Exploring the development of academic self-concept: a qualitative study of student success among Sama Dilaut University graduates.

Health services around the world are experiencing significant redevelopment and improvement efforts in response to a global movement towards value-based healthcare and a pressing need for sustainability in healthcare delivery. These changes are necessary to meet the escalating health demands, driven by factors such as population growth and ageing societies, the rising prevalence of complex and often interrelated health issues, and the increasing impact of climate change on public health. Transformative redevelopment projects are among the most substantial and costly changes in health services, often spanning several years. For instance, in Australia, health redevelopment projects can cost anywhere from AU$50 million for a small or regional project to over AU$2 billion for a major redevelopment, such as the redevelopment of the Royal Adelaide Hospital. More than $2.5 billion worth of health infrastructure projects formed part of the 2022–23 budget of one Australian state government, and another state committed $2.1 billion to health infrastructure in its 2024–25 budget. The literature reports persistent gaps in the quality of change management in hospital redevelopment. For example, failure to align stakeholder interests and incentives can give rise to resistance to adopting and using innovations. The literature has also emphasised several potential barriers to successful change management efforts including limited leadership capability to facilitate and support the change process and insufficient organisational commitment to fostering a culture that enables and sustains change. Issues with resourcing change initiatives, due to workforce shortages, time allocation, and funding, were often described as key barriers to achieving desired outcomes and realising benefits. A notable Australian example is a $187 million redevelopment of a regional hospital, where issues with organisational culture and governance, poor planning and resourcing, and limited stakeholder engagement led to delays and operational challenges when transitioning to, and staffing, the new facility. Numerous methods, models, and frameworks are available for managing change more effectively in redevelopment projects of this scale. These approaches offer structured guidance to plan, deliver, and embed change in clinical and operational ways of working throughout the stages of change (planning, implementing, and sustaining) and across activities such as stakeholder engagement, workflow and model-of-care redesign, or transition planning., Examples of such approaches include widely used models such as Kotter’s eight-step model, the Prosci ADKAR model, and Lewin’s Three-Step Change Model., Many healthcare organisations may also develop their own context-specific structured approaches to guide change within their setting. Whatever their form, a common principle across these approaches is that effective change management requires engagement of all relevant stakeholders throughout the process, executive sponsorship and leadership, and the interpersonal skills of those leading and managing change. Taken together, the reported challenges of managing change effectively in practice, despite an abundance of structured approaches offering theoretical guidance, may point to a gap between the theory of change management and its implementation, and barriers operationalising these approaches in practice.