Relentless Incrementalism: Shifting Front-Line Culture from Institutional to Recovery-Oriented Mental Healthcare

St. Joseph's Health Care London is a publicly funded hospital that has led mental health service system transformation in south west Ontario following directives from the Health Services Restructuring Commission (HSRC). This paper documents how provincial policy, HSRC directives, organizational planning, research projects, quality initiatives and change management activities drove, shaped and accomplished a cultural shift at the front line to recovery-focused care. Simultaneous to these activities, beds and related ambulatory services were divested to four other hospitals, beds and employment services were closed and two new, state-of-the-art facilities were constructed, adding considerable complexities to achieving cultural change. This paper documents the incremental steps that were taken to achieve that change.