LAUSR

In our longitudinal, in-depth case study of strategic change within the English National Health Service we compare three practices related to contracting healthcare services. Contrary to what we would have believed from the extant literature, we found that the most profound change did not emerge in practices that witnessed the greatest increase in the quantity of resources or in which change agents were given the highest degree of control. Instead, change emerged in a practice that was not treated as a priority and that subsequently attracted interest from a very limited number of individuals. Our findings contribute to the resourcing literature by showing that the ability to use resources is shaped by how they are valued and distributed and that strategic change initiatives can act as triggers for resource revaluations and redistributions. Specifically, we demonstrate that strategic change initiatives may contribute to the emergence of favorable conditions for change in practices that do not become associated with valued resources. This is because a lack of valued resources attracts limited interest from stakeholders, thereby allowing changes to emerge as powerful agents face minimal coordination costs and scrutiny when attempting to align arrangements with their own interests. Our study thereby shows how and why change initiatives can trigger divergent developments across multiple practices and lead to change emergence in unexpected places. It also highlights the role of what we call resourcing space in contributing to emergent change.