Case study: Examining failure in change management

Ernst Patrick Graamans, Kjeld Aij, Alexander Vonk, Wouter ten Have

Research output: Contribution to JournalArticleAcademicpeer-review


This case study aims to shed light on what went wrong with the introduction of new surgical suture in a Dutch hospital operating theatre following a tender. Transition to working with new surgical suture was organized in accordance with legal and contractual provisions, and basic principles of change management were applied, but resistance from surgeons led to cancellation of supplies of the new suture.

Researchers had access to all documents relevant to the tendering procedure and crucial correspondence between stakeholders. Seventeen in-depth, 1 h interviews were conducted with key informants who were targeted through maximum variation sampling. Patients were not interviewed. The interviews were recorded, transcribed and analysed by discourse analysis. A trial session and workshop were participatively observed. A cultural psychological perspective was adopted to gain an understanding of why certain practices appear to be resistant to change.

For the cardiothoracic surgeons, suture was more than just stitching material. Suture as a tactile element in their day-to-day work environment is embedded within a social arrangement that ties elements of professional accountability, risk avoidance and direct patient care together in a way that makes sense and feels secure. This arrangement is not to be fumbled with by outsiders.

Practical implications
By understanding the practical and emotional stakes that medical professionals have in their work, lessons can be learned to prevent failure of future change initiatives.

The cultural psychological perspective adopted in this study has never been applied to understanding failed change in a hospital setting.
Original languageEnglish
Pages (from-to)319-330
Number of pages12
JournalJournal of Organizational Change Management
Issue number2
Early online date18 Feb 2020
Publication statusPublished - 2020


  • change management
  • cultural psychology
  • discourse
  • emotion
  • health care management
  • medical practices
  • operating theatre


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