The analysis of the large group discussion transcripts revealed several key findings/factors that are essential for the faculty to be change agents rather than a change blocker. These findings were organized under four main themes.
Theme 1: Individual factors that help the academic medical faculty to be change agents.
Theme 2: Environmental factors that help the academic medical faculty to be change agents.
Theme 3: System/organizational related factors that help the academic medical faculty to be change agents.
Theme 4: Network/interactions-related factors that help the academic medical faculty to be change agents.
The above themes are elaborated below as follows: Discussion of each key theme with a summary of the findings. This is followed by an expanded description of participants' narratives about their perceptions and experiences. Excerpts from the large group discussion and the actual words used by participants are integrated into these narratives. It is important to emphasize that when a direct quote from a large group discussion participant is used, this is not a random choice. Quotes were selected that represent the views expressed by a majority of participants. The quotes are attributed to the participants (P), who participated numbered from 1 to 30.
3.1 Theme 1: Individual factors that help the academic medical faculty to be change agents.
The majority of the participants agreed that a change agent should have transformational leadership attributes, which depend upon influence and inspiration, not authority, the excitement of the minds of our stakeholders, and empowering others to do the required change. They also indicated that a transformational change agent can help others to understand how to cope with change as he should be the role model having passion, consistency, trust, and vision. One participant (P10) reflected on a real-life experience during establishing a new academic department at his institution and added ‘In providing our support during this change cycle, we adopted transformational leadership which is highly ethical and depends upon influence, not authority and inspiration, not dictation to excite the minds of our stakeholders and empower them to do the required change. Transformational leadership is a suitable leadership style for managing organizational change. In addition, it can assist followers to understand how to cope with change”?
Participants classified the essential skills a change agent should have into three main groups: communication skills, training/presentation skills, and conflict resolution skills. As one participant (P14) stated that ‘In my institution, the leaders during the pandemic crisis were keen to constantly communicate with the staff through two steps which are knowledge to launch the change and knowledge to sustain the change’. Another participant (P9) added that ‘the institutional leaders used the open discussion to convince the staff about the need for change’.
Further elaboration revealed other skills such as professionalism, building rapport, patience, flexibility, empathy, and creativity. They agreed that training is a structured process that provides participants with the knowledge and skills to perform change tasks, and the desire to use them. One of the participants (P18) reflected on his experience “I think I was a good information provider as I used different methods to provide the knowledge, train, educate and work closely with the people and coaching them to acquire the ability to perform effectively.’
By reflecting on their own experiences, most participants discussed the need for the change agent to have a sense of urgency. It was defined as acting promptly and making change happen efficiently and effectively. This sense of urgency can be made up of two parts: i) the extent to which our sense powers (like sight, sound, touch, etc.) perceive a situation or problem is important; and ii) whether that situation or problem requires deliberate versus swift or urgent action. Reflecting a sense of urgency could be done properly by exploring short and long-term outcomes of change and by showing how change could be anchored in the system. One participant (P5) added “Leading a team during a transformation at any level will often require an ability to create an atmosphere of urgency that can, in turn, bring about an atmosphere for success ‘
3.2 Theme 2: Environmental factors that help the academic medical faculty to be change agents.
The participants were asked to describe the characteristics of a “change culture” and to explain how they believed these characteristics could be found. Participants were quick to acknowledge that to build the need for a culture of change there should be a moral purpose in which each change agent should have a responsibility to the organization and the whole environment and should have innovative ideas but also understands that the change process is difficult. The participants also agreed that in cultural change, efforts to motivate and energize low-participants and improve relationships between people can have a significant effect on the whole institutional change. One participant (P1) explained that “Culture is the spirit of the organization, the change agent should build a culture of continuous improvement and change”. They have also summarized the different factors that may contribute to the changing culture in developing a change agent as shown in Fig. 3
Additionally, participants described the change-resistant environment as a major obstacle to change. They have discussed the reasons for resistance and identified the lack of awareness about the need for change, lack of agreement and proper communication, and lack of motivation. As one participant (P22) highlighted "I spent most of the time struggling with the minds of the people to convince them about the need for change “awareness” and asking them for support due to its benefits for all “desire”. Another important reason for creating this resistant environment, as indicated by the participants, is the tendency of the change agent to focus on a single person rather than the entire team as well as a resistant culture may be fueled by political, economic, and social factors opposing the change.
