Table 1.

Summary of Included Studies

Lead Author	Date	Design	Method	Setting	Sample	Change Management Method	Objective	Key Findings
Abd El-Shafy48	2019	Quantitative	Administrative data	Paediatric trauma Surgery Unit, New York, USA	All department and staff	Lewin’s change model	To reduce nonsurgical trauma admission rate and better align resources to provide care for injured children	Reduction of nonsurgical admission of trauma patients from 30% to 3% and Reduction in length of stay by 21%
Alonso29	2013	Qualitative	Quality indicators	Medway Maritime Hospital emergency department (ED), Kent, UK	Employees working in the emergency department	Kotter’s 8-step	Address problems and inefficiencies with the triage system and to meet the latest ED quality clinical indicators	After six weeks, nursing staff decided to adopt navigation for 24 a day because it allowed them to identify high risk patients on arrival, and make quicker and safer assessments
Andersen30	2013	Quantitative	Interrupted prospective method (time series analysis	Bispeberg Teaching hospital, Denmark	510 beds - Hospital level data	Kotter’s 8-step	To optimise the use of antimicrobial medications	Immediate and sustained reduction in the use of cefuroxime, and an increase in the use of ertapenem, piperacillin/tazobactam and beta-lactamase sensitive penicillin, Although the consumption remained unaffected *instead maybe: an alternative approach to contain a problem with resistant bacteria that does not require ongoing antimicrobial stewardship was developed which resulted in a sustained change in the consumption of antimicrobials and a decreasing rate of ESBL-KP
Balluck60	2020	Case study	Case study	State based healthcare system, US	25 hospitals	ADKAR and CLARC Change Models	Discuss the methodological journey of transition from primary to team nursing.	The nurse executive deployed a successful transition for the new nurse care model using ADKAR and CLARC change models.
Baloh31	2018	Qualitative	Semi-structured interview	Rural hospitals in Iowa, USA	17 small rural hospitals; 47 key informants	Kotter’s 8-step	Implementation of team STEPPS	In half the hospitals, performance of the initial phase influenced the success of the other phases. In the other half, success was dependent on the scope of implementation and the strategies utilised.
Bousquet32	2019	Quantitative	Research and obtained data	ARIA organisation	Hospitals using ARIA	Kotter’s 8-step	Providing an active and healthy life to patients with rhinitis and to those with asthma multimorbidity across the lifecycle irrespective of their sex or socioeconomic status to reduce health and social inequities incurred by the disease	ARIA Phases 1 and 2 were developed in accordance to the Kotter 8-step change model and can be used as a model of CM in patients with chronic diseases. However, there are still unmet needs for the management of rhinitis and asthma in real life.
Bowers49	2011	Mixed methods	Autoethnography and audit	Community nurses seeing housebound patients	Seven community nurses	Lewin’s change model	Health gain; and encourage a new culture of clinical care	Increase in team engagement, teamwork and open discussion. Presence of a revert back into the handwritten caseload due to a lack in continues driving force thereby making resistance forces increase.
Bradley50	2013	Mixed method	Quasi-experimental and Ethnographic interviewing	3 Acute wards in 3 rural hospitals in South Australia	Nine self-selected inpatients and forty-eight self-selected nurses	Lewin’s change model	to empirically explore the process and outcome of implementation of nurse-to-nurse bedside handover	Patients preferred bedside handover rather than closed-door office handover approach, improving the patient/health provider relationship. Also, the level of patient involvement increased.
