Orchestrating emergent change: the 'hospitalist' movement in US Healthcare

Wallace, Mike ORCID: https://orcid.org/0000-0001-9631-9689 and Schneller, Eugene 2008. Orchestrating emergent change: the 'hospitalist' movement in US Healthcare. Public Administration 86 (3) , pp. 761-778. 10.1111/j.1467-9299.2008.00740.x

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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.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Business (Including Economics)
Subjects:	E History America > E151 United States (General) H Social Sciences > H Social Sciences (General) H Social Sciences > HD Industries. Land use. Labor H Social Sciences > HD Industries. Land use. Labor > HD28 Management. Industrial Management H Social Sciences > HJ Public Finance R Medicine > RA Public aspects of medicine
Publisher:	Wiley
ISSN:	0033-3298
Last Modified:	19 Oct 2022 08:59
URI:	https://orca.cardiff.ac.uk/id/eprint/19667

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