An Integrated Process Model of Change: An Iterative Grounded Study of Change in Health Systems in India

19 Pages Posted: 27 Feb 2014 Last revised: 24 Apr 2014

Date Written: February 25, 2014


Health systems undergo demographic and with it associated epidemiological transition. They thus need manage change associated with this, which is continuous, incessant and speed and magnitude of change being dependent upon a multitude of contextual factors. Change management in health systems is a less researched and understood subject, given the large scale presence of inequalities in distribution of health care indices. Addressing inequalities in health care services delivery is thus a major cause of concern for both researchers and practioners.

This multiple case embedded processual study compares the performance of two state health systems over time and how they have tackled the issue of change associated with the epidemiological transition they encountered.

Critically, it posits that, to manage the requirements of transition, Health systems need to show a functional cognitive architecture which would maintain the attention of policy makers to the changes occurring in the health needs of the population, convert them into health interventions and its service delivery components, give direction to their macro processes to generate, allocate, distribute required resources and finally position appropriate administrative mechanisms to ensure execution resulting in desired health outcomes. Thus implementation of change is a function of Attention, Direction and Governance of health policy/programmes.

It contributes to health care literature by giving a practitioner oriented model and posits that the model needs to be structured into the health systems if they are to successfully handle epidemiological transitions.

Keywords: Health systems transition, Change management, cognitive architecture, processual study, India

Suggested Citation

Narayana, Bhyrovabhotla V. L., An Integrated Process Model of Change: An Iterative Grounded Study of Change in Health Systems in India (February 25, 2014). Available at SSRN: or

Bhyrovabhotla V. L. Narayana (Contact Author)

Centre for Railway Information Systems ( email )

Centre For Railway Information systems , chanakya
New Delhi, delhi 110021
9971077115 (Phone)
9971077115 (Fax)

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