Burden33	2016	quantitative	Pre-post surveillance data analysis	A NHS Trust, UK (not identified)	Surgical team	Kotter’s 8-step	To improve breast surgical site infection rates	Overall surgical site infection rate fell from 7% to 2% with inpatient and readmission rates dropping from 2.2% to 0%
Carman34	2019	Qualitative	Interviews	Rural health centre, US	21 interviews with administrators, physicians, support staff, care-coordinators	Kotter’s 8-Step Process	To understand and evaluate significant organizational change improve preventive care service delivery, close care gaps, and reduce health disparities among its patients.	Steps 1 through 7 of Kotter’s 8 steps of change in the POE implementation process showed evidence. Step 8, anchoring new approaches in the organizational culture, was an area for improvement
Chaboyer51	2009	Qualitative	Semi-structured interview and survey	Regional hospital, Queensland, Australia	Patients and 27 Nurses	Lewin’s change model	Improving patient-centred care through bedside handover in nursing	Support from shift coordinators and team leaders, Improved patient safety,efficiency, teamwork and improved patient outcome through bedside handover
Champion35	2017	quantitative	Surveys	Ottowa Hospital, Canada	Frontline staff in surgical unit	Kotter’s 8-step	To target high surgical site infection rates	Implementation of improved communication methods has resulted in short term wins.
Detwiller66	2014	Qualitative	Observation	Interior Health, British Columbia, Canada	Multiple database	C.A.P. model	Moving a large healthcare organization from an old, non-standardized clinical information system to a new user-friendly standards-based system.	For a change to be successful, there must be authentic, committed leadership visible to everyone within the organization throughout the duration of an initiative. Leading change activities included having a sponsor or champion and team members who demonstrated visible, active, public commitment and were supportive of the change.
Dort36	2020	Quantitative	Eight KPIs	Academic Teaching Hospital, Canada	Head and Neck surgery Department	Kotter’s 8-Step Process	Outline and describe a quality management program	Demonstrated sustained high clinical performance when compared to a non-pathway managed cohort using 7 years of prospective outcomes data.
Dredge37	2017	Mixed Methods	Working party and survey	Calvary Health Care Bethlehem community palliative care service, NSW, Australia	Nurses in an outpatient palliative care service	Kotter’s 8-step	To change anticipatory medicine practices in palliative care	Study identified carers found it difficult to attend training however, found the step by step instructions useful to administer medicines in a timely manner without a nurse.
Gazarin59	2020	Quasi-experimental	Surveillance data	Rural Teaching Hospital, Canada	224 patients with urinary catheters	Influencer Change Model and the Choosing Wisely Canada toolkit	To create a bundle of interventions that would reduce the unnecessary use of urinary catheters in hospitalised patients	There was gradual improvement during PDSA cycle 2, with the percentage of inappropriate urinary catheter use dropping from an initial 31% before any interventions to less than 5% by the end of this study.
Hennerby65	2011	Quantitative	Competency assessment tool	Acute children’s hospital, Dublin, Ireland	Registered general agency nurses	Young’s nine stage framework	Implementation of a competency assessment tool for registered general agency nurses	18% of agency nurses scored below expected standard and were not employed. Communication with agency provider and undertaking of competency assessment to check for experience and skills before employing agency nurses
Henry38	2017	Quantitative	Surveys	a 533 bed hospital in Pennsylvania, USA	Frontline staff in a 98 bed maternity ward	Kotter’s 8-step	To increase enculturation of frontline maternity staff with Baby-Friendly Hospital Initiative practices.	Kotter's principles provided the structure to achieve the necessary changes to attitudes and behaviours. Intervention resulted in increased mothers breastfeeding on discharge and improved use of community support groups helped the maintenance of breast milk as the primary nutrition for newborns post discharge
Hopkins39	2015	Quantitative	Administrative data	New Jersey Hospital Association and the Greater New York Hospital Association, USA	Physicians in both hospital	Kotter’s 8-step	Achieve a successful gainsharing culture which capitalizes on creativity, knowledge and problem-solving ability	Resolving problems related to large-scale implementation, operation, and administration of gainsharing, achieved improvements in efficiency, promoted patient safety and quality of care, provided support for care redesign saving $822 per admission on average.
