A turbulent field: Theory, research, and practice on organizational change in health care

The oft-quoted Plato once remarked that the only certainties in life are death and taxes. When considering the lives of organizations in the healthcare industry, we can add another sure thing to this list: change. The various sectors that make up the broader healthcare industry have undergone unrelenting and dramatic change over the last two decades. Federal and state regulatory shifts, innovative new medical technologies, the emergence and evolution of managed care, and continued social and demographic transformation have all been accompanied by major reconfiguration in the system, the organization, and the delivery of health care. Nowhere has this been felt more than in the multitude of different organizations that make up the healthcare industry. Historical, regulatory, and geographic boundaries that traditionally divided the various sectors of the industry have toppled, creating new opportunities for organizations to expand outside their traditional domains. Traditionally the focal point of health care delivery, hospitals have seen their markets invaded by physician group practices and a variety of sub-acute care providers. Changing technology and population demographics have given rise to a multitude of organizational types providing niche services or products at various points along the continuum of