Prior to 1994, the South African Health Department was characterised by a fragmented health care system, which was largely curative and hospital based, with services planned and managed without community involvement and participation. The government, through the establishment of a district health system, integrated the health services with the aim of overcoming the fragmentation, and providing integrated comprehensive health care services that are equitable, accessible, efficient and effective. The integration of health services in Gauteng, meant the devolution of primary health care services from the provincial health department to the local authority health department, because the local authority services are nearer and accountable to the community. The process of integration of health services also meant the closing down of provincial clinics and transferring of provincial authority nurses to the local authority clinics. The transfer process impacted negatively on staff morale and on the resources available for health care delivery to the communities. It is against this background that the researcher decided to investigate the integration process. The researcher then conducted focus group interviews with the local authority nurses, provincial authority nurses and the district management team as these nurses's immediate supervisors. The results revealed that the local and provincial authority nurses were integrated without proper consultation and as a result integration was rejected. The following themes emerged from the results as negative perceptions and obstacles towards integration: lack of consultation, disparities in conditions of service and resistance to change. Positive perceptions also emerged from the results as strategies to improve the integration, and these strategies were used to develop guidelines to operationalise the model. It is envisaged that the proposed model will serve as a theoretical framework for nurse managers from both spheres of government, local and provincial to improve the integration of nurses through proper consultation, and involvement of nurses in the process affecting them. It is further envisaged that the model will serve as guideline to introduce changes within the district health system with more understanding and acceptance by nurses affected. Health care managers will find the model useful to overcome disparities in conditions of service among nurses and, in turn this may boost the moral of nurses and lead to successful integration of provincial and local authority nurses. / Health Studies / D.Litt. et Phil (Health Studies)

Syfte: Syftet med studien är att undersöka hur mellanchefer kan hantera motstånd inom offentliga organisationer i samband med organisationsförändringar. Studien ämnar vidare undersöka vilka förutsättningar som mellanchefer behöver från ledningen för att hantera medarbetarnas förändringsmotstånd. Frågeställningar: • Hur använder mellanchefer i offentliga organisationer sitt ledarskap för att hantera förändringsmotstånd? • På vilket sätt påverkas mellanchefer i samband med organisationsförändringar i offentliga organisationer? Metod: I studien har en kvalitativ forskningsdesign använts. Sex stycken semi-strukturerade intervjuer har genomförts på två olika statliga myndigheter. Genom teoretiskt tematisk analys har empiri analyserats. Empirin har kodats utefter relevanta begrepp och teorier. Slutsats: Studien har påvisat att kommunikation är viktigt genom hela förändringsprocessen, både gällande att informera om förändringen och dess betydelse, men också för att möjliggöra att en dialog kan föras med medarbetare kring deras upplevelse av förändringen. Studien har även funnit att medarbetarinvolvering och delaktighet är viktigt men att detta behöver motiveras och mellanchefer behöver även informera om vad delaktighet innebär för att medarbetare ska ha rätt förväntningar. Delaktighet, kommunikation och hanteringsverktyg är delar som myndigheter behöver arbeta med på olika nivåer. Detta för att mellanchefer ska kunna ha rätt förutsättningar för att kunna hantera motstånd i förändring. / Purpose: The purpose is to examine how middle managers can manage resistance in state agencies. The purpose is also to examine the conditions middle mangers need to manage employees’ resistance to change. Research questions: • How does middle mangers use their leadership in managing resistance to change in state agencies? • How does organizational change in state agencies affect middle managers? Method: The authors conducted a qualitative method for this study. The authors preformed six semi-structured interviews with middle managers working in two different state agencies. Empirical evidence has been analyzed through theoretical thematic analysis. The empirical data was coded along relevant concepts and theories. Conclusion: The need of communication is very important through the whole change process. Communication in this case includes both giving information about the change but also to give employees the opportunity to express their feelings about the change. It is also important for middle managers to involve employees in the change. The involvement needs to be motivated and middle managers also need to communicate what employees can expect from their involvement. Involvement, communication and strategies for dealing with resistance to change are vital parts that needs to be handled on all levels in the organization.This is important because it will enable the right conditions for middle managers to handle resistance to change.

