Table 1.

Themes and Illustrative Quotes That Articulate the Factors Contributing to Successful Change in the Participants’ Experience

Theme	Illustrative Quote
Change Management Approaches	● ... yes, it (health industry) does need a change management approach ... not sure if ... we need to have something that’s so prescriptive that you cannot use it flexibly. So I guess it’d have to be a balance between some guide tools; templates but also some guidance on how they can be used flexibly ...
	● ... we are an environment of constant change ... and I think we very much need processes and tools that can help navigate that ... I think there’s also a need around those processes and tools to actually help, one, to drive consistency. Two, is also around, if there are approaches that get trialled and have a positive outcome, then we should be looking at replicating those. So being able to share that via healthcare system processes and tools, rather than have different agencies trying to figure it out themselves. So I think that comes a little bit back to that bottom-up versus top-down approach ...
	● there’s a lot of resistance from different departments, so just for example trying to get buy in XX department, it would end up being extra work for the XX department and because it does not directly affect any of their KPIs, there was a lot of a resistance there. There had to be a lot of involvement of our Health manager and different executives to try and get the process improved. Thankfully we did have supportive management
	● ... it has taken quite a bit of time for some people to overcome those emotions. But at the same time, if we had pushed it and said, you will do this, and not give people a bit of flexibility, I think we would have met with more resistance.
	● ... I think it (NSW Health system support) could be improved ... I think there’s an acceptance that change management is required but I think it is some consistency of methodology that we use for having some agreement on what is proven and evidenced to be the best methodologies within say health environment or just – like a big system such as ours and dedicated investment and resourcing to support that as well ...
Change Resources	● ... in terms of these large-scale, system-wide changes, what is it that we can commit to and the resources that would support that and the time to allow that change to happen ... a lot of new initiatives and changes ... does not always allow enough time for the change to occur or allow enough resourcing. So we take on more and then more and more ... some of those initial things ... do not get implemented in an ideal way just because our resourcing is stretched too far.
	● ... after the change has been initiated those that were in project management roles exit from that and staff are left with change that they do not understand, is not well resourced, has problems, and there’s nowhere to go to help with the resolution. So, people see then change as a negative thing ...
	● ... it was a great evidence-based project that had adequate resources ... it was resourced, implemented and delivered
Capacity, Capability and Leadership	● ... we need to change the focus of change management being a specialist skillset and look at it as a core fundamental capability of being a leader or a manager ... so the fundamental skillsets for managers and leaders need to speak to a context now where the environment does not stand still ... but the capabilities of our managers and leaders have not caught up with that. It’s going to be challenging work, but it’s got to be now considered as our new way of being and it’s business as usual ...
	● we have silos agency to agency ... silos professional groups to professional groups ... so the key one (capability for implementing change management processes) is sponsorship ... it’s a leadership capability I guess is what I am saying, and that leadership capability needs to be expressed and felt at all levels. It also ties into other leadership capabilities ... strategic prioritisation ... clinical and business leadership.
	● ... we definitely need to do more in terms of building change management capability at all levels, and in particular with leadership. I think that every leadership program, every performance, the whole employee journey or leadership journey should be assessed against the manager’s ability to manage change ...
	● ... we do not have the ability to seek any sort of backfill of staffing to make sure the change happened. It’s just expected that we move away from our clinical workload which is maximum capacity and somehow make a very large change that runs through, pretty much affects the whole hospital and any ward in the hospital can have patients going into our clinic. So we find the ability to have enough staff to do this is quite difficult, particularly in a small hospital where if one staff member’s down, you have effectively lost 10% of your workforce ...
Culture, Values and Behaviours Supportive of Change	● I do not know whether people are worn out or they think everything’s too bureaucratic or no one will listen anyway. I do not know if it’s because hospitals have got too big or what, but I think our culture is - it does not embrace it (change management) ...
	● ... there’s a bit of culture of if I stay still long enough the change will roll over the top of me, I will not need to make the change and then therell be another change coming anyway; so thatll take over from this change. The health industry I guess is probably similar to other industries, but it does stand apart with that particular culture. Yes, it does need a change management approach.
	● ... health as an industry is extremely agile ... they do cope with change quite well and I think what they do is reactive change rather than proactive change. I think the culture is there, the capability is there, the capacity is probably not there ... I think the system does – should support change. The only constant is change so you have to support it and what does support look like? I think that support is cultural ...
	● I think probably the culture might be a bit of an issue and capability, so depending on what you are trying to change [in treatment] and with stakeholders get involved and you are very - there’s some specific stakeholders that can really let a project run or stop it right in its tracks ...