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Institutional Change and Healthcare Organizations

From Professional Dominance to Managed Care

Few large institutions have changed as fully and dramatically as the U.S. healthcare system since World War II. Compared to the 1930s, healthcare now incorporates a variety of new technologies, service-delivery arrangements, financing mechanisms, and underlying sets of organizing principles.

This book examines the transformations that have occurred in medical care systems in the San Francisco Bay area since 1945. The authors describe these changes in detail and relate them to both the sociodemographic trends in the Bay Area and to shifts in regulatory systems and policy environments at local, state, and national levels. But this is more than a social history; the authors employ a variety of theoretical perspectives—including strategic management, population ecology, and institutional theory—to examine five types of healthcare organizations through quantitative data analysis and illustrative case studies.

Providing a thorough account of changes for one of the nation’s leading metropolitan areas in health service innovation, this book is a landmark in the theory of organizations and in the history of healthcare systems.

452 pages | 62 line drawings, 41 tables | 6 x 9 | © 2000

Sociology: Formal and Complex Organizations

Table of Contents

List of Figures and Tables
List of Case Illustrations
1. A World in Transition1
2. The Case of the San Francisco Bay Area: Focal Populations and Organizations
3. Changing Healthcare Delivery Systems
4. Processes Shaping Organizational Populations: Ecological and Adaptive Change
5. Resource Environments and Organizational Dynamics
6. The Changing Institutional Environment
7. Institutional Environments and Organizational Legitimacy
8. Horizontal, Vertical, and Virtual Integration of Healthcare Organizations
9. Institutional Environments and the Organizational Field
10. Institutional Change and Structuration Processes
App. A. Data Sources for Organizational Populations
App. B. A Supplemental Data and Analyses
App. C Quantitative Methodology
Glossary of Abbreviations and Acronyms


ASA Occupations & Organizations Section: Max Weber Award

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