Small business operations contribute to economic growth and account for 110 million new jobs in the United States. Despite the increase in the number of businesses created in the United States, some business leaders fail to manage change effectively. The purpose of this multiple case study was to explore the strategies that some leaders of small businesses used to reduce employees' resistance to change. Lewin's 3-phase change theory served as the conceptual framework. The target population consisted of 3 successful leaders of small businesses in the central and southern region of Texas. Each participant had more than 5 years of experience and successfully used strategies to reduce employees' resistance to change in the workplace. Data were collected from semistructured interviews, review of company documents, and observations. Thematic coding, text/word queries, and a cross-case analysis revealed three central themes: communication, support, and evaluation. The implications of this study for positive social change include engaging employees in the change process, which might enhance the work environment and reduce employee stress and resistance to change. An improvement in a business leader's change management initiatives may generate beneficial outcomes for the businesses that may improve community growth through increased local employment rates.

Prior to 1994, the South African Health Department was characterised by a fragmented health care system, which was largely curative and hospital based, with services planned and managed without community involvement and participation. The government, through the establishment of a district health system, integrated the health services with the aim of overcoming the fragmentation, and providing integrated comprehensive health care services that are equitable, accessible, efficient and effective. The integration of health services in Gauteng, meant the devolution of primary health care services from the provincial health department to the local authority health department, because the local authority services are nearer and accountable to the community. The process of integration of health services also meant the closing down of provincial clinics and transferring of provincial authority nurses to the local authority clinics. The transfer process impacted negatively on staff morale and on the resources available for health care delivery to the communities. It is against this background that the researcher decided to investigate the integration process. The researcher then conducted focus group interviews with the local authority nurses, provincial authority nurses and the district management team as these nurses's immediate supervisors. The results revealed that the local and provincial authority nurses were integrated without proper consultation and as a result integration was rejected. The following themes emerged from the results as negative perceptions and obstacles towards integration: lack of consultation, disparities in conditions of service and resistance to change. Positive perceptions also emerged from the results as strategies to improve the integration, and these strategies were used to develop guidelines to operationalise the model. It is envisaged that the proposed model will serve as a theoretical framework for nurse managers from both spheres of government, local and provincial to improve the integration of nurses through proper consultation, and involvement of nurses in the process affecting them. It is further envisaged that the model will serve as guideline to introduce changes within the district health system with more understanding and acceptance by nurses affected. Health care managers will find the model useful to overcome disparities in conditions of service among nurses and, in turn this may boost the moral of nurses and lead to successful integration of provincial and local authority nurses. / Health Studies / D.Litt. et Phil (Health Studies)

This study focuses on four common factors believed to affect resistance to change in public organizations. It contributes to existing literature by examining the effect of higher education and trust on the police officer's level of resistance to change and the effects of participation and communication on trust. 286 police officers from two north Texas towns responded to the survey. Regression analysis and bivariate correlations were used to determine the relationship between, resistance to change, and participation, trust, communication, information, and education and the relationship between trust and the other independent variable. The analysis failed to support previous research, which listed participation as the most important factor, but did support the concept that participation and communication improved trust.

