Attitudes toward Organizational Change Strategies among Healthcare Professionals and Administrative Staff: An Applied Study in King Fahd Medical City, Riyadh

In the face of the rapid modernization across various domains, organizations of all types are encountering significant challenges that necessitate continuous renewal. This organizational adaptation is crucial for staying abreast of changing societal needs and involves enhancing institutional capabilities and performance to maintain sustainability and excellence [1].

The change within an organization can manifest in numerous forms. It may involve the introduction or cessation of businesses or activities, an amalgamation of activities, alterations in the size of the workforce, technological advancements through machine augmentation, policy changes, modifications in work methodologies, procedures, or organizational structures. Such changes could also include the reconfiguration of administrative units, the establishment of new departments, or merging of departments [2].

Within the healthcare sector, hospitals exemplify organizations that strive for success and continual care service provision. However, their success pivots on their ability to adapt swiftly to ongoing advancements in medical research, treatment modalities, and technological innovations [3].

Despite the imperative and significance of change, it often encounters resistance due to its disruptive nature. Such resistance is a natural response and can stem from multiple sources, including individual personality traits, psychological factors such as fear of the unknown, anticipated failure, or concerns about skill development in a new environment [3]. Other potential resistance sources could be related to the approach adopted for change implementation or individual perceptions of the change itself [3]. Therefore, when implementing change, organizations may encounter varying levels of resistance. Thus, it is incumbent upon management to strategize effectively, plan thoroughly, and develop methods to attenuate individual resistance, thereby ensuring successful change implementation [4].

There are principally four management strategies for organizational change (OC), which include re-educative, persuasive, facilitation, and power-coercive [5, 6]. The re-educative strategy involves providing objective facts and information to organizational workers, with the assumption that these individuals are rational and capable of evaluating the information, consequently modifying their behavior as necessary [7]. The persuasion strategy, on the other hand, instigates change through intentional bias in the presentation of data and information to individuals, emphasizing the “selling” of the idea to be adopted through manipulation and policy [6]. The facilitation strategy operates on the premise that organizations have acknowledged the problem and established a treatment plan, are open to external help, and are eager to rely on self-change efforts, typically employing team building, sensitivity training, and specialized advice [8]. Lastly, the power-coercive strategy leverages penalties and coercion to ensure the implementation of change, relying heavily on individual compliance. The effectiveness of these strategies hinges on the degree of individual dependency within the organization [9].

Although contemporary organizations strive for sustainable results [3], the successful execution and realization of OC largely depend on employees’ disposition toward such changes. This disposition may elicit a positive response, facilitating acceptance, support, and collaboration in the change implementation. Conversely, a negative reaction could lead to resistance and nonacceptance. While OC has been widely studied, much of the existing literature focuses on Western or generalized global contexts, often overlooking the intricate role of cultural, institutional, and professional dynamics in shaping employee attitudes. For instance, research indicates that cultural values significantly mediate OC outcomes, influencing factors such as leadership perception and employee engagement [10]. Additionally, studies highlight that organizational culture impacts the successful implementation of Total Quality Management initiatives, with region-specific nuances playing a critical role [11, 12]. This gap is particularly evident in Saudi Arabia, where healthcare systems are undergoing rapid transformation under the Vision 2030 framework, aimed at improving service delivery and operational efficiency. The distinct cultural context – characterized by hierarchical structures, collectivist values, and varying professional norms – demands tailored change management approaches that differ from global models. Our study contributes to filling this gap by examining how Saudi healthcare employees at King Fahad Medical City (KFMC) perceive and respond to OC, offering insights that can guide more culturally sensitive and effective change management strategies in the region.

