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The purpose of this paper is to present a case study of the World Health Organization’s Global Healthcare Workforce Alliance (GHWA). Based on a commissioned evaluation of GHWA, it applies network theory and key concepts from systems thinking to explore network emergence, effectiveness, and evolution to over a ten-year period. The research was designed to provide high-level strategic guidance for further evolution of global governance in human resources for health (HRH).

Methods included a review of published literature on HRH governance and current practice in the field and an in-depth case study whose main data sources were relevant GHWA background documents and key informant interviews with GHWA leaders, staff, and stakeholders. Sampling was purposive and at a senior level, focusing on board members, executive directors, funders, and academics. Data were analyzed thematically with reference to systems theory and Shiffman’s theory of network development.

Five key lessons emerged: effective management and leadership are critical; networks need to balance “tight” and “loose” approaches to their structure and processes; an active communication strategy is key to create and maintain support; the goals, priorities, and membership must be carefully focused; and the network needs to support shared measurement of progress on agreed-upon goals. Shiffman’s middle-range network theory is a useful tool when guided by the principles of complex systems that illuminate dynamic situations and shifting interests as global alliances evolve.

This study was implemented at the end of the ten-year funding cycle. A more continuous evaluation throughout the term would have provided richer understanding of issues. Experience and perspectives at the country level were not assessed.

Design and management of large, complex networks requires ongoing attention to key issues like leadership, and flexible structures and processes to accommodate the dynamic reality of these networks.

This case study builds on growing interest in the role of networks to foster large-scale change. The particular value rests on the longitudinal perspective on the evolution of a large, complex global network, and the use of theory to guide understanding.

The purpose of this paper is to present a detailed case study of the evaluation strategies of a complex, multi-faceted response to a public health emergency: drug-related overdose deaths. It sets out the challenges of evaluating such a complex response and how they were overcome. It provides a pragmatic example of the rationale and issues faced to address the what, the why and particularly the how of the evaluation.

The case study overviews British Columbia’s Provincial Response to the Overdose Public Health Emergency, and the aims and scope of its evaluation. It then outlines the conceptual approach taken to the evaluation, setting out key methodological challenges in evaluating large-scale, multi-level, multisectoral change.

The evaluation is developmental and summative, utilization focused and system informed. Defining the scope of the evaluation required a strong level of engagement with government leads, grantees and other evaluation stakeholders. Mixed method evaluation will be used to capture the complex pattern of relationships that have informed the overdose response. Working alongside people with drug use experience to both plan and inform the evaluation is critical to its success.

This case study builds on a growing literature on evaluating large-scale and complex service transformation, providing a practical example of this.

This chapter provides a discussion of Roger Slee and Julie Allan’s 2001 article “Excluding the included: A reconsideration of inclusive education” published in International Studies in Sociology of Education. “Excluding the included” is a salient example of the influential work of these two scholars, threads of which can be found throughout their prior and following work, and in the work of other scholars in the area. The importance of the work and its ongoing impact on the field of inclusive education is discussed.

The British Columbia Ministry of Health’s Clinical Care Management initiative was used as a case study to better understand large-scale change (LSC) within BC’s health system. Using a complex system framework, the purpose of this paper is to examine mechanisms that enable and constrain the implementation of clinical guidelines across various clinical settings.

Researchers applied a general model of complex adaptive systems plus two specific conceptual frameworks (realist evaluation and system dynamics mapping) to define and study enablers and constraints. Focus group sessions and interviews with clinicians, executives, managers and board members were validated through an online survey.

The functional themes for managing large-scale clinical change included: creating a context to prepare clinicians for health system transformation initiatives; promoting shared clinical leadership; strengthening knowledge management, strategic communications and opportunities for networking; and clearing pathways through the complexity of a multilevel, dynamic system.

The action research methodology was designed to guide continuing improvement of implementation. A sample of initiatives was selected; it was not intended to compare and contrast facilitators and barriers across all initiatives and regions. Similarly, evaluating the results or process of guideline implementation was outside the scope; the methods were designed to enable conversations at multiple levels – policy, management and practice – about how to improve implementation. The study is best seen as a case study of LSC, offering a possible model for replication by others and a tool to shape further dialogue.

