Institutional change and healthcare organizations: from professional dominance to managed care

Donald W Light

doi:10.5334/ijic.45

Abstract

Institutional change and healthcare organizations: from professional dominance to managed care

Highlights

From an historical and sociological perspective, ‘integrated care’ has emerged as part of institutional efforts to break up professional fiefdoms, especially of subspecialists entrenched in hospitals, and to reorganise services around clinically integrated pathways and services for the patients. It was the more enlightened part of what I have called the ‘buyers’ revolt’, which occurred in the 1980s when those who had long paid the bills became so fed up by the waste, excesses, and variability of services delivered under professional dominance that they started to take forceful action w1x
The book can serve as a model for any country or regional health care system that wants to think through what ‘integration’ really means and analyse its own system
Scott used a coveted award that provides a large, 3-year budget to carry out a project of one’s choosing to organise his graduate students and assemble the first history of an area’s health care system over the past 50 years, at all levels

Summary

Introduction

From an historical and sociological perspective, ‘integrated care’ has emerged as part of institutional efforts to break up professional fiefdoms, especially of subspecialists entrenched in hospitals, and to reorganise services around clinically integrated pathways and services for the patients. Scott used a coveted award that provides a large, 3-year budget to carry out a project of one’s choosing to organise his graduate students and assemble the first history of an area’s health care system over the past 50 years, at all levels.

Results

Conclusion