KFMC is a prominent healthcare provider in Saudi Arabia, playing a crucial role in delivering essential health services to the community. In line with national healthcare reforms and technological advancements, KAMC is undergoing OCs aimed at enhancing operational efficiency and service quality, which inevitably impact employees’ roles and responsibilities. Understanding their attitudes is critical to designing strategies that foster acceptance, mitigate resistance, and ensure the successful implementation of OC. Given this context, the current study explored the attitudes of healthcare professionals and administrative staff at KFMC, Riyadh, Saudi Arabia, toward OC. It is specifically interested in understanding preferences for diverse management strategies, including re-educative, persuasive, facilitation, and power-coercive approaches and their association with acceptance or resistance to OC. In addition, it analyzed the interference of demographic and professional factors with attitudes toward OC and further preferences for management strategies. This study holds significant value as it focuses on a key healthcare provider in Saudi Arabia, providing region-specific insights into a critical organizational challenge. The unique cultural and environmental contexts of the setting may influence attitudes toward OC, particularly preferences for diverse management strategies and their association with acceptance or resistance to change. Moreover, it provides insights into HCWs’ motivations and potential responses to change, essential for decision-making. The study also elucidates the interplay between employees’ personal and organizational variables and their change attitudes, enabling tailored approaches for employee engagement based on individual backgrounds.

This was a cross-sectional study conducted at KFMC, Riyadh, Saudi Arabia, between August 30 and September 23, 2022. It involved healthcare personnel and administrative employees of the participating center.

The participant pool comprised all staff members at KFMC, consisting of approximately 7,300 healthcare professionals and administrative staff. A convenience sampling method was used to include all consenting participants. Hence, no exclusion criteria were applied.

Data were collected using an electronic questionnaire, adapted from an unpublished work by Ali (2020). This questionnaire was chosen because it aligned with our study objectives and had undergone face and content validation, as well as a pilot testing, in a comparable population. Furthermore, questionnaire’s domains are found on widely accepted OC strategies: re-educative, persuasion, facilitation, and coercive power strategies. These strategies are well documented in OC literature as effective tools for assessing and managing employee attitudes toward change [5, 6].

The questionnaire explored both demographic information (gender, nationality, qualification, job category, years of experience) and responses concerning the staff’s attitudes toward OC and other management strategies. Thus, the questionnaire comprised of two sections. The first section captured demographic data, while the second section was categorized into five domains each exploring the healthcare professionals’ attitudes toward a specific management strategy: re-educative strategy (six items), persuasion strategy (six items), facilitation strategy (six items), coercive power strategy (six items), and OC (eight items). Responses were recorded using a 5-point Likert scale, where 1 corresponded to “strongly disagree,” 2 to “disagree,” 3 to “neutral,” 4 to “agree,” and 5 to “strongly agree.”

The questionnaire was administered in both Arabic and English languages. The questionnaire was administered in both Arabic and English languages. The Arabic version was translated from the English version using the backward translation method with two independent bilingual translators. Initially, one translator translated the English version into Arabic. Then, a second translator, who had no prior exposure to the original English version, translated the Arabic version back into English. The two English versions (original and back-translated) were compared to identify and resolve any discrepancies or ambiguities. This process ensured that the Arabic version accurately reflected the content and meaning of the original English questionnaire.

For each management strategy, a subscale attitude score was calculated as the sum of the corresponding item’s scores. Thus, the scores ranged between “6–30” for re-educative, persuasive, facilitation, and power-coercive strategies and 8–40 for OC.

Attitudes toward OC were dichotomized into resistance and acceptance based on a cut-off score of 32, which corresponds to a minimum item score of 4 (agree or strongly agree) for each of the eight items. This cut-off value also aligns with the population’s mean score (32.03). Likewise, attitude toward the four management strategies was categorized as unfavorable or favorable using a cut-off score of 24, assuming a minimum item score of 4 (indicating agreement) for each of the six items to indicate favorable attitudes.

The primary outcome of the study is attitudes toward OC, indicated by the attitude score. The study model hypothesized that resistance or acceptance of OC may be determined by the preference for a management strategy as well as by various sociodemographic and professional factors. Additionally, sociodemographic and professional factors may, in turn, influence attitudes toward the various management strategies (Fig. 1).

The questionnaire (https://docs.google.com/forms/d/1AkG2_x060wUXm-ZhwN8X7W0jNF5SrwIslKhliPYuGKI/) was shared with all potential participants via their personal phone numbers. It remained active from August 30, 2022, to September 23, 2022, during which 365 responses were collected.