Experimentos têm mostrado que ratos criados isolados consumem mais álcool durante a idade adulta que ratos criados em condições de interação social; no entanto, poucos experimentos têm explorado os efeitos do isolamento sobre a persistência na procura de álcool. A presente serie de estudos avaliou os efeitos do isolamento em etapas iniciais do desenvolvimento sobre a persistência na procura de álcool em contextos associados à sua entrega. Nos estudos, ratos foram distribuídos imediatamente depois do desmame em duas condições alojamento: isolamento (ISO) e interação (INT). Na idade adulta, os ratos foram treinados em esquemas múltiplos nos quais diferentes contextos de estímulos foram associados a diferentes taxas de entrega de álcool -magnitudes ou a reforçadores diferentes-. A persistência na procura de álcool foi avaliada como resistência à mudança em sessões de extinção. No Capítulo I foi avaliada a persistência em contextos associados a diferentes frequências de entrega de álcool. Foi achado que ratos ISO mostraram maior persistência que ratos INT em contextos associado a frequências altas e baixas de entrega de álcool. No Capítulo II foi estudado o efeito da concentração (5% ou 15%) de álcool sobre a persistência do comportamento de procura. Os resultados mostraram que concentrações altas de álcool geram maior persistência do comportamento de procura, embora gerem taxas baixas de resposta na linha de base. No capítulo III foram realizados dois estudos nos quais foi achado que ratos criados em isolamento persistem mais em contextos associados a concentrações altas de álcool (Experimento 3) e que o isolamento afeta particularmente a procura em contextos associados ao álcool quando comparados com contextos associados a outros reforçadores (Experimento 4). Os achados gerais demonstram que o isolamento em etapas inicias do desenvolvimento incrementa tanto o consumo quanto a persistência na procura por álcool, o que sugere que o estresse social em etapas iniciais do desenvolvimento é um fator de risco para o desenvolvimento de dependência ao álcool / Several experiments have shown increased alcohol consumption in rats reared in social isolation compared to rats reared in group conditions; however, few experiments had explored the effects of social isolation on persistence of alcohol seeking. The studies presented here assessed the effects of social isolation on persistence of seeking in alcoholrelated contexts. For the studies, rats were assigned to on of two conditions after weaning: Social Isolation (ISO) or social Interaction (INT). During adulthood, rats were trained within a multiple schedule of reinforcement, in which different contextual stimuli were related to differential frequencies, magnitudes or qualities of alcohol. Persistence was assessed as resistance to extinction in extinction sessions. Chapter I measured persistence by ISO and INT rats in contexts related to high and low rates of alcohol reinforcement. It was found that ISO rats persisted more than INT rats regardless of the frequency of reinforcement. In Chapter II was studied the effect of alcohol concentration (5% and 15%) on persistence of alcohol seeking. Results showed that high alcohol concentrations are related to higher persistence during extinction. Chapter III presented two studies that found that ISO rats are more persistent in contexts related to high alcohol concentrations (Experiment 3), also that isolation differentially increased persistence in contexts related to alcohol compared to contexts related to other reinforcers (Experiment 4). General findings show that social isolation increase both consumption and persistence in alcohol related contexts, suggesting that social stress early in the development could be a considered a risk factor for alcohol use disorders

To stay competitive in today’s business environments companies have to adapt to the fast-changing business conditions. Hereby change management plays an important role; companies and consultants often apply certain change models to plan and implement change projects. The two change models by John Kotter, published in 1996 and 2014 are one of the most famous and most often applied ones. Within this thesis, the authors developed a modified change management model where they developed Kotter’s ideas further and enlarged them with new perspectives that were not included before. Resistance to change is considered in the new approach from a positive perspective, which means that it is seen as an opportunity instead of being an obstacle. Besides that, the modified change model includes several leadership aspects that were neglected in Kotter’s change models. New leadership aspects are reflection, a concrete leadership style, sensemaking, as well as the different leadership characters between female and male leader. Out of these new insights, the authors developed a modified change model, which allows to plan and manage the change project better than before.

As organizations strive to remain competitive despite economic pressures and the rapid pace of technology innovation, Enterprise Resource Planning (ERP) systems provide businesses with the functional best practices and customisable capabilities they need to adapt to these changes. However, the high rate of failure of these Enterprise Resource Planning (ERP) systems remain a challenge for the managers who are usually tasked with ensuring the huge investments achieve its purpose and yield a return on investment. In attempting to explain the reasons behind these Enterprise Resource Planning (ERP) implementation failures, previous research has identified user adoption as one of the main drivers of ERP implementation success. An abundance of technology adoption theories and change management models have been proposed as solutions to user adoption, by measuring different factors they consider are important to the adoption of these systems. However, ERP systems still fail to achieve their intended purpose because these theories have not been able to explicitly explain how these factors impact on adoption. To address this gap, this research takes a comprehensive approach to identifying the change management influences on user adoption by integrating change management and technology adoption constructs. The main contribution of this research is a common-sense perspective of the realities of user resistance. The study provides a causal model derived from Structural equation modelling, which explains the multiple influence relationships between the measured constructs. An adoption tool is also developed for managers to use as a yardstick to benchmark the effectiveness of an implementation strategy. Using a structural equation modelling approach, a theory was developed from a survey of 616 ERP users across 6 organizations. Six constructs were identified as the key influences of user adoption – Trust, Communication and Engagement, System Qualities, Training, Organizational Benefits and Resistance. The theory explains the multiple influence relationships between these constructs and Adoption, and assists in the pinpointing of failure points that need to be addressed by Enterprise Resource Planning project managers. The resulting theory developed indicates the multiple influence relationships between these constructs as determinants of Adoption of ERP systems. In addition, the theory assists in the pinpointing of failure points that need to be addressed by Enterprise Resource Planning (ERP) project managers.

