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This comprehensive and comparative study of health service change focuses on the influence of health professionals on the process and shape of change. The book examines the development and implementation of national health system reorganizations in the United Kingdom, Sweden and The Netherlands. Separate chapters examine the development, implementation and outcomes of reform. The author's research highlights a crucial link in the chain of implementation: the occupational and organizational consequences of reform for physicians and other health professionals and the way physicians influence pro

The Third Edition of the bestselling Diagnosing Organizations shows how consultants and applied researchers can help decision makers quickly and flexibly diagnose problems and challenges and decide how to deal with them. This thoroughly revised edition can help practitioners of diagnosis directly address concerns that are critical to clients, rather than just provide feedback on current conditions and operations. In an authoritative yet readable fashion, author Michael I. Harrison presents updated treatments of the uses of diagnosis, evaluating organizational effectiveness, improving team performance, planning organization redesign projects, and assessing organization-environment relations and competitive strategy. Also treated are the politics of change management, professional dilemmas, and ethical issues confronting practitioners.

Until recently, studies of the impact of bureaucratic employment on professionals drew heavily on structural models, such as the theories of proletarianization and of professional stratification. In contrast, this paper develops a processual approach to professional control. This approach views control as resulting from struggles by occupational groups for institutional recognition and from struggles and negotiations within and between occupations. The structural and processual approaches are applied to the explanation of union activity-an increasingly prominent form of collective action among employed professionals. Unionization and union militancy are examined among Israeli physicians, who have a long history of bureaucratic employment. Although they are helpful, neither the proletarianization nor the stratification theories adequately account for the overall pattern of medical unionization or for individual and subgroup involvement in a lengthy physicians' strike. The processual approach points to several forces that help explain unionization and variations in strike involvement. These forces include institutional and contextual conditions, power differences between professional-subgroups, interactions among multiple actors in and around the professions, and the professionals' subjective interpretations and feelings. Although the processual approach is a loose perspective, rather than a tight-knit theory, it offers a better guide than the structural theories to investigating both professional-bureaucratic relations and collective actions aimed at enhancing professional control.

Health care organization leaders and policy makers seeking ways to reform the delivery of health care have become increasingly interested in transformational change. To foster understanding of how organizational transformation occurs and to stimulate further research, we report findings from a systematic review of empirical research on transformational change in the health care and non–health care literature, with a focus on the antecedents, processes (or paths), and outcomes of transformational change. Fifty-six studies, of which 13 were in health care, met our selection criteria. With one exception, all were published since 1990, indicating the recent upsurge of interest in this area. Limited differences were found between health care and non–health care studies. Available research documents the multiplicity of factors affecting change and the complexity of their interactions, but less information is available about the processes of transformational change than about its antecedents and consequences. Research and practice implications are discussed.

Care management (CM) is a promising team-based, patient-centered approach "designed to assist patients and their support systems in managing medical conditions more effectively." As little is known about its implementation, this article describes CM implementation and associated lessons from 12 Agency for Healthcare Research and Quality–sponsored projects. Two rounds of data collection resulted in project-specific narratives that were analyzed using an iterative approach analogous to framework analysis. Informants also participated as coauthors. Variation emerged across practices and over time regarding CM services provided, personnel delivering these services, target populations, and setting(s). Successful implementation was characterized by resource availability (both monetary and nonmonetary), identifying as well as training employees with the right technical expertise and interpersonal skills, and embedding CM within practices. Our findings facilitate future context-specific implementation of CM within medical homes. They also inform the development of medical home recognition programs that anticipate and allow for contextual variation.