Data analysis was carried out using the Statistical Package for Social Sciences (SPSS), version 21 for Windows (Armonk, NY: IBM Corp.). Descriptive statistics were used to present the categorical data as frequencies and percentages, while continuous data were presented as mean (standard deviation [SD]). The five questionnaire subscales were tested for reliability by calculation of Cronbach’s alpha. The association of sociodemographic factors with attitudes toward the different management strategies and OC was analyzed by comparing the respective attitude scores across the factors’ categories using independent t test or one-way ANOVA, as applicable. The association of attitudes (resistance or acceptance) toward OC with sociodemographic factors and attitudes toward the various management strategies was analyzed using chi-square test. Independent factors associated with resistance to OC were analyzed using logistic regression, with calculation of the odds ratio with 95% CI. A p value <0.05 was deemed statistically significant.

Of the 365 participations, 42 were excluded due to their unsuitability for statistical analysis. The final number of responses included in the analysis was 323. There was a high female ratio (67.8%) among the participants, and the majority were of Saudi nationality (60.7%). With regard to educational qualification, the largest group held a bachelor’s degree (65.3%), followed by those with postgraduate degrees (25.7%). In terms of job categories, nursing staff made up the largest proportion (46.4%), followed by physicians (31.0%), and health technicians (12.1%), while administrative staff (9.3%) and pharmacists (1.2%) represented a minority. In terms of experience, most participants had less than 5 years of experience (32.8%), 27.9% had 5 to less than 10 years, and 23.8% had 10 to less than 15 years (Table 1).

The assessment of attitudes toward re-educative, persuasive, facilitation and power-coercive management strategies is depicted in Table 2. For the re-educative strategy domain, over 82% of the participants either agreed or strongly agreed with the items, with mean scores ranging from 4.23 to 4.36. The highest agreement was for providing employees training courses in the proposed change field (mean [SD] score = 4.36 [0.77]) and encouraging academic growth (continuing education; mean [SD] score = 4.36 [0.86]).

In the persuasive strategy domain, between 82% and 89% of respondents agreed or strongly agreed with the items. The highest agreement was toward clarifying the personal benefits of employees from the change, with a mean score of 4.35.

Analyzing attitudes toward facilitation showed substantial support, as over 82% agreed or strongly agreed with the items in this domain, and mean scores ranged from 4.17 to 4.36. Top agreement was for explaining the real reasons for the change and the expected results of the change, each scoring a mean of 4.36.

On the other hand, the power-coercive strategy domain showed a less favorable response. A significant proportion of participants disagreed or strongly disagreed, particularly with using a threatening method for everyone who resists change (58.5%, mean score of 2.48) and imposing change through algebraic force (51.7%, mean score of 2.50). The most accepted item in this domain was using internal laws to implement change programs, with a mean score of 3.48.

With regard to attitudes toward OC, most participants expressed agreement. Specifically, respondents agreed most strongly with the notion of using professional consultants before making OC, with 91.4% in agreement (agreed or strongly agreed) and a mean score of 4.33. The idea that OC leads to the development of work methods also garnered significant support, with 83.3% agreement and a mean score of 4.13. Similarly, 81.4% agreed or strongly agreed that OC improves the quality of medical services for patients, denoted by a mean score of 4.11. However, the sentiment that employees accept change well, even if their opinion is not taken into consideration, saw more resistance, with only 45.5% of respondents agreeing, reflecting a comparatively low mean score of 3.25 (Table 3).

Reliability analysis for the subscales showed high internal consistency of all five constructs, with Cronbach’s alpha values ranging from 0.872 to 0.933. Specifically, attitudes toward OC showed a Cronbach’s alpha of 0.884, with a mean score of 32.03 (SD = 5.14). The mean (SD) attitude scores were comparable across the re-educative (mean = 25.88 [SD = 4.15]), persuasion (mean = 25.56 [SD = 4.48]), and facilitation (mean = 25.76 [SD = 4.53]) strategies, whereas power-coercive strategy scores were remarkably lower (mean = 17.71 [SD = 5.57]).

The analysis of factors associated with attitudes toward different management strategies is presented in Table 4. Gender was found to have a significant impact on all strategies. Female respondents scored lower on average than male respondents across all strategies (p < 0.05 for all), except for power-coercive strategy where females scored higher (p = 0.028).

Similarly, non-Saudi respondents scored lower than Saudi respondents across all strategies, except for power-coercive strategy where they scored higher than Saudi participants (p < 0.001). The difference was most pronounced in the re-educative strategy, with non-Saudi respondents scoring 24.72 (SD = 3.87) compared to Saudi respondents’ score of 26.63 (SD = 4.16; p < 0.001).