Drawing upon punctuated equilibrium theory, stakeholder salience theory and status quo bias theory, this research develops a framework for dealing with organisational change recipients’ resistance to change. Due to the effects on the organisational environment of political, legal, and technological triggers, organisations need to change in order to survive, remain competitive and prosper. However, deploying a given organisational change, and in particular radical change, is challenging for change managers. A major reason for this is change recipients’ resistance to change. Therefore, this research advances understanding of how to cope with change recipients’ resistance in times of organisational change, and specifically radical planned change i.e. reorientation. To do so, this research develops a framework that incorporates the salience level of change recipients in relation to reorientation program, which has not been considered in prior studies, in association with the modes and causes of their resistance to change to identify relevant strategies that address their resistance to change. The research methodology adopted for the research is qualitative case study. The findings are derived from 30 semi-structured interviews along with relevant documents from two cases (14 interviews from Case A and 16 interviews from Case B) that implemented an organisational reorientation program. The findings reveal that the three attributes of stakeholder salience theory (i.e. power, legitimacy, and urgency) are inadequate to identify the salience of change recipients in relation to change. In addition to these attributes, a further attribute is required, which defines the extent to which change recipients are affected by change namely the attribute of impact. Furthermore, the findings introduce seven strategies (negotiation and agreement, education, implicit coercion, persuasion by peers, two-way communication, facilitation, and rewards) that are effective for overcoming the resistance to change of recipients who belong to six salience classes and resist change for different reasons and to various levels. These findings make a theoretical contribution to each of the theories employed in the research, punctuated equilibrium theory, stakeholder salience theory, and status quo bias theory, as well as the extant literature regarding strategies to cope with change recipients’ resistance to change. The findings have implications for practice by introducing a diagnostic tool that change managers can use to explore the modes and causes of change recipients’ resistance as well as their levels of salience in relation to change.

