Successful implementation of change in postgraduate medical education – a qualitative study of programme directors

INTRODUCTION: Leaders in postgraduate medical education are responsible for implementing educational change. Although difficulties in implementing change are described both in the general leadership literature as well as in the field of medical education, knowledge of what characterises successful change leadership in postgraduate medical education is limited. The aim of this study is to explore the process used by educational leaders in successful change implementation in postgraduate medical education. METHODS: Semi-structured interviews were conducted with 16 programme directors to explore how they had implemented successful change projects. The sample consisted of programme directors who had reported in a previous survey having high educational impact at their workplace. Interviews were analysed using Ödman’s qualitative interpretative method. RESULTS: The interviews identified similarities in how participating programme directors had implemented changes. Five interconnected themes crystallised from the data: (1) belonging to a group, (2) having a vision and meaning, (3) having a mandate for change, (4) involving colleagues and superiors, and (5) having a long-term perspective. CONCLUSIONS: Our findings illuminate important aspects of successful change management in postgraduate medical education. Change is ideally based on a clear vision and is implemented in coalition with others. A long-term strategy should be planned, including involvement and anchoring of key persons in several discrete steps as change is implemented. While some of these findings are congruent with the general literature on change management, this study emphasises the importance of a mandate, with successful change leadership dependent on coalition and the facilitation provided by the next level of leadership.