In terms of qualifications, respondents with secondary education scored the lowest on the power-coercive strategy (13.00, SD = 3.46), which was significantly different from those having higher degrees (p = 0.003). However, no significant differences were observed for other strategies (p > 0.05).

Looking at the job category, administrative respondents scored the highest on average in all strategies, except power-coercive strategy where pharmacists scored higher. The differences were statistically significant in all but facilitation strategy. More specifically, regarding OC, health technicians scored the highest, followed by administrative staff, while pharmacists scored the lowest (p = 0.017). It is important to note that the administrative staff accounted only for 9.3% of respondents and the pharmacists for 1.2%.

As for years of experience, only the facilitation strategy showed significant differences, with those having less than 5 years of experience scoring the highest (26.74, SD = 4.33) and those with 10–15 years of experience scoring the lowest (24.86, SD = 3.85; p = 0.028). For the remaining strategies, no significant differences were noted (p > 0.05).

The bivariate association analyses of attitudes toward OC with sociodemographic factors and attitudes toward the four management strategies are depicted in Table 5. Notably, favorable attitudes toward any of the four management strategies were positively correlated with acceptance of OC (all p values <0.001).

Independent factors of resistance to OC, analyzed using multivariate logistic regression, are depicted in Table 6. Non-Saudi employees were significantly more resistant to change than Saudi ones, with an OR of 2.65 (95% CI: 1.17–5.96, p = 0.019). Among job categories, health technicians were significantly less resistant to change compared to physicians (OR = 0.21, 95% CI: 0.07–0.62, p = 0.005), whereas there were no significant differences in resistance to change for nursing staff, pharmacists, and administrative staff. Regarding attitudes toward management strategies, only facilitation and power-coercive strategies were independently associated with OC. Specifically, participants who had favorable attitudes toward the power-coercive strategy were independently less resistant (OR = 0.04, 95% CI: 0.01–0.13, p < 0.001). Likewise, favorability toward facilitation significantly reduced resistance to change (OR = 0.23, 95% CI: 0.08–0.61, p = 0.003). Overall, the model indicates that non-Saudi nationality, job category, and favorable attitudes toward persuasion and power-coercive management strategies are significant factors associated with reduced resistance to OC in this hospital setting. The model explained 42.1% (Nagelkerke R² = 0.421) of the variance in the dependent variable.

This study sought to explore the attitudes of healthcare professionals at KFMC toward different OC strategies, given their critical role in determining the successful implementation of changes in a rapidly evolving healthcare environment. The findings highlight the significance of management strategies in determining the acceptance of or resistance to OC among healthcare personnel. The study also demonstrated the interplay of sociodemographic and professional factors in shaping attitudes toward both OC and various management strategies. The participants generally expressed positive attitudes toward OC, as well as re-educative, persuasive, and facilitation management strategies. The power-coercive strategy, however, received lower acceptance, especially for items related to coercion. More specifically, a majority agreed that OC improves service quality and work methods, and approved the use of professional consultants. Nonetheless, employee inclusion was crucial, as evidenced by lower agreement for change without their opinions considered. Gender and nationality significantly influenced attitudes toward all management strategies and OC, with female and non-Saudi respondents recording lower attitude scores toward most strategies, except for the power-coercive ones. Among professional factors, job category was particularly significant with health technicians being the most favorable to OC and most of the management strategies.

Among the four management strategies, an unfavorable attitude toward facilitation or power-coercive strategies was independently associated with resistance to OC. These findings suggest that tailored management approaches that consider demographic and professional diversity, alongside strategic education and persuasion efforts, can effectively mitigate resistance and foster a supportive environment for OC. Furthermore, the robustness and reliability of the constructs are supported by the high Cronbach’s alpha values, all exceeding 0.7, a widely accepted threshold for satisfactory internal consistency [13].

