Applying Change Models and Methods During a Period of Vast Digital Transformation: A Systematic Review of Practice in Healthcare

INTRODUCTION: Reflection and learning about the use of virtual care in healthcare delivery has become a central goal for health systems internationally. Insights drawn in the aftermath of the COVID-19 pandemic have led to vast changes to embed virtual care in health care delivery. This study explored the methodologies used to manage change that encompasses virtual care and factors contributing to success. METHODS: A systematic review and narrative synthesis was undertaken. Eligible articles were those reporting structured change management processes in the context of virtual care published between 1st January 2019-31st December 2023, identified by searching four electronic databases (Scopus, MedLine, PsycInfo and Business Source Premier). Data were extracted and synthesised from the eligible studies. RESULTS: Seventeen studies met inclusion criteria describing changes occurring within hospital settings or in community health centres. Kotter's 8-Step Model was the most frequently applied change framework, often combined with other approaches. Commonly enablers included high quality communication among all parties involved and strong leadership. Common barriers included overemphasis on technology at the expense of people and processes, linear application of models, and lack of mechanisms to monitor change progress. DISCUSSION: Structured change methodologies were often integrated in a strategic change framework with process improvement methods utilised to support the change process. Managing change relating to the technology with attention to the clinical and people aspects of change was considered a key gap and challenge in the context of virtual care change. Change leadership and the integration of technical and clinical teams were identified as key enablers.