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ORCHESTRATING EMERGENT CHANGE: THE ‘HOSPITALIST MOVEMENT’ IN US HEALTHCARE
Author(s) -
WALLACE MIKE,
SCHNELLER EUGENE
Publication year - 2008
Publication title -
public administration
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.313
H-Index - 93
eISSN - 1467-9299
pISSN - 0033-3298
DOI - 10.1111/j.1467-9299.2008.00740.x
Subject(s) - orchestration , metaphor , health care , public relations , sociology , healthcare system , perspective (graphical) , business , knowledge management , political science , computer science , law , art , musical , linguistics , philosophy , artificial intelligence , visual arts
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.