 2: Learning
Learning goals. Following the recommendations of this study, the academic leaders will
know the following learning goals and be able to perform the critical behaviors identified to be
able to achieve the organizational goal of implementing the integration with THS:
1. Execute their role in leading the integration process and implementing strategies to
anticipate barriers to a change process (Procedural Knowledge).
2. Reflect on the progress of the integration process in real time and make adjustments as
needed to accomplish the goal (Metacognitive Knowledge).
3. Evaluate the strengths and weaknesses of the academic leadership team and then generate
and execute a plan to increase collaboration and trust (Collective Self-Efficacy).
ORGANIZATIONAL CHANGE 97

4. Analyze the organizational concerns around accountability, ethical behavior, and trust,
and then use that understanding to create a plan that improves and monitors
organizational satisfaction in these areas (Cultural Model).
5. Examine the organizational concerns around communication, and then use that
understanding to create a plan that improves and monitors organizational satisfaction in
this area (Cultural Setting).
Program. The program is recommended for the academic leaders starts with bi-weekly,
team-building sessions with a consultant that focuses on the academic leadership team’s
understanding of its role in the integration. These sessions will also focus on examining the
strengths and the weakness of the team, enforcing concepts of leading change and barriers to
anticipate when leading a change process. These sessions are intended to foster teamwork,
collaboration, and trust within the team. These sessions will also reinforce the need for the team
to approach the remaining integration with a plan that utilizes all of their roles and skills in a
strategic way that will move the organization forward. By building the team component, the
remaining milestones of the integration can be approached by the team, so that all members are
participating and informed on the progress toward completing the organizational goal.
Simultaneously, the academic leadership team will be reflecting on the milestones already
achieved in the integration process and mapping out the next steps to move the team toward
completing the organizational goal.
Another recommendation is that academic leadership team focus on examining the
organizational concerns around accountability, ethical behavior, and trust. By conducting focus
groups and monthly surveys, the academic leadership team will work to review and analyze the
feedback and create a plan that can be executed parallel to the remaining milestones for the
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integration to increase stakeholder involvement in the integration process. It is important that the
senior leadership of the organization adopts this plan, so that all stakeholders are invested and
accountable to the process. The academic leadership will utilize this same process to manage and
understand the concerns that have arisen around organizational communication. Part of this plan
should include regular updates on the progress of the achievement of integration milestones and
progress on the plan to promote organizational accountability, ethical behavior, and trust. As
milestones are met, the communication plan should include recognition of the organizational
achievements, details that arise, and drops in organizational satisfaction, with discussion
surrounding potential reasons for increases or decreases in satisfaction.
Evaluation of the components of learning. Kirkpatrick and Kirkpatrick (2016)
identified several components necessary to evaluate learning. First, they recommended that the
academic leadership team evaluate its declarative and procedural knowledge, commitment,
attitude, and confidence (Kirkpatrick & Kirkpatrick, 2016). When the academic leadership
understand their roles in the integration and can execute the roles by anticipating potential
barriers to change, they will have achieved declarative knowledge. When the team can evaluate
their strengths and weakness as a team and devise and implement a plan that will increase team
trust and collaboration, they will have achieved skills. As organizational satisfaction scores
increase in the areas of ethical behaviors, trust, accountability, and communication, the attitudes,
commitment, and confidence of the academic leadership team will increase. Table F-4, below,
details the evaluation components of the proposed learning program.