Jacelon52	2011	Qualitative	Unstructured interview	Jewish Geriatric Services, Massachusett, America	Multidisciplinary health team and residents	Lewin’s change model	Creating a model which can be used to organize the entire system including the residential facilities and nursing components.	Implementing the JGS-CCM with Lewin’s model has transformed the way care is provided; framework of interaction and communication between informed residents, families and knowledgeable interdisciplinary teams led by nurses resulted in better patient centred care
John40	2017	Quantitative	Administrative data on service user access	Kent and Medway NHS and Social Care Partnership Trust, UK	nurses in acute inpatient mental health units	Kotter’s 8-step	Setting up recovery clinics and promoting service user involvement	Initial results show that the initiative has driven an increase involvement between nurses and service users.
Kuhlman63	2019	Quantitative	Surveillance data	State Hospital, US	200,691 patients identified as adults with chest pain	Advent Health Clinical Transformation (ACT) cycle.	Develop a clinical pathway for management of adults with chest pain in ED	Baseline-Year was compared with the Performance-Year, chest pain patients discharged from the ED increased by 99%, those going to the ‘Observation’ status decreased by 20%, and inpatient admissions decreased by 63% (p b 0.0001)
Lin56	2011	Multi-method	Documentation, direct observation, physical artefacts, interviews, progress metrics	4 medical-surgical units in two Northern California Kaiser Permanente hospitals (Sacramento and Clara), USA	150 participants from multi-disciplinary groups	Cake model, Concerns-Based, and Lewin’s Model	How to implement and spread service design concept (Nurse Knowledge Exchange) in large, complex organizations	Application of change management theories resulted in a redesign of implementation methods and inspired a more human-centred approach to spread the service design concept
Manchester53	2014	2 Case studies	Chart reviews and Cohorts	Geriatric Education Centres in Maine and Virginia USA	All stakeholders e.g medical director, nurse director, registered nurse, chief nurse officer for the hospital, pharmacists, social workers, physical therapist, clerk and administrative assistant	Lewin’s change model	To understand the contextual factors themselves, surrounding health professions’ ability to change and adopted practices to be sustained	Early involvements of stakeholders and the planning for both the intended and unintended effects can improve the likelihood of change.
Mork47	2018	Qualitative	Pre- and postintervention staff surveys, quality indicators, leadership rounding	592 Academic Medical centre, Wisconsin, USA	24-bed medical/surgical intensive care unit	Kotter’s 8-step	To describe the process of implementing and sustaining complementary quality initiatives in a medical surgical, level 1 trauma intensive care unit (ICU)	Active partnership with the patient and the family during these changes promoted a strong intensive care unit culture of patient- and family-centred care
Radtke54	2013	Qualitative	Survey and Interview	Medical/surgical intermediate care unit, Wisconsin, USA	Patients and Nurses	Lewin’s change model	To determine if standardizing shift report improves patient satisfaction with nursing communication	A rise in patient satisfaction in nursing communication to 87.6%, an increase from 75% in the previous 6 months
Rafman41	2013	Quantitative	Outcome measures	Emergency department, 977 bed national hospital, Singapore,	Emergency department	Kotter’s 8-step	To provide timelier access to inpatient and urgent outpatient specialist care for emergency patients. To influence multiple stakeholders to modify their traditional practices and sustain changes.	Specialist outpatient appointments given within the timeframe requested by the ED doctor increased from 51.7% to 80.8%. Early discharges increased from 11.9% to 26.6% and were sustained at 27.2%. 84% of eligible patients received earlier defined specialist care at the ED. The change management achieved excellent clinician compliance rates ranging from 84% to 100%. Median wait for admission remained unchanged.
Reddeman42	2016	Qualitative	Documentation, direct observation, physical artefacts, interviews, progress metrics and adaptation	Cancer Care Ontario, Canada	14 regional cancer centres	Kotter’s 8-step	To increase peer review of plans for patients receiving radical intent RT.	The initiative is ongoing, but early results indicate that the proportion of radical intent RT courses peer reviewed province wide increased from 43.5% (April 2013) to 68.0% in (March 2015)
Sale64	2019	Case study	Not available	Radiology department, Australia	Radiotherapy department staff	Riches four-stage model of change	To describe the successful move of the radiation therapy department to its new site	The move to the new site was a great success with a transition period working across two sites enabling a slower ramp up of activity at the new site supporting staff and patients in adjusting to the new environment. The four-stage model of change assisted in the smooth implementation of a transition plan for radiation oncology.