Overall, our results suggest a general acceptance of OC, particularly when the process is guided. This aligns with the findings of Nilsen et al. [14], who interviewed 30 healthcare professionals about successful OC in healthcare. Their study highlighted the importance of involving healthcare professionals in the change process, emphasizing the need for staff preparation and the perceived value of the change [14]. However, in Australia, Pomare et al. [15] observed “apprehension and negative expectations” toward OC among healthcare and non-care staff in a large hospital. Respondents attributed their negative attitudes to past unfavorable experiences, feelings of being uninformed about the change, and being overburdened with work during the new organizational transition [15]. These differences likely stem from the nature, objectives, and past experiences with OCs. This underscores the critical role of tailored strategies in managing OC, emphasizing the need to address staff concerns and prepare them effectively for transitions. Proactive communication, addressing past negative experiences, and clarifying change objectives are essential for fostering positive attitudes.

Additionally, respondents in the present study displayed strong agreement with the necessity of integrating professional consultants in the OC process. OC in healthcare is a purposeful and planned process, requiring clear objectives and expert guidance. Therefore, professional consultants are vital in managing OC within healthcare settings. They guide hospitals in adapting to their environment, streamline operations, and encourage a shift from traditional to objective-based management. Furthermore, consultants facilitate conflict resolution, build trust, and help transition from centralized to decentralized systems. The inputs of these consultants are pivotal in refining work procedures, adapting leadership styles, and aligning individual behavior with OCs, making them crucial for effective transformation [16].

Eventual areas of resistance to OC were observed when the employees’ opinions were not considered. As highlighted by Abdelouahab and Bouchra’s study, considering the needs and views of employees is paramount for a successful transition, notably by clarifying change objectives and dispelling fears about job security [17]. Hence, the process of OC is not solely a structural shift but also a human-centered endeavor that requires transparency, effective communication, and respect for employee concerns to ensure a smoother transition and mitigate resistance. This is supported by our findings that show a high preference for persuasive strategy among employee, as persuasion relies primarily on effective communication. Additionally, we observed a positive relationship between acceptance of persuasion strategies and OC, an association that approached the statistical significance in the adjusted model (p = 0.069). A study by Pomare et al. [15] highlighted the significance of comprehensive employee communication during OC. Keeping employees well informed about the change process, its mechanisms, and implications can alleviate resistance and enhance transition success [15]. However, communication alone may not alleviate negative expectations; additional strategies, such as leveraging change-supporting employees and providing adequate training, are crucial. This approach not only mitigates resistance but also enhances assurance, fostering a collaborative atmosphere crucial for the fruitful implementation of change plans [15].

One of the remarkable findings is that attitudes toward power-coercive strategies displayed the strongest independent association with attitudes toward OC. This observation contradicts the managerial ideals, which suggest that power-coercive strategies, particularly in the healthcare industry, are likely to negatively impact professional engagement and induce counterproductive behaviors among employees [18]. However, contrary to these theoretical premises, the choice of management strategy is context-dependent, and the same strategy may have different outcomes in different contexts. Thus, power-coercive strategies may be more efficient in some cases without adversely affecting organizational performance [19]. This aligns with a study by Szabla et al. [20], which showed a significant association between power-coercive strategies and episodic change. Interestingly, the same study highlighted the significance of the change content in determining change strategy [20]. This emphasizes the need for domain-specific management models tailored to the healthcare environment rather than standardized business models. In healthcare organizations, such models should be practice-based, considering the specificities of the medical environment, patient care dynamics, and the unique challenges faced by healthcare professionals [21].

On the other hand, it is important to consider that our study collected opinions on a hypothetical change, which has not yet been implemented or characterized. This means that the attitudes might significantly shift if the OC was imminent and its resources already allocated. Evidence of this potential variability is found in the study of Alharbi [22], which highlighted the importance of organizational readiness in the Saudi healthcare system for changes planned by 2030. Alharbi [22] concluded that high readiness, available resources, and favorable conditions lead to greater initiative, effort, determination, and cooperation among organizational members, facilitating efficient and effective implementation of planned transformations.

