Faculty of Health Sciences, The University of Western Ontario,
London, Canada
Abstract
Purpose – To explore the shared experience of organizational change from centralized allocation and control of services and resources to an empowering partnership approach to service delivery in one
Canadian home care program.
Design/methodology/approach – Applying an interpretive phenomenological design, data from in-depth interviews with a purposeful sample (n ¼ 28) of providers, clients and informal caregivers were analysed using hermeneutic techniques, and validated by member checking and peer review.
Findings – The overall experience of change was comprised of two dynamic change patterns: extrinsically introduced organizational development, facilitated by contextual factors; and intrinsically developed transformational change, impeded by the same contextual factors. The patterns together comprised participants’ enactment of an answer to the existential question, “To have or to be?”
Research limitations/implications – While interpretive research does not elicit generalizable results, the findings of this study illuminate the importance of choosing change strategies appropriate for the intended change, addressing what the change may mean to all involved, and confronting the contextual factors that undermine the change.
Practical implications – New strategies are needed if engrained attitudes, values and beliefs about professional service delivery are to be changed.
Originality/value – The interpretation exposes the nature of professional practice in health and social services, the impact of this work context on practice, and concrete strategies for managing organizational change.
Keywords Organizational change, Health services, Home care, Social services, Canada
Paper type Research paper

Introduction
Declining resources and organizational restructuring distract attention from efforts to develop more client-centred, empowering partnership approaches to health and social services delivery (Falk-Raphael, 1996; Montgomery, 1993; Stewart et al., 2003). Yet in the field of home care, heightened consumer expectations and evaluations of approaches affording clients greater autonomy and voice in their care at home (Alberta
Ministry of Health, 1993; Manitoba Ministry of Health, 1994; Saskatchewan Health,
This interdisciplinary study was funded by the Medical Research Council of Canada and the
Canadian Institutes of Health Research. The findings and conclusions are those of the authors.
No official endorsement by the funding bodies should be concluded, nor should it be inferred.
The authors wish to acknowledge the technical assistance of Ms Lisa Tran with the preparation of Figure 1.

Journal of Organizational Change
Management
Vol. 19 No. 2, 2006 pp. 119-135 q Emerald Group Publishing Limited
0953-4814
DOI 10.1108/09534810610648861

JOCM
19,2

120

1996) support change in this direction. The limited research evidence suggests that clients demonstrate potential for involvement (Fast and Chapin, 1996), but changing care approaches to empower them as partners in care may be slow (England and
Evans, 1992), stressful (Charles et al., 1996) and impeded by organizational barriers
(Ferronato, 1999; McWilliam et al., 1994, 2001).
Publicly funded home care programs in Canada currently confront this dilemma.
Their services normally are delivered in a brokerage model by a diversity of service providers with varying degrees of client involvement in their care. Providers include case managers, often nurses or social workers by professional background, who assess client needs, and based on their assessments, decide, access, coordinate, monitor and control amounts and timeframes of resources and services. These case managers act as brokers, contracting direct in-home service from other provider groups, including professional nurses, occupational, physical and speech therapists, and social workers,
and