Recommended action-oriented strategies included engaging local champions; supporting local adaptation for implementation of clinical guidelines; strengthening local teams to guide implementation; reducing change fatigue; ensuring adequate resources; providing consistent communication especially for front-line care providers; and supporting local teams to demonstrate the clinical value of the guidelines to their colleagues.

Bringing a complex systems perspective to clinical guideline implementation resulted in a clear understanding of the challenges involved in LSC.

This paper aims to describe methods and models designed to build a comprehensive, integrative framework to guide the research to policy and practice cycle in health care.

Current models of science are summarised, identifying specific challenges they create for knowledge to action (KTA). Alternative models for KTA are outlined to illustrate how researchers and decision makers can work together to fit the KTA model to specific problems and contexts. The Canadian experience with the evolving paradigm shift is described, along with recent initiatives to develop platforms and tools that support the new thinking. Recent projects to develop and refine methods for embedded research are described. The paper concludes with a summary of lessons learned and recommendations that will move the KTA field towards an integrated science.

Conceptual models for KTA are advancing, benefiting from advances in team science, development of logic models that address the realities of complex adaptive systems, and new methods to more rapidly deliver knowledge syntheses more useful to decision and policy makers.

KTA is more likely when co‐produced by researchers, practitioners, and policy makers. Closer collaboration requires shifts in thinking about the ways we work, capacity development, and greater learning from practice.

More powerful ways of thinking about the complexities of knowledge to action are provided, along with examples of tools and priorities drawn from systems thinking.

The purpose of this paper is to examine the mediating effect of employee job satisfaction on the relationship between electronic human resource management (e-HRM) use and e-HRM macro-level consequences.

Data were collected through a survey involving 32 organizations, using e-HRM applications. A purposive sampling technique was employed. A structural equation modeling technique with the use of the process macro approach was used to analyze collected data.

E-HRM use has a positive and significant effect on e-HRM macro-level consequences and constituent elements of e-HRM operational, relational and transactional consequences. Employee job satisfaction partially mediates the relationship between e-HRM use and e-HRM macro-level consequences.

The use of e-HRM, complemented by human resource best practices, enhances employee job satisfaction. At an indirect level, job satisfaction partially mediates the effect of e-HRM use on e-HRM macro-level consequences. Organizations should invest in job satisfaction-enhancing practices to ensure attainment of intended organization-wide consequences on a more consistent basis.

The study broadens the scope through which the association between e-HRM use, e-HRM macro-level consequences and employee job satisfaction are viewed. The study illustrates the limitations of the deterministic view of e-HRM use, while supporting the assumptions of the moderate determinism approach, which pin the success of e-HRM systems on the performance and satisfaction of e-HRM actors. The level of employee job satisfaction mediates the relationship between e-HRM use and e-HRM macro-level consequences. The study, to the authors' knowledge, is the first in establishing such an effect.

The questions addressed by this review are: first, what are the guiding principles underlying efforts to stimulate sustained cultural change; second, what are the mechanisms by which these principles operate; and, finally, what are the contextual factors that influence the likelihood of these principles being effective? The paper aims to discuss these issues.

The authors conducted a literature review informed by rapid realist review methodology that examined how interventions interact with contexts and mechanisms to influence the sustainability of cultural change. Reference and expert panelists assisted in refining the research questions, systematically searching published and grey literature, and helping to identify interactions between interventions, mechanisms and contexts.

Six guiding principles were identified: align vision and action; make incremental changes within a comprehensive transformation strategy; foster distributed leadership; promote staff engagement; create collaborative relationships; and continuously assess and learn from change. These principles interact with contextual elements such as local power distributions, pre-existing values and beliefs and readiness to engage. Mechanisms influencing how these principles sustain cultural change include activation of a shared sense of urgency and fostering flexible levels of engagement.

The principles identified in this review, along with the contexts and mechanisms that influence their effectiveness, are useful domains for policy and practice leaders to explore when grappling with cultural change. These principles are sufficiently broad to allow local flexibilities in adoption and application.

This is the first study to adopt a realist approach for understanding how changes in organizational culture may be sustained. Through doing so, this review highlights the broad principles by which organizational action may be organized within enabling contextual settings.