Although not being independently associated with attitudes toward OC, the re-educative strategy received the highest acceptance by the hospital employees. This suggests that it is the most preferred strategy, regardless of its relationship with OC. In contrast, the power-coercive strategy ranked the lowest in terms of acceptability. Punitive measures such as exclusion and firmness were viewed most unfavorably, whereas applying internal laws and issuing warnings met with less resistance. This is in line with the study by Salam and Alghamdi [9], who highlighted the effectiveness of the re-educative strategy in facilitating OC and mitigating common resistance concerns, primarily due to its educational focus. On the other hand, authors emphasized the need for judicious use of the coercive strategy, as it could amplify resistance if not applied wisely, indicating the importance of thorough planning and flexible strategies in managing change [9]. Similarly, Milton et al. [23] underscored the role of the educative approach in successful OC. They observed improvements in the work environment and a shift toward more positive attitudes among employees following the implementation of an educative strategy, despite initial resistance, highlighting the need for prioritizing understanding and cooperation in change management initiatives [23]. The high preference for the re-educative strategy among employees, as seen in our study, aligns with these findings, indicating its potential effectiveness in fostering a receptive environment for OC.

The two other management strategies, i.e., persuasive and facilitation, elicited a comparable interest among the participants. According to the questionnaire items, the persuasive management strategy in OC is marked by open communication, shared decision-making, and a focus on education. It aims to convince employees about the need for change, elucidating its benefits at both organizational and individual levels. By looking into individual items, the highest scoring items are related to clarifying the general implications and personal benefits of the expected changes. In line with this observation, Pomare et al. [15] emphasized the importance of keeping employees well informed about the change process, its mechanisms, and implications to alleviate resistance and enhance transition success. Thus, managers using this strategy hold discussions and meetings, clarifying the transition from the current to a more desirable future state.

Paradoxically, the item that scored lower in persuasive strategies was related to “trying to convince employees of the need for change.” This counterintuitive result can be attributed to the inherent nature of explicit persuasion. Explicit efforts to persuade, such as directly attempting to convince employees of the need for change, can actually trigger cognitive resistance, as individuals might perceive these efforts as manipulative or insincere [24]. On the other hand, implicit strategies that subtly prime the idea of change, rather than explicitly pushing it, can be equally effective and require less cognitive resources, thereby causing less resistance among employees [25]. This suggests that subtle persuasion strategies might be more effective in facilitating OC. According to Gabutti et al. [24], persuasive strategies in OC utilize several processes to engage employees and garner their support for the new initiatives. Progressive implementation, for instance, prompts small, incremental attitude changes, which, when accumulated, lead to a significant shift in overall position. This gradual adaptation reduces resistance and encourages acceptance. The similarity method utilizes subjects akin to the proposed change, avoiding direct confrontation of sensitive topics and facilitating smoother discussions. Furthermore, social pressure plays a role, leveraging the influence of group conformity and unity to encourage individual alignment with the change [24]. By using these approaches, persuasive strategies can foster commitment and participation while minimizing resistance.

As for the facilitation strategy, the corresponding questionnaire items align well with the characteristic features of this strategy [26]. More specifically, “employee participation in developing change plans” and “surveying employees before making the change” correspond with the emphasis on team building and active participation within the facilitation strategy. The item “the director’s interest in problems and criticisms and working to solve them” aligns with the notion of recognizing the problem and defining the treatment plan, indicating an open and receptive management. “Explain the real reasons for the change” and “explain the expected results of the change” match the strategy’s emphasis on providing useful information to enable problem diagnosis and solution development. Finally, “the proposed change aims to use modern methods of work” aligns with the strategy’s focus on leveraging modern, specialist advice, and techniques to facilitate change, thereby enhancing the organization’s adaptability.

Building on these observations, it appears that the best management strategy is that combining various approaches from the different management strategies, depending on the specific circumstances and the change content. It is interesting to note that the objectives of OC in healthcare structures align with different management strategies to drive transformation. For instance, the objectives relating to promoting problem-solving and shifting from individual to team-centric approaches are likely to align with the re-educative strategy. On the other hand, persuasive strategies may be more efficient in fostering collaboration with specialized groups, achieving job satisfaction, and promoting a shift from traditional management methods to management by objectives. Lastly, facilitation strategies align with the objectives of creating an atmosphere of trust and openness, decentralizing authority and fostering participatory decision-making, and expediting work procedures [16]. This alignment suggests that a flexible, hybrid management strategy could be an effective approach to realize the diverse objectives of OC in healthcare structures. It allows for the tailored application of different strategies to best suit the specific circumstances and target objectives. As such, integrating elements from various management strategies provides a comprehensive toolset to drive the desired change, empowering organizations to optimally balance between the educational, persuasive, coercive, and facilitative aspects of change management. The model of reactions to change (RTC), proposed by Pataki et al. [27], enhances these conclusions by acknowledging the multifaceted nature of RTC, including cognitive, emotional, and actional aspects. It parallels our study’s emphasis on different change phases, reinforces the need for nuanced RTC measures, and underscores the importance of communication and participation. This approach accommodates environmental fluctuations and allows adjustments in response to evolving circumstances, contributing to the resilience and effectiveness of the change process.

