TY - JOUR
T1 - Orchestrating emergent change
T2 - The 'hospitalist movement' in us healthcare
AU - Wallace, Mike
AU - Schneller, Eugene
PY - 2008
Y1 - 2008
N2 - 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.
AB - 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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U2 - 10.1111/j.1467-9299.2008.00740.x
DO - 10.1111/j.1467-9299.2008.00740.x
M3 - Article
AN - SCOPUS:53149130617
SN - 0033-3298
VL - 86
SP - 761
EP - 778
JO - Public Administration
JF - Public Administration
IS - 3
ER -