Purpose: This paper seeks to describe the exploration of human resource issues in one large-scale program of innovation in healthcare. It is informed by established theories of management in the workplace and a multi-level model of diffusion of innovations.
Design/methodology/approach: A realist approach was used based on interviews, ethnographic observation and documentary analysis.
Findings: Five main approaches ("theories of change") were adopted to develop and support the workforce: recruiting staff with skills in service transformation; redesigning roles and creating new roles; enhancing workforce planning; linking staff development to service needs; creating opportunities for shared learning and knowledge exchange. Each had differing levels of success.
Practical implications: The paper includes HR implications for the modernisation of a complex service organisation.
Originality/value: This is the first time a realist evaluation of a complex health modernisation initiative has been undertaken.