Adapting the CACAO model to support higher education STEM teaching reform

Background Efforts to achieve improved student outcomes in STEM are critically reliant on the success of reform efforts associated with teaching and learning. Reform efforts include the transformation of course-based practices, community values, and the institutional policies and structures associated with teaching and learning in higher education. Enacting change is a complex process that can be guided by change theories that describe how and why a desired change takes place. We analyzed the utility of a theory-based change model applied in a higher education setting. Our results provide guidance for change efforts at other institutions. Results Use of the CACAO model to guide the transformation of STEM instruction at a large public university resulted in changes to faculty teaching practices and department culture consistent with the vision defined for the project. Such changes varied across STEM departments in accordance with the emergent nature of project activities at the department level. Our application of the CACAO model demonstrates the importance of (1) creating a vision statement (statement of desired change or end-state); (2) attending to different levels of the organization (e.g., individuals, departments, and colleges); (3) working with change agents who are situated to be effective at different organizational levels; and (4) employing strategies to meet the needs and interests of faculty at different stages of adoption with respect to the desired change. Conclusion Our work, which demonstrates the utility of the CACAO model for change and captures its key elements in a matrix, provides a potential foundation for others considering how to frame and study change efforts. It reinforces the value of using change theories to inform change efforts and creates a structure that others can build on and modify, either by applying our CACAO matrix in their own setting or by using the matrix to identify elements that connect to other change theories. We contribute to the growing body of literature which seeks to understand how change theories can be useful and generalizable beyond a single project.

Mapping social structures for sustainability transformation at McGill University, Canada

Purpose For a university to be a prime mover for sustainability transformation, all units of the university should contribute. However, organizational change in educational institutions is often studied by examining specific domains such as research or operation in isolation. This results in a less-than-complete picture of the potential for university-wide change. In contrast, this paper aims to examine the network of social relations that determine the diffusion and sustainability of change efforts across a university. The authors use McGill University (Canada) as a model system to study the network of actors concerned with sustainability to learn how this network influences the penetration of sustainability throughout the university. Design/methodology/approach To explore the existing social structure, the authors use an innovative approach to illuminate the influence of social structure on organizational change efforts. Using a mixed methods approach combining social network analysis with qualitative interview data, the authors examine the influence of the social structure on sustainability transformation at McGill University. The authors conducted 52 interviews between January and April 2019 with representatives of different sustainability groups at the university across six domains (research, education, administration, operations, connectivity and students). Findings The authors find that McGill University has a centralized system with a low density. The network is centralized around the Office of Sustainability. The limited cross-domain interaction appears to be a result of differences in motivation and priorities. This leads to a network that has many actors but only a limited number of connections between them. The quality of the relationships is often utilitarian, with only a few relationships aiming for support and mutual growth. Originality/value This study brings together social network analysis, sustainability transformation and higher education in a new way. It also illustrates the complexity of guiding a large organization, such as a university, toward a sustainability transformation. Furthermore, it reveals the importance of considering each part of the university as part of an interconnected network rather than as isolated components.

Ripple Effects Mapping: Capturing the Wider Impacts of Systems Change Efforts in Public Health

Background: Systems approaches are currently being advocated and implemented to address complex challenges in Public Health. These approaches work by bringing multi-sectoral stakeholders together to develop a collective understanding of the system, and then to identify places where they can leverage change across the system. Systems approaches are unpredictable, where cause-and-effect cannot always be disentangled, and unintended consequences – positive and negative – frequently arise. Evaluating such approaches is difficult and new methods are warranted. Methods: Ripple Effects Mapping (REM) is a qualitative method which can capture the wider impacts, and adaptive nature, of a systems approach. Using a case study example from the evaluation of a physical activity systems approach in Gloucestershire, we: a) introduce the adapted REM method; b) describe how REM was applied in the example; c) explain how REM outputs were analysed; d) provide examples of how REM outputs were used; and e) describe the strengths, limitations, and future uses of REM based on our reflections. Results: Ripple Effects Mapping is a participatory method that requires the active input of programme stakeholders in data gathering workshops. It produces visual outputs (i.e., maps) of the programmes activities and impacts, which are mapped along a timeline to understand the temporal dimension of systems change efforts. The REM outputs from our example were created over several iterations, with data collected every 3-4 months, to build a picture of activities and impacts that have continued or ceased. Workshops took place both in person and online. An inductive content analysis was undertaken to describe and quantify the patterns within the REM outputs. Detailed guidance related to the preparation, delivery, and analysis of REM are included in this paper. Conclusion: REM may help to advance our understanding and evaluation of complex systems approaches, especially within the field of Public Health. We therefore invite other researchers, practitioners and policymakers to use REM and to continuously evolve the method to enhance its application and practical utility.

Digital Health Value Realization Through Active Change Efforts

Digital health has massive potential in health care but has been slow to evolve in comparison to other information-intensive industries, which have more readily taken advantage of new technology. One of the key barriers has been the complex relationship between the perceived return on investment for the investor and the resulting value to patients and caregivers. Those actors who pay for technologies do not always see an appreciable return for themselves, while those actors who must apply the technology to generate value are not always incentivized to do so. This misalignment across health system payers and administrators, clinicians and patients must be better understood and addressed to help accelerate digital health. This paper will examine this challenge through the clinician experience, using empirical case examples from Canada to illustrate opportunities for change. While many factors may influence digital health adoption, this paper specifically aims to explore the shifts in the balance of the perceived value of implementing digital health tools, vs. the efforts required to adopt them. It will explore two contrasting case examples: clinical adoption of EMRs in Canada from 2009 to 2015, and clinical adoption of virtual care technologies during the COVID-19 pandemic from 2020 to 2021. In 2006, Canada lagged peer countries significantly in the adoption of electronic medical records (EMR) in community-based care. Financial support and cooperation of multiple levels of government and clinical stakeholders were required to address the misaligned incentives, which led to significant uptake by care providers. The rapid adoption of virtual care in Canada in response to the pandemic provides another relevant example of the importance of alignment among the factors of clinical workflows, clinical appropriateness, technology integration and payment models. Experts have highlighted the need for standardization, regulation, and clear policy to ensure sustainable, high quality virtual care that complements in-person care. In both cases, the costs and effort of adopting new technologies outweighed direct clinician value, requiring change initiatives to catalyze progress. This imbalance could be unique to these examples in Canada, and may not be globally generalizable to the adoption of all digital health tools. However, how change efforts can be tailored to adjust to a rapidly evolving health care workforce, spanning diverse jurisdictions and stakeholder groups will be critical to the sustainability of virtual care adoption. Furthermore, what key elements must be considered to guide change initiatives for successful implementation, designed to influence change while adding value for patients, clinicians and Canada's health care systems? Using insights from successful change initiatives past and present, this paper aims to answer these questions to enable a smoother transition to digital health innovations of the future.

External Communities as Initiators of Organizational Change

Organizational change literature has long described the ways change efforts are designed and executed, with particular attention to where the change effort initiated: whether from the top down or the bottom up. In this paper, we expand this focus and describe how communities external to organizations can also be initiators of change within organizations. Through two examples, the Black Lives Matter movement and Old Coke Drinkers of America, we demonstrate the power of communities outside of organizations for initiating meaningful and lasting change within organizations. We explain that the power of such communities for initiating organizational change is derived in part from their members’ psychological sense of community (PSOC). We propose that scholars and practitioners alike should pay attention to this phenomenon by offering an agenda for developing research on impacts of communities and their PSOC that may affect organizational change.