Um comportamento é dito mais resistente à mudança quanto menor for a alteração observada diante de modificações ambientais. Assim, estudos sobre resistência à mudança têm investigado a alteração do comportamento após a inserção de algumas operações que podem mudar comportamento que está em curso (evento perturbador). Essa proposta pode ser eficaz em investigações voltadas aos efeitos do consumo de drogas, como por exemplo, o etanol, que estimula determinadas áreas do Sistema Nervoso Central, responsáveis por possíveis alterações no valor reforçador de estímulos. O presente trabalho teve como objetivo avaliar se a presença do etanol acarretaria em alguma alteração diferencial nas condições com diferentes taxas de reforço e se sua presença e ausência poderiam ser caracterizadas como um evento perturbador. O Experimento I constou de duas partes. Na primeira parte foi analisada a função do etanol como evento perturbador. Dez ratos autoadministravam por via oral (gelatina) etanol (ET) 10% ou maltodextrina (MALTO) antes de sessões experimentais de treino de pressão à barra sob um esquema múltiplo VI 15 s-VI 45s. Na segunda parte, a pressão à barra foi colocada em extinção, mas as condições de autoadministração das substâncias foram mantidas para observar o efeito do etanol sobre a resistência à mudança dessa resposta. O Experimento II teve como objetivo avaliar o efeito da retirada de ET depois de intoxicações aguda e crônica. O experimento constou de duas partes. Na primeira, uma única dose de 20% de ET foi administrada por gavagem a ratos (n=9) previamente treinados sob o esquema múltiplo VI-VI; após 12 e 36 horas da administração, a resposta de pressão a barra sob o esquema múltiplo VI-VI foi observada. Na segunda parte, os mesmo ratos autoadministraram a cada 12 horas gelatina de ET a 10% por 21 dias; após 12 e 36 horas da administração, a resposta de pressão a barra sob o esquema múltiplo VI-VI foi novamente estudada. Os resultados do Experimento I indicaram que as doses consumidas de ET (10g/Kg) não tiveram função de evento perturbador. Quando houve algum efeito de queda ou aumento das taxas de respostas, esse não foi observado apenas no componente correlacionado com maior taxa de reforço, mas sim em ambos. Quanto à administração de ET na resistência à mudança empregando-se extinção como evento perturbador, não se obteve qualquer alteração. Contudo, quando a análise foi voltada à administração da gelatina, fosse com MALTO ou ET, houve diferentes efeitos em relação à fase de linha de base. Na primeira fase do Experimento II (retirada após intoxicação aguda) foi observado que a retirada do etanol teve efeito de evento perturbador apenas para sessões após 12h, mas não após 36h. Na segunda fase (retirada após a administração crônica) não houve efeito de retirada: os ratos continuaram se comportando de maneira semelhante aos dias com etanol. A retirada do etanol somente após a administração aguda apresentou tal efeito, que pode ser explicado devido ao efeito rebote de sua remoção do organismo, que foi observado somente após poucas horas do término do consumo (12 horas). Esse efeito rebote parece ter sido alterado pela taxa de reforço estabelecida nas condições do presente experimento (menos alterada ix na condição com maior taxa de reforço). Essa diversidade de resultados pode ter sido em função das diferenças entre consumo agudo e crônico ou por diferenças nas vias de administração empregadas / A behavior is considered resistant to change as the smallest change is observed before environmental modifications. Therefore, studies on resistance to change have investigated the change in behavior after the administration of some operations which can change the behavior in course (disrupting operation). This approach can be effective regarding investigations related to the effect of drug consumption such as ethanol, which stimulates specific areas in the Central Nervous System responsible for modifications in the reinforcement value of reinforcing stimuli. Thus, the purpose of the present study was to evaluate if the presence of ethanol would bring on any differential alteration in the reinforcement value of conditions with different rates of reinforcement and if its presence could be seen as a disruptive operation. Experiment I consisted of two parts. In the first, the function of ethanol as a disruption operation was analyzed. Ten rats self-administered orally (gelatin) ethanol (ET) 10% or maltodextrin (MALTO) before trial sessions of bar pressing training under a multiple VI 15 s-VI 45 s schedule. On the second part, the bar pressing was in extinction, but the conditions of the self-administration of the substances were maintained to observe the effects of ethanol on the resistance to change of this response. The purpose of Experiment II was to evaluate the effects of ET withdrawal after acute and chronic intoxications. The experiment was divided into two parts. On the first, a single dose of 20% ET was administered by force feeding to rats (n=9) previously trained under multiple schedules VI-VI; after 12 and 36 hours of the administration, the response bar pressing under the schedule VI-VI was observed. On the second part, the same rats self-administered every 12 hours ET gelatin at 10% for 21 days; after 12 and 36 hours of administration, the response bar pressing under the multiple schedule VI-VI was assessed. The results from Experiment I indicated that the consumed doses of ET (10g/Kg) did not function as a disrupting operation. When there was some effect or increase in response rates, it was not only observed in components co-related to a higher reinforcement rate, but in both. Regarding the administration of ET related to resistance to change when employing extinction as a disruption operation, there was no alteration. Nonetheless, when the analysis was directed to the administration of the gelatin either with MALTO or with ET there were different effects related to the baseline phase. On the first phase of Experiment II (withdrawal after acute intoxication) ethanol withdrawal had the effect of a disrupting operation only during sessions after 12hr, but not after 36hr. On the second phase (withdrawal after chronic administration) there was no effect of the withdrawal: rats continued to behave on the same way as they did on the days with ethanol. The ethanol withdrawal only presented such an effect after the acute administration which can be explained due to the rebound effect of its removal from the organism, which was observed only a few hours after the end of the consumption (12 hours). This rebound effect seems to be changed through the reinforcement rate established on the conditions of the present xi Experiment 2 (unless changed in the condition with the highest rate of reinforcement). The same results were not observed after the end of the chronic administration of the ethanol. This difference in results could be due to the differences between acute and chronic consumption or the differences in the methods of administration employed