In the present study, demographic and professional factors played a significant role in shaping the attitudes toward the organization change and the related management strategies. Females, non-Saudis, and pharmacists displayed less favorable attitudes, while health technicians, administrative staff, and physicians scored higher. This divergence in attitudes could be attributed to the varying degrees of exposure to and engagement with the organization’s operations, depending on their roles. Specifically, physicians, health technicians, and administrative staff might have a more holistic view of the organization’s workings and unmet needs of the patients, hence acknowledging the necessity for change more readily. Conversely, other professionals might interact with narrower segments of the organization, and thus, they might be more inclined to preserve the status quo, owing to their limited visibility of the broader institutional requirements for change. The findings by Nilsen et al. [14] shed light on a crucial aspect of the change process, emphasizing the importance of personnel experience and professionalism in the successful implementation of OCs. The authors underscore that the most professionally experienced employees often display a higher tendency to embrace change associated with their willingness to participate in the change process [14]. In our study, higher inclination among certain job categories might be due to their exposure to organizational issues related to direct patient care, resulting in a deeper understanding of the need for continual improvement. Consequently, when they perceive that the proposed change aims to augment patient care, their willingness to support and engage with the change process is significantly amplified.

Further organizational and individual factors have been observed to shape the attitudes toward OC. The study of Hayajneh et al. [28] links job satisfaction with successful OC, suggesting that enhancing job satisfaction, through training opportunities and improved work environments, can alleviate stress and fears often linked with change. This study did not assess job satisfaction, a limitation that future research could address. The importance of leadership in change acceptance is highlighted in the research of Oreg and Berson [4]. Effective leadership styles, usually demonstrated by experienced leaders, can influence change perception and acceptance positively [4]. Amarantou et al. [29] spotlighted individual factors such as propensity toward change, expected effect of change, employee-management relationship, personal traits, participation in decision-making, and job security as significant determinants in change acceptance or resistance.

Our study offers crucial insights for implementing effective OC in hospitals, particularly in Saudi Arabia, with broader implications for healthcare managers in similar contexts. The findings emphasize the importance of acknowledging diverse attitudes toward change, understanding their roots, and tailoring strategies accordingly.

Healthcare managers can implement a phased, hybrid approach to change management. Initiating change with re-educative strategies – focusing on education, collaboration, and stakeholder engagement – can foster buy-in and promote long-term quality improvements. This strategy is particularly effective in driving cultural shifts and sustaining reforms. However, when voluntary adoption meets resistance, managers can transition to power-coercive measures, leveraging authority and enforcement to ensure compliance. This approach is especially critical during urgent situations, such as regulatory compliance or pandemic responses, where immediate results are necessary.

Employee engagement in the change process is essential to foster acceptance and commitment. Management should adopt a participative approach by involving employees from the onset, giving them the opportunity to voice their concerns and suggestions. This fosters a sense of ownership and helps identify potential challenges early. Regular feedback mechanisms and comprehensive communication plans play a crucial role in reinforcing re-educative strategies, ensuring that staff remain informed, engaged, and motivated throughout the change process.

Managers should continuously assess staff responses to different strategies and adjust their approaches accordingly. Incorporating data-driven decision-making allows for the evaluation of strategy effectiveness, enabling timely modifications to enhance outcomes. This iterative process helps in aligning change initiatives with staff needs and organizational goals.

Anticipating potential areas of resistance and addressing them proactively are crucial. Fears about job security should be allayed by clearly communicating the implications of change for individual roles. Given the variations in attitudes toward change among different professional and demographic groups, managers must customize their communication and engagement strategies to suit the unique needs of each group. Tailored management strategies that address the diverse characteristics of the workforce can optimize change outcomes.

