Nobody in charge: Distributed change agency in healthcare
通过前列腺癌治疗服务改进的案例，研究在没有正式管理计划、角色和结构的情况下，分布式变革代理如何实现复杂的组织变革，发现变革角色广泛分布且责任在大量非正式参与者之间迁移。
This article illustrates how distributed change agency can implement complex organizational changes in the absence of formal management plans, roles, and structures. Distributed change agency typically involves small teams and senior groups. In this qualitative study of service improvements in the treatment of prostate cancer at an acute hospital, Grange, change roles were distributed more widely, with responsibilities `migrating' among a large informal cast supporting four central characters. This distribution appears to have been triggered by the change goals and substance, and by the network organization through which services were delivered. Cross-case comparisons with other hospitals, Henley and Norwood, suggest that a combination of factors contributed to the development of a distributed approach. Analytical generalization invites speculation concerning the transferability of this model, with `nobody in charge', to other settings. One policy implication concerns the provision of development in change agency competencies to staff other than those in senior positions.