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Table F-4
Evaluation of the Components of Learning for the Program
Method(s) or Activity(ies) Timing
Declarative Knowledge “I know it.”
Monitored discussion of the academic leadership
team by the vice dean in real time that will
demonstrate their understanding of their roles in the
integration process.
During training sessions and in individual
meetings with the academic leaders outside of
trainings to determine continuing
understanding on the job
A plan created that addresses the upcoming
milestones for the integration with detailed
deliverables that can be monitored by the vice dean.
Bi-weekly at the academic leadership team
meetings
Procedural Skills “I can do it right now.”
Comments and observation by the vice dean that
identify the increase in collaboration, support, and
trust among the academic leadership team.
During training sessions and in individual
meetings with the academic leaders outside of
trainings to determine continuing
understanding on the job
One-on-one meetings with the vice dean, where
academic leaders comment on the status of the team
and the achievement of the integration milestones and
their individual and team role in the achievement of
the goals.
Monthly individual meetings with academic
leaders to determine the application of the
concepts, theories, and team activities that are
presented and applied at the training sessions
Attitude “I believe this is worthwhile.”
Comments from check-ins with the vice dean. Monthly individual meetings with academic
leaders to determine the application of the
concepts, theories, and team activities that are
presented and applied at the training sessions
Group discussion and feedback in the academic team
meetings.
Real-time feedback and reflection that occurs
during academic leadership team meetings
and trainings.
Confidence “I think I can do it on the job.”
Comments from check-ins with the vice dean. Monthly individual meetings with academic
leaders to determine the application of the
concepts, theories, and team activities that are
presented and applied at the training sessions
Group discussion and feedback in the academic team
meetings.
Real-time feedback and reflection that occurs
during academic leadership team meetings
and trainings.
Commitment “I will do it on the job.”
Comments from check-ins with the vice dean. Monthly individual meetings with academic
leaders to determine the application of the
concepts, theories, and team activities that are
presented and applied at the training sessions.
Group discussion and feedback in the academic team
meetings.
Real-time feedback and reflection that occurs
during academic leadership team meetings
and trainings.

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Level 1: Reaction
Level 1 focuses on the reactions of the participants to the trainings being provided. As
detailed by Kirkpatrick and Kirkpatrick (2016), level one addresses the participants views on
how engaging the program or training is, how relevant the training is to them, and whether the
training has addressed their customer service needs. Table F-5, below, shows the methods that
will be used to determine how the academic leadership team reacts to the proposed learning plan.
Table F-5
Components to Measure Reactions to the Program
Method(s) or Tool(s) Timing
Engagement
Attendance records Attendance will be taken at all training sessions
and academic leadership team meetings.
Meaningful questions, team members will
be asked to bring at least one question to
each meeting or training around proposed
training or agenda items
Questions will be answered and discussed over
the course of the training or team meeting.
Relevance
Pulse checks will be utilized during
trainings and academic leadership team
meetings
At the conclusion of agenda items, or training
sessions/segments, the facilitator or vice dean
will use a few minutes to check in with the
participants.
Customer Satisfaction
For each session or meeting, an observer
will be selected to monitor body language
and interactions of the group
During each training session and team meeting

Evaluation Tools
Immediately following the program implementation. Kirkpatrick and Kirkpatrick
(2016) recommended following up immediately post-training session with an evaluation that
gauges the interest and relevance of the participants in the training that occurred. This survey can
be found in Appendix G. This survey will be disseminated to the academic leaders after trainings
that are focused on leveraging their skills to enhance their functioning as a team leading the
integration process. The survey will be deployed by the vice dean’s office, and members of the
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team will remain anonymous. This survey will be focused on Level 1 reaction and Level 2
behaviors of the Kirkpatrick Model. The results of the survey will be collected and reviewed by
the consultant with recommendations to the vice dean for potential changes or enhancement for
future sessions.
Delayed for a period after the program implementation. Kirkpatrick and Kirkpatrick
(2016) also recommended implementing a delayed program evaluation that focuses on Level 3
critical behaviors and Level 4 results or required drivers of the model. This survey is specifically
focused on the performance of the academic leadership team, its development, and performance
as a team and the progress toward its stakeholder goal. The anonymous survey was deployed by
the office of the vice dean 30 days after the initial implementation of the program and will
continue as the integration moves forward to monitor the academic leadership team performance.
As integration is a continuous progress, this survey will be deployed every 30 days until the goal
is reached. The results of this survey tallied by staff in the vice dean’s office and will be shared
with the vice dean, who will make recommendations for adjustments to long-range planning or
changes of focus for the academic leadership team moving forward. This survey will be focused
on the performance of the academic leadership team and can be found in Appendix H. As part of
the implementation, the academic leadership team will be collectively creating a survey that will
be deployed to monitor the satisfaction and engagement of the SoM community as the
integration process moves forward. While this is not directly linked to the stakeholder goal of
this study, it is an important element for monitoring the achievement of the overall
organizational performance goal.