Small43	2016	Quantitative	Survey	Isreal Deaconess Medical Centre, Boston, Massachusetts, USA	Surgical orthopaedic trauma unit.	Kotter’s 8-step	To describe the implementation of a bedside handoff process using Kotter’s change model and the DMS to report the implementation effects on nurse compliance, patient and nurse satisfaction, and their perceptions of the process.	Thirty (88%) of the patients reported that a bedside communication occurred between 2 nurses at change of shift. Twenty-nine (96%) were satisfied or very satisfied that nurses per- formed this communication at the bedside. Furthermore, all of the patients expressed satisfaction in the manner the information was shared
Sokol57	2020	Case Study	Surveillance data	Academic health care centre, US	Family medicine clinic	Lewin’s Three-Step Change Theory, and McKinsey 7S Model of Change	Describe our 5-year process of using cultural and structural elements to support change management for safe opioid prescribing and opioid use disorder treatment.	Change management theory to support both safe opioid prescribing and treating patients with OUD over the past 5 years resulted in changes to the practices, people, skills, and infrastructure in the clinic.
Sorensen44	2016	Qualitative	Semi-structured group interview	Ambulatory care clinics, Minnesota, United States of America	Pharmacists and medical practitioners from six health systems with a well-established medication management program	Kotter’s 8-step	To describe the influencing the adoption, growth and sustainability of medication management services	A supportive culture and team-based collaborative care are necessary for medication management services’ sustainability.
Spira61	2017	Quantitative	Surveillance data and surveys	Two hospitals, Uganda	Maternity Departments	Accelerated Implementation Method	To increase the use of intrapartum and postnatal essential interventions (EIs) in two hospitals in Uganda	EIs that were regularly used had no improvement, however, seldom used EIs had a significant improvement in use due to the implementation package of activities developed
Spira62	2018	Quantitative	Surveillance data	Two tertiary teaching hospitals, Nepal	Maternity Departments	Accelerated Implementation Method	To increase the use of intrapartum and postnatal essential interventions (EIs) in two hospitals in Nepal	Only the timely administration of antibiotics caesarean increased, with all other EIs not showing improvement
Stoller46	2010	Mixed method	Randomised control trail, observational and in-person interviews	Respiratory therapy department, Cleveland clinic, Cleveland, Ohio	RCT on 145 patients, 71 RTCS groups and 74 physicians. Interviews on 8 RT department leaders	Kotter’s 8-step, and Silversin and Kornacki’s model - Amicus	Implementing respiratory care protocols to reduce misallocation of respiratory care	There were 11 desired featured to the change. Understanding and embracing change is important.
Tetef58	2017	Multi method	Surveys and feedback interviews	Union hospital, southern California, USA	The organization as a whole	Lewin’s change model and Roger’s diffusion of innovation theory	Implement a successful bronchial thermoplastic program, while maintain patient safety and ensuring staff competency	The program was success at a union level by using Roger’s theory, the BT program was successful because planning and development of the program. Also, with leadership of change which includes acknowledging the feelings and social and emotional aspects of the staff
Townsend45	2016	Quantitative	Retrospective Review	Emergency Department, Southern New Jersey, United States of America	1000 patients per quarter over 2 years	Kotter’s 8-step	To reduce ED falls by implementing fall reduction plan and a specific risk fall assessment	During the first quarter of the intervention there was an increase in falls without injury (potentially due to staff awareness) and a decrease in falls with injury. In the second and third quarters of the intervention, the number of falls significantly dropped, with zero falls with injury in the third quarter.
Westerlund55	2015	Qualitative	Survey and Interview	3 hospitals within a Region in Sweden	Change Facilitation Staff, managers and clinic staff	Lewin’s change model	To achieve a system wide organisational change	The study highlighted the need to clarify the division of roles and responsibilities between managers, facilitators and others, as well as ownership of the change process