Leadership development is vital for successfully navigating OC. Training programs should equip healthcare managers with the skills to balance re-educative and power-coercive strategies, enabling them to recognize the appropriate contexts for each approach. This will enhance organizational adaptability and resilience, ensuring that change initiatives are both effective and sustainable in the dynamic healthcare environment. Additionally, emphasizing training and professional development as core components of change management can enhance staff readiness and adaptability.

Promoting a culture of continuous improvement can create an environment where change is viewed as an opportunity for growth rather than a threat. Policymakers should mandate structured staff engagement initiatives to foster a sense of ownership and trust in the change process. Policies should also encourage flexible, hybrid management strategies that combine educational, persuasive, coercive, and facilitative elements to drive effective transformation.

The successful implementation of OC in hospitals hinges on a comprehensive, participative approach that recognizes and addresses the concerns of different employee groups, prioritizes education, and fosters a culture of continuous improvement. Evidence from studies like those by Salam and Alghamdi [9] and Szabla et al. [20] supports these recommendations, reinforcing the need for tailored, adaptable change management frameworks in healthcare settings.

Despite its insightful findings, this study bears certain limitations. Primarily, the research design is cross-sectional, providing a snapshot view of attitudes toward OC but not necessarily capturing how these attitudes might evolve over time or in response to specific change initiatives. Furthermore, the study did not account for individual or organizational factors such as job satisfaction, previous experiences with change, organizational culture, etc., which could potentially influence attitudes toward change. Another limitation is the reliance on self-reported data, which might be subject to social desirability bias. Finally, the generalizability of the findings could be restricted due to the focus on a single hospital setting, potentially limiting its applicability to diverse hospital environments or other healthcare settings. Future research may consider longitudinal studies, additional individual factors, and a broader range of settings to overcome these limitations.

This study highlights a general acceptance of OC among healthcare employees at KFMC, particularly when guided by professional consultants and when employees’ voices are considered. This underscores the need for transparency, effective communication, and addressing employee concerns to ensure a smoother transition. Among the various management strategies, the re-educative strategy was favored, indicating the importance of understanding and cooperation in change management.

Our findings reveal that favorable attitudes toward persuasive and power-coercive strategies are positively correlated with acceptance of OC, suggesting that, when appropriately applied, these strategies can reduce resistance. No one-size-fits-all strategy exists; therefore, a flexible, hybrid approach integrating elements from various strategies may be more effective. This approach balances educational, persuasive, coercive, and facilitative aspects, fostering resilience and adaptability.

Additionally, demographic and professional factors – notably nationality and job category – significantly influenced attitudes toward OC. This highlights the necessity of tailoring communication and actions to ensure inclusivity and respect for diversity. OC in healthcare is not merely a structural shift but a human-centered endeavor that requires addressing the diverse needs of all employees.

Healthcare managers should adopt hybrid change strategies by initiating re-educative approaches to foster engagement and understanding, transitioning to power-coercive measures when necessary, especially in urgent scenarios like regulatory compliance or public health crises. Policies should mandate structured staff engagement from planning to execution, fostering ownership and reducing resistance. Continuous education and professional development programs are essential to enhance staff readiness, ensuring employees understand the rationale, benefits, and processes involved in change. Communication strategies must be tailored to demographic and professional differences, addressing concerns related to job security, role changes, and workplace culture. Lastly, data-driven decision-making should guide the evaluation of staff responses, allowing for timely adjustments to improve implementation outcomes.

The study protocol received ethical approval from the Research Ethics Committee of King Saud University (KSU-HE-22-475) and KFMC Institutional Review Board Committee (H-01-R-012) IRB, Log Number 22-292. Written informed consent was obtained by explicit agreement integrated in the questionnaire, prior participation.

The authors have no conflicts of interest to declare.

The authors have not received any financial support.

All authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship. Mana Alshahrani contributed to the conceptualization of the study, data collection, and manuscript writing. Mohammed Alshamrani was involved in study conceptualization, data collection, and manuscript writing. Sami Mohamed Alhabib contributed to the conceptualization of the study, reviewed the data analysis, and contributed to manuscript writing and reviewing. All authors have read and approved the final version of the manuscript.

The data that support the findings of this study are not publicly available due to their containing organizational information that could be perceived as sensitive, but are available from the corresponding author upon motivated request.