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Purpose: This paper seeks to describe the exploration of human resource issues in one large-scale program of innovation in healthcare. It is informed by established theories of management in the workplace and a multi-level model of diffusion of innovations. Design/methodology/approach: A realist approach was used based on interviews, ethnographic observation and documentary analysis. Findings: Five main approaches ("theories of change") were adopted to develop and support the workforce: recruiting staff with skills in service transformation; redesigning roles and creating new roles; enhancing workforce planning; linking staff development to service needs; creating opportunities for shared learning and knowledge exchange. Each had differing levels of success. Practical implications: The paper includes HR implications for the modernisation of a complex service organisation. Originality/value: This is the first time a realist evaluation of a complex health modernisation initiative has been undertaken. © Emerald Group Publishing Limited.

Original publication




Journal article


Journal of Health, Organisation and Management

Publication Date





55 - 72