Sub-theme 55: Re-examining the Organization of Healthcare: Institutional, Technological and Clinical Challenges

Daniele Mascia
Catholic University of the Sacred Heart, Rome, Italy
Federica Angeli
Maastricht University, The Netherlands
Americo Cicchetti
Catholic University of the Sacred Heart, Rome, Italy

Call for Papers

On the demand side, the impact of elderly people hand in hand with the diffusion of chronic diseases is increasing the need for an integrated delivery of services. In this scenario, highly specialized healthcare actors such as individual physicians, clinical teams and healthcare organizations have to better coordinate their actions with the ultimate objective to provide a timely and appropriate response to the patient. On the supply side, shortage of funds urges hospital restructuring in many health systems around the world with the aim to improve efficiency without reducing quality of care. Coordination mechanisms play a major role in this complex scenario, where a high number of interdependent providers need to provide quick responses in a very uncertain scenario. Such changes have in turn a major impact on governance mechanisms, performance appraisal approaches, human resource management tools, as well as internal processes and operations of healthcare organizations.

New delivery formulas – for example, based on healthcare networks (Lomi et al., 2014) – are necessary, along with new business models. The need to redefine the very pillars of healthcare delivery is compelling. The healthcare sector is traditionally structured around highly professionalized organizational units that are believed to maximize economies of scale by concentrating specialized knowledge and equipment. Medical advancements and technological innovations, such as telemedicine or portable ECG units, have recently made it possible to transfer tasks and activities to less professionalized units, or even to the ultimate patient, and thus overcome the prominence of hospitals and medical practices. Conceptual and practical room has thus emerged for re-examining healthcare delivery towards more cost-effective but also more patient-oriented configurations.

The scale and relevance of innovating healthcare delivery assumes the connotation of disruptive innovation (Christensen et al., 2000), because of the necessity to recombine and reorganize resources along innovative frameworks. However, a strong systemic inertia glued by the economic interests of the professional groups forming the current setup provides important barriers to the implementation of innovation in healthcare delivery (Scott et al., 2000; Battilana & Casciaro, 2012). In some instances, organizations may not even be able to conceptualize a new business model, because of the strong cognitive imprinting derived from established formulas (Reay & Hinings, 2005; 2009). Moreover, healthcare is one of the most regulated sectors, with a strong governmental presence, as a payer but also as a regulator (Ferlie & Shortell, 2001).

A complex nexus of powerful institutions, a well-rooted professional culture, new technological possibilities, cost-curbing regulations and rapidly evolving patient needs create a highly dynamic environment that exerts potentially clashing demands on healthcare organizations. The ground is thus fertile for re-examination and redefinition of the 'established' care, in order to transit to a more socially responsible healthcare delivery.

We invite papers from a range of theoretical and methodological approaches which may address, without being limited to, the following research questions:

  • How do institutional, technological, and clinical dynamics translate into compelling forces driving organizational change in the healthcare sector?
  • How do healthcare organizations innovate to adapt to the institutional, technological, and clinical dynamics?
  • Which new business models result from adaptation efforts?
  • What is the role of inter-organizational networks in favoring or hindering adaptation efforts? And in boosting inter-provider coordination and integrated care?
  • How do organizational change and restructuring interventions (e.g. lean organization) reverberate in turn their effects on the reconfiguration of internal clinical processes, and organizational routines? And how do they affect the emergence of new social roles, professional skills and the evolution of organizational culture?
  • How does the co-existence of plural logics – clinical, managerial and entrepreneurial – in healthcare influence important decision-making processes such as the adoption of new organizational models or the assessment of medical innovations?
  • How does the increased hybridization of human resources (e.g. the emerging role of clinician managers or nurse coordinators) in healthcare affect patterns of change and adaption in this field?
  • How do macro-level (health system), meso-level (organization) and micro-level (individual) changes dynamically interact and translate their effect on performance?
  • How do institutional, technological, and clinical dynamics affect the relevance which the different dimensions of performance (quality, efficiency, appropriateness, equity, integrated care) assume for healthcare organizations?
  • Which ecological processes explain the growth and survival of new – and more competitive – organizational forms and populations in healthcare provision?




  • Battilana, J., & Casciaro, T. (2012): "Change agents, networks, and institutions: a contingency theory of organizational change." Academy of Management Journal, 55 (2), 381–398.
  • Christensen, C.M., Bohmer, R., & Kenagy, J. (2000): "Will disruptive innovations cure health care?" Harvard Business Review, 78 (5), 102–112.
  • Ferlie, E.B., & Shortell, S.M. (2001): "Improving the quality of health care in United Kingdom and the United States: a framework for change." Milbank Quarterly, 79 (2), 281–315.
  • Lomi, A., Mascia, D., Vu, D., Pallotti, F., Conaldi, G., & Iwashyna, T.J. (2014): "Quality of care and interhospital collaboration: a study of patient transfers in Italy." Medical Care, 52 (5), 407–414.
  • Reay, T., & Hinings, C.R. (2005): "The recomposition of an organizational field: health care in Alberta." Organization Studies, 26 (3), 351–384.
  • Reay, T., & Hinings, C.R. (2009): "Managing the rivalry of competing institutional logics." Organization Studies, 30 (6), 629–653.
  • Scott, W.R., Ruef, M., Mendel, P., & Caronna, C. (2000): Institutional Change and Healthcare Organizations: From Professional Dominance to Managed Care. Chicago: University of Chicago Press.


Daniele Mascia is Assistant Professor of Organizational and Management Theory, Catholic University of the Sacred Heart, Rome, Italy. His research interests include the administration and management of healthcare organizations, the study of inter-personal and inter-organizational networks, and the analysis of industry-academia relations in the biopharmaceutical field. His work has been published in internationally renowned journals and honoured with several awards.
Federica Angeli is Assistant Professor of Healthcare Management at Maastricht University, The Netherlands. Her current research activity investigates the determinants and outcomes of inter-organizational networks in the healthcare and biopharmaceutical sectors; the factors enabling business model innovation for inclusive healthcare; the evolution of organizational culture and identity and their implications for integrated care. Her work has been published in leading international journals and honoured with several awards.
Americo Cicchetti is Full Professor of Management, Catholic University of the Sacred Heart, Faculty of Economics, Rome, Italy. He is Director of the Graduate School of Health Economics and Management at the Catholic University. His research interests include organizational design in healthcare settings, health policy and health technology assessment. His research appears in leading organizational journals and edited books.