Sub-theme 52: The Art of Making Do and the Science of Organizing in Future Health Care
Call for Papers
Reorganizing healthcare is nowadays becoming an imperative in many countries around the world. This reorganization
is imposing the adoption of new models, which concern national/regional governments (macro level) as well as single
organizations and individuals (meso and micro level) that are increasingly called to provide better care at an affordable
Health care appears particularly complex however because changes adopted at macro, meso and micro levels are not fully aligned (Best et al., 2012). Often, national reforms are implemented under the pressure of societal and political tensions, are only partially supported by governments, and are implemented with budgetary constraints that heavily limit the feasibility and efficacy of organizational change (e.g. Humphreys & Piot, 2012). In addition, reforms are often not correctly communicated, leaving organizations and individuals unable to fully understand both change objectives and pathways. Finally, although health reforms aim at stirring healthcare providers towards efficiency and effectiveness of care, their effects remain ultimately unpredictable (Gaynor & Town, 2011). In a healthcare environment characterized by unstructured and informal routines, uncertain work environments, ad hoc decision-making based largely based on informal exchanges (Tjora & Scambler, 2009), care processes are difficult to standardize and evaluate, and organizational change is not likely to occur as a smooth reaction to superimposed new rules (Battilana & Casciaro, 2012).
In this context permeated by high uncertainty and ambiguity, the survival and growth of organizations seem to be largely tied to their resistance and persistence (e.g. Gittell, 2002). We believe that the organizational capability to (re)act hinges on a wide variety of managerial skills hand in hand with their art of making do. The effective design and mobilization of new organizational models in health care cannot be examined solely by adopting rational decision-making lens, but rather it requires an analysis of how social actors are capable of interpreting and handling an ambiguous context in novel and more effective ways (Klingebiel & De Meyer, 2013).
We invite papers from a wide range of theoretical and methodological approaches, which may address, without being limited to, the following research questions:
- What is the role of healthcare organizations' 'making do' in explaining the outcomes of policy reforms? And what are the implications for patient outcomes, in terms of integrated care, quality of care and quality of life?
- Which external strategies do healthcare organizations adopt to respond to institutional triggers, such as pro-competitive legislation, or financial crises?
- What is the role of inter-organizational networks as strategies to cope with increasing uncertainty, ambiguity and institutional pressure?
- Which internal strategies do healthcare organizations use to make do when responding to new competitive challenges, and how do human resources profiles change over time?
- Do new business model innovations emerge under the pressure of new competitive challenges, and how do these dynamics vary across countries and health systems?
- Do new entrepreneurial behaviours emerge under the pressure of new competitive challenges, and how do these dynamics vary across countries and health systems?
- What is the profile of strategists and entrepreneurs in healthcare organizations and how have they changed over time in response to increased uncertainty and competitive pressure in the market?
- How has the role of the patient within healthcare organizations transformed, along with new market dynamics and institutional challenges? Is a patient-centredness perspective guiding new forms of healthcare delivery?
- What is the role of eHealth technologies in enabling or hindering new organizational coping strategies? (How) can eHealth or new forms of eHealth support better treatment, patient empowerment, dissemination of best practices, use of Big Data for more accurate diagnoses and quicker care pathways?
- Battilana, J., & Casciaro, T. (2012): "Change Agents, Networks, and Institutions: A Contingency Theory of Organizational Change." Academy of Management Journal, 55 (2), 381–398.
- Best, A., Greenhalgh, T., Lewis, S., Saul, J., Carroll, S., & Bitz, J. (2012): "Large-System Transformation in Health Care: A Realist Review." Millbank Quarterly, 90 (3), 421–456.
- Gaynor, M., & Town, R.J. (2012): "Competition in Health Care Markets." In: T.G. McGuire, M.V. Pauly & P.P. Barros (eds.): Handbook of Health Economics, Vol. 2. Amsterdam: Elsevier North-Holland, 499–637.
- Gittell, J.H. (2002): "Coordinating Mechanisms in Care Provider Groups: Relational Coordination as a Mediator and Input Uncertainty as a Moderator of Performance Effects." Management Science, 48 (11), 1408–1426.
- Humphreys, K., & Piot, P. (2012): "Scientific Evidence Alone is not Sufficient Basis for Health Policy." British Medical Journal, 344, 27 February 2012; doi: http://dx.doi.org/10.1136/bmj.e1316.
- Klingebiel, R., & de Meyer, A. (2013): "Becoming Aware of the Unknown: Decision Making During the Implementation of a Strategic Initiative." Organization Science, 24 (1), 133–153.
- 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.
- Tjora, A.H., & Scambler, G. (2009): "Square Pegs in Round Holes: Information Systems, Hospitals and the Significance of Contextual Awareness." Social Science & Medicine, 68 (3), 519–525.