Large-scale organizational and managerial change in health care: a review of the literature.

This paper takes an overview of the organizational and managerial literature on recent large-scale change efforts within health care organizations. Such literature refers to issues of enhanced policy significance, as a succession of such changes has swept through health care, at an international level. Interpretive and case study method have been widely employed in this field. While the literature is emergent, key empirical concerns can be identified: (1) Changing roles and relationships, with the rise of management and the challenge to clinical domination; some argue that radical deprofessionalization now is evident, while others take a more nuanced view. (2) The impact of marketization, with health care becoming more of a commodity; various models of a health care 'quasi market' have been formulated. (3) Understanding the process of change in health care organizations, such as the development of a management of change literature. New theoretical frameworks have been developed, notably 'the reform cycle' as a way of understanding progressive cycles of organizational reform, the impact on health care of the rise of the new public management, and examining the demedicalization thesis through the more generic literature on professions. The paper concludes with a discussion of what this research base could contribute to policy-making.