Furthermore, the participants discussed the importance of an environment that allows the existence of a coherent team comprising various important roles. They also agreed on the essential elements that could guarantee team members’ commitment to change including the creation of competition, regular positive feedback, recognition, rewards, incentives, celebrating progress, and recognizing success. These sentiments are captured in the comments of one participant (P26) who explained “It is one of my own experience as the dean help any member of academic staff in his/her research but a special reward for me was the provision of an extra-help in my research by giving me a vacation to continue my studies longer than given and it was a reward for sharing in extra-time teaching in college”
3.3 Theme 3: System/organizational related factors that help the academic medical faculty to be change agents.
Participants in the large group discussion were asked to elicit the system/organizational-related factors that help faculty to be change agents. They highlighted the role of institutional vision. The participants agreed that the destination to make people agree to change is developing and communicating a shared vision, which is an ongoing process that can occur at every stage in a change process. One of the participants (P10) added that “Shared vision will serve as a shared language and shared imagination for the future of the institution, additionally it makes the stakeholders feel as they own the change project rather than they will be affected by it”
Furthermore, the vision should be based on an accurate analysis of the current situation and should empower others to act on goals and eliminate obstacles. The participants outlined essential steps that the system could follow to lead a change including raining the feeling of urgency, starting with small goals and short-term objectives to finally achieve a bigger one, considering creativity, persistence, building strong teams, creating short-term wins, and incorporating change. Many participants acknowledged the importance of developing Key Performance Indicators (KPIs) to evaluate the change results and also measure the efficacy and effectiveness of the whole process. One of the participants (P16) reflected on his experience on introducing a new teaching method and highlighted the importance of the evaluation of the change results “After doing the change we checked the performance of the demonstrators in sections and the feedback of students for doing the experiments of physiology by using this virtual lab software”. Additionally, different evaluation models could be adopted, and results should be announced and communicated. Quick wins should be assessed regularly and solve any detected obstacles immediately. The previous concept is captured in the words of participant (29) “Change management requires a strong system that should set comprehensive plan to avoid resistance and to anchor change”.
3.4 Theme 4: Network/interactions-related factors that help the academic medical faculty to be change agents.
Here, the participants agreed that any change agent could not work alone, instead, he/she needs people who believe in them and are ready to take the initiative for change. These people also should show enthusiasm to adopt new behaviors and concepts and disseminate them to others. The participants agreed that a change agent should be a role model and a good communicator having strong social connections to enable him to recruit a strong supportive team. A significant role play in this team is the innovators. According to one participant, the innovators are pushing the process of change to adapt to the present situation. Another participant (P14) added ‘Innovators are considered one of the essential endeavors in the education and teaching challenges. As from my vision, any change to happen needs the collaboration of the innovators whom the wheel of change can rotate, and the change comes to the light.’
Essential techniques to engage the targeted community in the change, as explained by the participants, are witnessing real short success and quick wins as well as recruiting a team of change adopters including public figures/ charismatic leaders who can recruit and inspire more people to be change adopters. However, one of the participants (P26) added “Diffusing the reform beyond early adopters could be another way for making reform part of the institutional culture and reach to all the faculty members within the institutions.”
The group participants indicated that important network-related barriers to change are the presence of skeptics and the inability to find the required supportive team. The skeptics were identified as the people who are highly suspicious of any information that challenges their points of view and own beliefs. The participants suggested strategies to dealing with the skeptics including understanding their intentions and the underlying reason that is directing their acts, involving them in each step may enable them to empathize, build a rapport, and learn more about their hobbies, their family, and their lives. One participant (P 20) suggested “Do not give up on the skeptics. Instead, understand their concerns and hesitations. Meet them where they are and show them the way. If all attempts fail, the best way might just be to ignore them. Get on your daily tasks and interface with the person only where needed.”
A lack of involvement in change was also identified as another important barrier. It may result in relapse/resistance to change. However, it can be easily avoided by early involving all stakeholders in the whole process of change, appreciating their opinions and efforts, asking for their opinions, selecting those who are interested and recruiting them to play major roles in the change process, encouraging discussions and continuously ask for feedback, and finally proper orientations and training. This view was echoed among most of the participants (P 2) “In my opinion, one of the main reasons of the relapse that occurred in my institution regarding online learning is non-involving of the staff members in the process of change and just asking them to implement those changes without proper orientation or training.”
By the end of the group, the participants have concluded the discussion by providing tips for a faculty to be a successful change agent as shown in Fig. 4.