Marchal et al. BMC Public Health 2010, 10:787 http://www.biomedcentral.com/1471-2458/10/787 were observed. Third, interviews were carried out with a wide range of staff. These included semi-structured indi- vidual and group discussions with key informants to obtain information about their perception of the (changes in) management practices at the hospital, the organisa- tional climate and the issue of organisational commit- ment. Two categories of staff were interviewed: (1) the ‘operational staff’ and (2) the management team mem- bers. We selected a stratified purposive sample that aimed at including staff members of various back- grounds. We first interviewed all 5 members of the core management team (average duration 58 min.) and 15 operational staff members, including nurses and nursing officers, doctors, para-medical staff, adminis- tration and support personnel (average duration 46 min, ranging from 27 min. to 1 h12 m). We undertook 6 group discussions to probe issues of organisational climate. The groups consisted of staff working in the same department, ranging from 3 to 8 staff members per discussion. Some consisted of members of the same cadre (for instance mid- wives working at the antenatal clinic), others included staff working in the same department (for instance theatre or laboratory staff). In total, 31 staff members participated in a group discussion, which on average took 42 minutes. Finally, we interviewed two health service man- agers from outside the district hospital to explore their view on Ho Municipal Hospital and the con- text issues of decentralisation, Ghana Health Service performance contracts, etc. (average duration 48 min). All except 2 interviews were recorded and transcribed verbatim. After each interview, contact summary sheets were written, and field notes were written up at the end of the day. Page 5 of 16 The analysis started with the drafting of a thick description [37] and a timeline of events on the basis of a review of hospital records and reports. It mapped key internal and external events in time and was comple- mented by the interviews. Each research question was answered by exploring the relevant data sets. We used NVIVO 7 software for qualitative data management and analysis. The initial round of coding was based on the MRT and the research questions, from which a preli- minary list of codes was drawn. This list was revised in the course of the interviews and the analysis. In a sec- ond round of analysis, we organised the emerging themes and patterns, guided by the categories from the- ory-driven evaluation [38]. We described the interven- tion (in this case the change strategy) in terms of content and application, and intended and actual out- comes. We drew on our interviews and observations to differentiate (proclaimed) vision (what the team wants), the discourse (what they say) and the actual practices (what they do). We described the organisational climate by analysing the interviews of the operational staff. In order to indicate how the intervention works, we identi- fied and analysed both the context and the intervening mechanisms, and attempted to identify the essential conditions. Results In this section, we describe the core management team’s (CMT) intervention and its results in terms of organisa- tional climate and health service provision (availability of services, volume and quality of services). The Core Management Team’s intervention Analysis of the documents and interviews indicates that the hospital went broadly through five phases since 2006. As shown by Figure 1, phase 1 (building the core man- agement team), phase 2 (situation analysis) and phase 3 (tackling the crises) took place in 2006-07, while the development of the strategic plan was undertaken in Figure 1 Sequence of change management steps.