Orchestrating emergent change: The 'hospitalist movement' in US healthcare
成果类型：
Article
署名作者：
Wallace, Mike; Schneller, Eugene
署名单位：
Cardiff University; Arizona State University; Arizona State University-Tempe
刊物名称：
PUBLIC ADMINISTRATION
ISSN/ISSBN：
0033-3298
DOI：
10.1111/j.1467-9299.2008.00740.x
发表日期：
2008
页码：
761-778
关键词：
摘要：
The metaphor of 'orchestration' is applied to an emergent change whereby developing different versions of a resource to solve local problems with managing hospitalized patient care in the USA became conceived as a nationwide innovation. A pluralistic framework incorporates Abbott's conception of a system of professions, a cultural and political perspective on interaction and the notion of 'orchestration' which is distinguished from leadership and management. Small-scale research in diverse settings shows how key stakeholders including academic medical researchers orchestrated the coalescence of disparate practices into a unified movement, although working in a relatively decentralized healthcare system featuring a complex mix of public, private and voluntary sectors. Sufficient confluence between diverse interests was nurtured for widespread acceptance of a new 'hospitalist' role coordinating inpatient treatment. It is suggested that the metaphor of orchestration may have wider potential as a heuristic for understanding emergent change that becomes more complex as it spreads.
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