Large-System Transformation in Healthcare and the Roles of Senior Leaders: A Case Study from Saudi Arabia

Abstract

The implementation of large-system transformation in healthcare is complex and multi-faceted, requiring effective leadership at all levels, particularly from senior leaders. However, there is limited conceptual clarity around large-system transformations in healthcare and the roles senior leaders play in driving such transformations, especially in a non-Western context. This thesis addresses these knowledge gaps by exploring senior leaders' perceptions of large-system transformation and their role in its implementation in Saudi Arabia. Using a qualitative single case study design, this research gathered insights from 22 senior leaders at national and regional levels of the Saudi healthcare system through semi-structured interviews. The study employed an inductive-deductive thematic analysis approach, guided by the Health System Dynamics Framework, sensemaking theory, and systems leadership perspectives. Two conceptual frameworks were developed: one delineating ten key components of large-system transformation in healthcare, and another outlining seven critical roles of senior leaders during such transformations, six categories of enablers, and eight types of challenges. The large-system transformation framework highlights the interconnected nature of contextual triggers, climate for change, vision, leadership, governance, actors, resources, processes, social forces (e.g., resistance to change), and information flow. The senior leaders’ roles, enablers, and challenges framework emphasizes leaders' responsibilities in creating a climate for change, communicating and learning, managing resources, engaging stakeholders, setting strategic direction, managing social dynamics, and developing key leadership attributes. The framework also indicates multiple enablers and challenges relevant to the roles of senior leaders, providing a nuanced understanding of the complexities involved in healthcare system transformations. This research contributes to the theoretical understanding of large-system transformation in healthcare and senior leaders' roles, enablers, and challenges, particularly in a non-Western context. It offers practical implications for healthcare leaders and policymakers engaged in system-wide transformations. Future research directions are suggested to further validate and expand upon these findings.