Orchestrating emergent change: The 'hospitalist movement' in us healthcare

Mike Wallace, Eugene Schneller

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)761-778
Number of pages18
JournalPublic Administration
Volume86
Issue number3
DOIs
StatePublished - Oct 8 2008

ASJC Scopus subject areas

  • Sociology and Political Science
  • Public Administration

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