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Data Analysis and Reporting
Once the data from the surveys are collected and analyzed, the vice dean’s office will
publish a dashboard on the progress of the academic leadership team’s integration efforts. Below
are two examples of dashboards that will be prepared. The first dashboard, in Figure F-1 depicts
the larger organizational outcomes that are external to the organization. Figure F-2 depicts the
internal organizational outcomes. The survey and other data points that will be required to supply
the data for this dashboard are not detailed in this plan; however, it is part of the larger
organizational metric for achievement of the overall organizational goal. Figure F-3 depicts the
stakeholder dashboard of the data that will be monitored based on the delayed survey that
focuses on Level 3 required drivers and Level 4 results. Kirkpatrick and Kirkpatrick (2016)
stated that monitoring the progress of program implementation will give the organization an
opportunity to adjust as needed to achieve organizational goals. By publishing the dashboard, the
organization will be able to make adjustments as needed and will also provide an opportunity for
communication on progress toward organizational and academic leaders’ stakeholder goal.

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Figure F-1. External organizational goals: Increased employee community engagement and
collaborative publications between SoM and THS.

Figure F-2. Internal organizational goals: Employee satisfaction.

0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
Community Engagment Collaborative Publications
External Organizational Goals
Employee Community Engagment and
Collaborative Publications
SoM Organizational External Goals
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
Accountability Ethical Behavior Communication
Internal Organizational Goals
Increased Employee Satisfaction
Internal Organizational Goals
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Academic Leadership Survey Results
Members have a collective understanding of the mission and vision
Strongly Agree
5
Agree
6
Neutral
0
Disagree
2
Strongly
Disagree
1
Members demonstrate planning toward goals and objectives
Strongly Agree
4
Agree
2
Neutral
1
Disagree
3
Strongly
Disagree
4
Members understand the roles of the other members of the team
Strongly Agree
5
Agree
5
Neutral
0
Disagree
2
Strongly
Disagree
2
Members communicate open, direct and honest
Strongly Agree
5
Agree
6
Neutral
0
Disagree
2
Strongly
Disagree
1
Members communicate changes to plans prior to implementing
Strongly Agree
3
Agree
3
Neutral
2
Disagree
3
Strongly
Disagree
3
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Members are open to input
Strongly Agree
2
Agree
2
Neutral
2
Disagree
4
Strongly
Disagree
4
Members actively seek input from other members prior to making decisions
Strongly Agree
5
Agree
6
Neutral
0
Disagree
2
Strongly
Disagree
1
Members are good listeners
Strongly Agree
5
Agree
6
Neutral
0
Disagree
2
Strongly
Disagree
1
Members view conflict as a positive
Strongly Agree
2
Agree
4
Neutral
0
Disagree
2
Strongly
Disagree
6
Members believe what other members say
Strongly Agree
0
Agree
4
Neutral
0
Disagree
5
Strongly
Disagree
5
Members are collaborative
ORGANIZATIONAL CHANGE 106

Strongly Agree
5
Agree
6
Neutral
0
Disagree
2
Strongly
Disagree
1
Members accept feedback
Strongly Agree
3
Agree
3
Neutral
3
Disagree
3
Strongly
Disagree
2
Members have a genuine appreciation for the accomplishments of others
Strongly Agree
1
Agree
0
Neutral
2
Disagree
7
Strongly
Disagree
4
Members value the skills and expertise of the other members of the team
Strongly Agree
0
Agree
0
Neutral
4
Disagree
5
Strongly
Disagree
5
Members trust each other
Strongly Agree
0
Agree
0
Neutral
3
Disagree
7
Strongly
Disagree
4
Members can depend on one another
Strongly Agree
3
Agree
5
Neutral
1
Disagree
3
Strongly
Disagree
2
Figure F-3. Academic leaders delayed-session data.
Note.14 surveys were administered, and 14 surveys were returned.
ORGANIZATIONAL CHANGE 107

Summary
Kirkpatrick and Kirkpatrick (2016) provided the framework used for the implementation
and evaluation of this study. It is important to devise a training and evaluation program that
assists you in reaching your intended results; this aim can be accomplished by utilizing all four
levels of the Kirkpatrick Model (Kirkpatrick & Kirkpatrick, 2016). By utilizing the Kirkpatrick
Model, the academic leadership team and the organization will be better able to monitor the
progress of attaining the organizational goal and the stakeholder goals. The intended results are
described in Level 4; the required drivers are detailed in Level 3, Level 2 covers the learning
phase of the plan, and Level 1 allows us to gage the reaction of the participants to the training
sessions. This plan covers all 4 levels as outlined above and will assist in the SoM’s application
and assessment of the recommendations made for this study.

ORGANIZATIONAL CHANGE 108

Appendix F
Academic Leadership Session Evaluation
Date____________________________
Session Facilitator____________________________________
Session Content Focus________________________________
Please make a check in the box that best describes your experience with the training.
Feedback Item
Excellent Above
Average
Average* Below
Average*
Poor*
Overall, how would you rate the
facilitator today?

Overall, how would you rate the
relevance of the content of the
session?

How would you rate the
organization and presentation of
the content?

Feedback Item
Strongly
agree
Agree Neutral* Disagree* Strongly
disagree
How confident are you that you
can use what you learned today?

*If you rated any of the items above as average, below average, poor, neutral, disagree or
strongly disagree please explain and make specific suggestions for improvements below.
ORGANIZATIONAL CHANGE 109

Please list the most significant insight that you had today about another member of the
academic leadership team.

Please list the most significant insight that you had today regarding your role within the
academic leadership team.

Please list any questions that came to you today regarding session content or team
dynamics that you did not have resolved.

ORGANIZATIONAL CHANGE 110

Appendix G
Academic Leadership-Delayed Session Evaluation
Date____________________________
Please rate the academic leadership team in the below areas by checking the box that most
closely demonstrates your perception of the team’s performance and dynamic.
Feedback Item
Strongly
Agree
Agree Neutral* Disagree* Strongly
Disagree*
Members have a collective
understanding of the mission and
vision

Members demonstrate planning
toward goals and objectives

Members understand the roles of the
other members of the team

Members communicate open, direct
and honest

Members communicate changes to
plans prior to implementing

Members are open to input
ORGANIZATIONAL CHANGE 111

Members actively seek input from
other members prior to making
decisions

Members are good listeners
Members view conflict as a positive
Members believe what other members
say

Members are collaborative
Members accept feedback
Members have a genuine appreciation
for the accomplishments of others

Members value the skills and
expertise of the other members of the
team

Members trust each other
Members can depend on one another

ORGANIZATIONAL CHANGE 112

*If you rated any of the items above as neutral, disagree or strongly disagree explain and
make specific suggestions for improvements and provide examples that support your
assessment.

Abstract (if available)

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Asset Metadata

Creator DiMattia, Andrea Kay (author)

Core Title Implementing organizational change in a medical school

School Rossier School of Education

Degree Doctor of Education

Degree Program Organizational Change and Leadership (On Line)

Publication Date 09/23/2019

Defense Date 12/01/2019

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag Integration,medical school,OAI-PMH Harvest,organizational change

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Hirabayashi, Kimberly (committee chair), Ephriam, Ronni (committee member), Picus, Lawrence (committee member)

Creator Email andreadimattia@hotmail.com,dimattia@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-222687

Unique identifier UC11673860

Identifier etd-DiMattiaAn-7840.pdf (filename),usctheses-c89-222687 (legacy record id)

Legacy Identifier etd-DiMattiaAn-7840.pdf

Dmrecord 222687

Document Type Dissertation

Rights DiMattia, Andrea Kay

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA