Social Science & Medicine 74 (2012) 273e280

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Social Science & Medicine

journal homepage: www.elsevier.com/locate/socscimed

Let’s dance: Organization studies, medical sociology and health policy

Graeme Currie a, *, Robert Dingwall a, b, Martin Kitchener b, c, Justin Waring a
a
Warwick Business School, University of Warwick, Coventry CV47AL, UK
b
School of Social Sciences, Nottingham Trent University, UK
c
Cardiff Business School, Cardiff University, UK

a r t i c l e i n f o a b s t r a c t

Article history: This Special Issue of Social Science & Medicine investigates the potential for positive inter-disciplinary
Available online 7 December 2011 interaction, a ‘generative dance’, between organization studies (OS), and two of the journal’s traditional
disciplinary foundations: health policy and medical sociology. This is both necessary and timely because
Keywords: of the extent to which organizations have become a neglected topic within medical sociology and health
Organization studies policy analysis. We argue there is need for further and more sustained theoretical and conceptual
Medical sociology
synergy between OS, medical sociology and health policy, which provides, on the one-hand a cutting-
Health policy
edge and thought-provoking basis for the analysis of contemporary health reforms, and on the other
Inter-disciplinary
hand, enables the development and elaboration of theory. We emphasize that sociologists and policy
analysts in healthcare have been leading contributors to our understanding of organizations in modern
society, that OS enhances our understanding of medical settings, and that organizations remain one of
the most influential actors of our time. As a starting point to discussion, we outline the genealogy of OS
and its application to healthcare settings. We then consider how medical sociology and health policy
converge or diverge with the concerns of OS in the study of healthcare settings. Following this, we focus
upon the material environment, specifically the position of business schools, which frames the gener-
ative dance between OS, medical sociology and health policy. This sets the context for introducing the
thirteen articles that constitute the Special Issue of Social Science & Medicine.
Ó 2011 Elsevier Ltd. All rights reserved.

Introduction genealogy of OS and its application to healthcare settings. We then

This Special Issue of Social Science & Medicine investigates the
potential for positive inter-disciplinary interaction, a ‘generative
dance’, between organization studies (OS), and two of the journal’s
traditional disciplinary foundations: health policy and medical
sociology. This is both necessary and timely because of the extent to
which organizations have become a neglected topic within medical
sociology and health policy analysis. For example, recent attempts
to understand the effects of competition upon health outcomes
would significantly benefit from a re-incorporation of organiza-
tional analysis into the space between the study of patients and the
study of policy (Bevan & Skellern, 2011). Equally, it is common to
find calls for more attention to the influence of organizational
‘context’ when explaining variance in the implementation of new
therapies, technologies or interventions (Kaplan et al., 2010). As
a starting point to discussion, in this introduction we outline the
* Corresponding author. Warwick Business School, University of Warwick,
Coventry CV47AL, UK. Tel.: þ44 (0) 2476 528432; fax: þ44 (0) 2476 524410.
E-mail address: graeme.currie@wbs.ac.uk (G. Currie).
consider how medical sociology and health policy converge or
diverge with the concerns of OS in the study of healthcare settings.
Following this, we focus upon the material environment, specifi-
cally the position of business schools, which frames the generative
dance between OS, medical sociology and health policy. This sets
the context for introducing the thirteen articles that constitute the
Special Issue of Social Science & Medicine.
Organization studies and healthcare
For nearly a century, the study of organizations has been
a “central speciality” within the social sciences (Ennis,1992). This has
helped to spur the development of a discipline of OS, which
encompasses the study of organizations from multiple perspectives,
methods, and levels of analysis. This included the micro-level anal-
ysis of individual and group behaviour, such as leaders and team, the
study of organizational structures, cultures and processes and their
influence of work practices, to more widespread interest in the wider
institutional field within which organizations are located (Scott,
2004:1). OS is a flourishing discipline supporting a broad range of
scholarly activity including: university departments, posts and

0277-9536/$ e see front matter Ó 2011 Elsevier Ltd. All rights reserved.
doi:10.1016/j.socscimed.2011.11.002
274 G. Currie et al. / Social Science & Medicine 74 (2012) 273e280
programmes; dedicated research journals (e.g., Organization Studies,
Organization), and associations including the European Group on
Organizations Studies (EGOS), the Organization Theory division of
the Academy of Management (AoM), and the Section on Organiza-
tions, Occupations and Work which is one of the three largest
sections within the American Sociological Association (ASA). Taking
the long view, OS has consistently benefitted from the study of
healthcare settings, just as the understanding of those settings has
been enhanced by the application of OS perspectives. Reflecting this,
there are also specific journals and associations concerned with OS
in healthcare e.g., the Organizational Behaviour in Healthcare
(OBHC) grouping, and the Journal of Healthcare Organization and
Management.
The development of OS can be traced, at least, to the manage-
ment analysts and industrial engineers of the early twentieth
century who were concerned with improving productivity. Most
viewed organizations primarily as settings within which work was
conducted, rather than as distinctive social settings (e.g., Taylor,
1911). In contrast, and encouraged by studies such as those at the
Hawthorne works (Mayo, 1933) that challenged the Taylorist
paradigm, the first generation of social scientists to use organiza-
tions as their primary unit of analysis began to elaborate two
contrasting views: that organizations were either: (a) ‘rational
systems’ that can be manipulated to achieve given ends, or (b)
‘natural’ systems’ that evolve through indeterminate processes
(Gouldner, 1959; Selznick, 1948).
OS has derived two significant contributions from sociological
analyses of healthcare/medical settings. First, the study of organi-
zational structures (formal and informal) has developed ways to
describe and differentiate among structural types and features,
explain their emergence and consequences (e.g., power, social
equity), and explore their change/resilience over time. Second, as
open systems models challenged myopic managerial frameworks
that neglected relations between organizations and their environ-
ment, researchers have considered the dualistic ways in which the
environment of medical settings (including policy) constitutes and
influences organizations, whilst organizations also affect their
environment. Seven main perspectives have emerged from OS,
encompassing concerns for: organizational structure and agency:
contingency, transaction costs, resource dependency, networks,
ecology, institutional, and complexity. As the following summary
demonstrates, each has been developed and/or applied fruitfully in
studies of healthcare/medical settings.
From the late 1950s, contingency theory was founded on the
recognition that, although organizations are dependent on their
environment for resources, environments vary in complexity and
uncertainty. In stark contrast to the universal prescriptions of earlier
managerial models (e.g. Taylor, 1911), contingency perspectives hold
that organizational performance is dependent upon the ‘fit’
between internal structures and strategy, and environmental
conditions. In addition to providing both an explanation of, and
justification for, organizational variety in healthcare, the enduring
influence of contingency theory reflects its appeal to practitioners
and researchers who seek to improve and/or understand organi-
zational performance (Donaldson, 2001).
A related explanation of organizational variety in healthcare is
provided by transaction cost perspectives (Williamson, 1981).
Building on economists’ insights into the varied nature of one envi-
ronmental contingency e transactions (exchanges of goods and
services) e it is suggested that, where transactions are more complex
and uncertain, formal organizations provide a more effective means
of governance than markets. This approach has provided the basis for
analyses of, for example, healthcare organizations’ decisions to ‘make
or buy’ areas of activity including American hospitals’ choices to
integrate with physician practices (Robinson, 1997).
Resource dependency theory (RDT) builds on insights from
contingency and transaction costs to present a more sociological
perspective (Pfeffer & Salancik, 1978). While RDT follows contin-
gency theory in stressing the performative importance of the fit
between organization and environment, it sees environments as
comprising both political and economic resources. While RDT
follows transaction costs in recognizing the importance of
exchanges for organizational design, it stresses that imbalanced
exchanges reflect power asymmetries and generate a potential for
political conflict. Studies of healthcare provider organizations have
analyzed how managers design their strategies and structures to
reduce resource dependencies and power asymmetries with, for
example, suppliers and regulators (Cook, Shortell, Conrad, &
Morrisey, 1983; Zinn, Weech, & Brannon, 1998).
From the 1970s, following psychologists’ insights into the
importance of networks in explaining interpersonal relations,
scholars have studied the implications of organizations’ location in
networks of relations, and the structure of those networks. Generic
critique of the network form of organization, as it has supplanted or
blended with markets and hierarchies (Powell, 1990), have been
followed by analysis of their application in healthcare settings,
which have cast a critical light on global policy in this direction
(Currie, Finn, & Martin, 2008; Ferlie & Pettigrew, 1996).
A common feature of these perspectives is the emphasis placed
on the capacity of organizations to adapt to environmental change
by, variously, re-fitting, amending buy/make strategies, and
networking. In contrast, the organizational ecology perspective
(Hannan & Freeman, 1977) holds that the most important change
occurs at the level of the population (of similar organizations).
There, aggregate level changes occur through organizational birth
and death rates, and composition alters by one structural form
replacing another. Wells, Harris Lemak, and D’Aunno (2005)
present an instructive application of this perspective to U.S drug
treatment centres.
Institutional analysis is the most clearly sociological perspective
and has been increasingly applied, and developed, in healthcare
settings. Its major contribution has been the stress placed on the
importance of symbolic elements (schemas, logics and scripts) in
shaping organizational structure, behaviour and survival (Meyer &
Rowan, 1977). These influences operate at many levels, but
researchers have concentrated on the organizational field, defined
as organizations operating in a functionally specific arena (e.g.
dentistry). In healthcare, this perspective has proved a fruitful
resource for inquiry into processes of institutional change and
inertia that reveal complex interplays between material resource,
competitive and institutional environments (Kitchener, 2002;
Scott, Ruef, Mendell, & Caronna, 2000).
Complexity theory has been used to explore the dynamics of
change in fields of healthcare organizations. This approach moves
away from homeostatic functionalist accounts to treat organiza-
tions as complex adaptive systems in which small changes to one
area may have dramatic effects on others (Anderson, 1999; Plesk &
Greenhalgh, 2001). Recent applications of complexity theory to
healthcare settings have focussed on primary care delivery, the
number and quality of connections within organizations, and on
the obesity epidemic (for an overview, see Fennel & Adams, 2011).
OS work in healthcare settings has, then, increasingly adopted
open systems conceptions, to investigate more and different facets of
organization/environment interactions, and extended study designs
to examine larger, more encompassing systems in which organiza-
tions are central players (Scott, 2004). Of the seven OS perspectives
outlined, the five with the strongest sociological roots (ecological,
network, RDT, institutional, and complexity) have been the most
widely used in healthcare analyses. In contrast to the performative
perspectives derived from economics and management, the more
 G. Currie et al. / Social Science & Medicine 74 (2012) 273e280
sociologically oriented perspectives provide productive bases for
studying topics including: leadership, knowledge mobilization,
organizational change, occupational roles, entrepreneurship, and
innovation (Battilana, 2011; Fennel & Adams, 2011; Ferlie, Ashburner,
Fitzgerald, & Pettigrew, 1996; Pettigrew, Ferlie, & McKee, 1992; Reay,
Golden-Biddle & Germann, 2006; Scott et al., 2000). Each of these
gives a central role to the concerns of sociologists and policy analysts
about power, resistance, and control. They also frame questions
about who benefits and suffers from existing and planned
arrangements.
An illustration of the varied and productive ways in which these
concerns have been addressed by applying OS perspectives in
healthcare setting is presented in a recent, four-volume edited
collection (Currie & Kitchener, 2010). The first section of this
collection presents papers concerned with macro issues of: inter-
organizational relations, based upon markets, hierarchies and
networks; regulation of professionals, considering issues of control
and autonomy; and performance management, exploring impli-
cations for its increased use in healthcare. The second section deals
with the more micro issues of: leadership, strategy, processes and
outcomes; and managing change, from practical and theoretical
perspectives.
Organization studies, medical sociology and health policy
The contributions in this Special Issue reflect the interaction of
OS with two of the journal’s core disciplines, medical sociology and
health policy. Particularly with respect to medical sociology, the
shared history and intellectual traditions of sociology and OS, such
as the interactionist and Weberian roots of much institutional
analysis, present few barriers to positive exchanges.
Once upon a time, medical sociologists had a lot to say about
organizations in health care. Robert S Lynd (1937) is not usually
considered to be part of the pantheon of medical sociology, but his
second study of Middletown singled out the construction of a new
hospital as one of the key social changes between 1925 and 1935.
With this had come a nucleus of younger, research-minded doctors
who challenged the conservatism of the established physicians,
particularly when it came to anything that smacked of socialized
medicine. Meanwhile, Talcott Parsons analyzed hospitals as orga-
nizations for the social control of the sick (Parsons & Fox, 1952), in
ways that anticipated both Goffman’s analysis of total institutions
(Goffman, 1961) and Foucault’s account of disciplinary institutions
(Foucault, 1975). The so-called ‘Second Chicago School’ of the 1950s
and 1960s developed a wide range of studies examining work and
organizations in health care, mainly inspired by the thinking of
Everett Hughes (Hughes, 1971). Although many of these focussed
on workers rather than on workplaces, they maintained a clear
sense of the importance of organizational context, for example in
medical education (Becker, Geer, Hughes, & Strauss, 1961), or care
delivery (Davis, 1963; Glaser & Strauss, 1968). Some, however,
focussed very specifically on organizations, for example, Freidson’s
work on professional social control in group medical practice
(Freidson, 1988). When Hughes and Allen (1993) came to review
this literature for a study commissioned jointly by the Milbank
Memorial Fund, from the US, and the King’s Fund, from the UK, they
found, however, that, by that date, very little work on organizations
was then being carried out by medical sociologists.
What had happened to this apparently vibrant tradition? The
story is not entirely clear but several elements seem to be involved.
An important one is clearly the impact of the material environment.
Many medical sociologists are employed in one way or another by
schools of medicine or health sciences rather than work in soci-
ology departments. As such many have come under pressure to
succumb to the blandishments of ‘sociology in medicine’ (Straus,
275
1957) doing work that will fit with the preferences of their
employers and sponsors, particularly where add-on funding may
be available around clinical priorities. As such, medical sociologists
often find themselves working alongside epidemiologists, health
service researchers or healthcare professionals on issues like health
inequalities, patient perspectives, mental health, risk, genetics, and
HIV. There is little demand for work that reflects critically upon the
context in which clinical practice occurs: very often, this is taken as
more or less given and the task is to elicit patient responses or to
adjust patient expectations and behaviour. The systemic thinking in
which sociologists are trained can easily get lost. Where medical
sociologists have remained within sociology departments, barriers
of funding and access have tended to divert their attention towards
topics that do not require substantial resources for empirical
investigation such as cultural studies of medicine and medical-
ization, where materials are readily and publicly available without
the need to navigate regulatory systems. As Strong and Dingwall
(1989) pointed out, there is also a certain cultural reluctance
among sociologists to engage positively with issues of manage-
ment, efficiency and effectiveness compared with their concerns to
document inhumanity or injustice. Finally, in the turbulent
academic labour market of the last thirty years, business schools
have hired more consistently and often with better pay and
conditions than those available in sociology departments. The
social scientific study of work and organization has progressively
moved from mainstream sociology into schools of business and
management. Although a recent four-volume collection of quali-
tative health research, edited by Dingwall (2008), devotes an entire
volume to studies of organizations, it is notable that the most
recent contributions tended to be drawn from OS sources. Orga-
nizational sociologists have then found themselves, in various
guises co-opted into the discipline of OS.
Health policy scholars have found engagement more difficult.
The institutional and epistemological gaps are much wider. This
relates variously to the empirical level of analysis (macro-level
analyses), the intended audience (policy-makers) and the associ-
ated normative positions. It results in a discrete set of academic
endeavours (a different set of journals, conferences, and policy
briefings). The gap is exacerbated by the focus of the highly cited
health policy academic literature on US health care, which is of
limited relevance to OS scholars based in Europe. Yet, as with
medical sociology, we can identify seminal works that link the
context of US policy to OS concerns. For example, much of the
recent academic interest in healthcare organization and manage-
ment draws upon Alford’s book on the politics of healthcare and
attendant corporate rationalization (Alford, 1975), and Scott’s
examination of institutional change in healthcare (Scott et al.,
2000). Health policy is also increasingly concerned about a trans-
lational gap between the development of effective clinical inter-
vention and its implementation. For example, in England, drawing
upon Canadian experience, concern is focused upon the second
translation gap [T2], or the ‘know do gap’, as much as the trans-
lation gap that relates to the development of the clinical inter-
vention in the first place [T1 gap], or the ‘know what’ gap (Cooksey,
2006). Bridging the T2 gap requires different disciplines to work in
a more integrated way, uniting not only clinical science and social
science, but also different social sciences with diverse but mutually
respected, epistemological perspectives; i.e. we label the challenge
one of bridging the ‘T1.5’ gap.
Having argued the potential for a generative dance, we recog-
nize that OS, medical sociology and health policy have frequently
moved past each other. In particular, for medical sociology and
health policy, there has often been greater attention to the specific
healthcare context being studied and the implications for those
who deliver and receive healthcare, rather than to the development
276 G. Currie et al. / Social Science & Medicine 74 (2012) 273e280
of a broader or more general theoretical account. OS seems much
more theoretically orientated, and despite being located in business
schools, appears sometimes decoupled from immediate practical
concerns. However, perhaps more importantly there is often an,
implicit or explicit, emancipatory expectation in both traditions
that research should in some way inform change, whether in terms
of giving voice to marginalized groups or challenging the influence
of those in power. As such, the empirical context is not primarily
there to develop a theoretical model, but to document prior
normative agendas. OS has not, been exempt from this ambition:
its key European journal, Organization Studies, is encouraging
submissions that seek to make societal impact. Again, we highlight
potential for the generative dance around such issues, with medical
sociology and health policy representing the lead dancer here.
In summary, whilst there are many points of difference, we have
highlighted points of convergence. The key is to remind ourselves
of the established connections, but also to look for areas that have
rarely been connected. This Special Issue encourages connection,
with a particular emphasis on the contribution that OS can make to
traditional concerns of medical sociology and health policy, while
recognizing the importance of reciprocal influence. Contemporary
organizational research has built on earlier works in medical soci-
ology and health policy, pushing their application beyond health-
care. Take for example, research on social institutions that has
experienced sustained theoretical elaboration and refinement
amongst OS scholars, often through healthcare case studies. This
research has substantially enhanced how we think about social
institutions, how they are manifest in social practice through
carriers and how social change can be enacted through various
kinds of work. Equally, through embracing the diversity of the
social sciences, OS can offer medical sociology a more holistic and
robust understanding of contemporary issues related to healthcare
organization and delivery. One example might be management
change, which has become a significant policy theme but where
medical sociologists have frequently lacked the knowledge, skills
and conceptual repertoire to understanding where such changes
originate, how they have been applied and what they might mean
for healthcare delivery or patient experience.
Reconciling disciplines: the problem of business schools
An important barrier to more productive relationships, though,
is the position of business schools within the academy. Concerns
about the effects on scholarship of the migration of individuals and
research agendas from academic departments to professional
‘trade’ schools highlight the anxiety that social scientists may
become more applied, dominated by economic and performative
criteria, and neglect themes of inequality and power. This may be
a particular issue for medical sociologists, which has frequently
seen itself as the bearer of concerns for social justice that are
believed to be at odds with concerns for the efficiency and effec-
tiveness with which public or private resources are used. These
cultural differences are reinforced by the structures of institution-
alized career paths, which engender sub-specialism at an early
career stage. In the United Kingdom at least, the centralized
performance management of research (e.g. the forthcoming
Research Excellence Framework) drives a ‘silo’ mentality, which
discourages inter-disciplinary work. In countries, such as the USA,
with tenure tracks driven by a need to publish in a prescribed list of
disciplinary journals, we perceive similar effects.
Whilst noting these concerns, we believe that Business Schools
have moved away from a managerialist positioning towards serving
a broader range of stakeholders, and indeed, driven by ‘science
envy’ have become much more theoretically inclined. They have
not always been successful, and there is a vigorous contemporary
debate about their purpose: are they ‘for’ management or ‘about’
management (in a way that mirrors debate in medical sociology
regarding whether sociology is ‘in’ or ‘for’, ‘of’ or ‘about’, medicine)?
Nevertheless, Business Schools are probably the most pluralist
social science departments in a modern university (commonly
encompassing academics from economics, sociology, psychology,
political science, and geography) and in methodological terms
(whilst US Business Schools orientate towards more positivist and
quantitative approaches, European Business Schools often practice
interpretivist and qualitative approaches equally). Moreover some
business schools are moving towards a so-called ‘business in
society’ perspective, looking beyond the immediate bottom line to
consider the need for enduring or sustainable organizations to
acknowledge and serve a wider group of stakeholders than share-
holders and management. This new, less managerialist direction is
reflected in a number of OS conferences where social science and
medicine academics might find a ‘home’ community: for example,
Critical Management Studies [CMS], EGOS, and OBHC.
Medical sociologists have also been increasingly willing to
reconsider the place of organizational studies within their agendas.
In the silver jubilee issue of Sociology of Health and Illness, for
instance, there were calls from Davies and Griffiths to give more
consideration to the context within which doctors and patients
encountered one another. Griffiths (2003) argued that medical
sociology should be more accommodating to insights from other
disciplines to enhance its understanding of health care delivery
(Griffiths, 2003). Davies (2003: 178) commented that medical
sociology had neglected the significance of new organizational
forms and approaches to health care management, ‘with no strong
sense of a growing corpus of work on the theme of organizations’.
More recently, May (2007) has argued that it is time for medical
sociologists to put their traditional concerns about the clinical
encounter into the context of organizational and managerial
arrangements. At the same time, some OS voices have been heard
to criticize past managerialist assumptions for marginalizing issues
of concern to other stakeholders. Learmonth (2003), for example,
has argued for a more sociologically informed approach to change
management. Similarly, from a sociologically informed perspective,
US commentators have shown how a various theoretical perspec-
tives on organizational change can be applied to healthcare orga-
nizations (Flood & Fennell, 1995).
Within health policy, commentators have noted increasing
emphasis on changes in organizational and managerial arrange-
ments. The emphasis has moved away from policy-making per se,
to addressing the implementation gap that follows aspirations
expressed in policy documents. The topics covered by OS, described
earlier (e.g., leadership, knowledge mobilization, re-engineering
organizations and occupational roles, strategic change, and entre-
preneurship and innovation) are currently central to policy-makers’
thinking, yet it is often in these areas that reforms tend to fail.
Surprisingly, in the face of an all-pervasive implementation gap,
academics in the health policy field seem to pay little attention to
theory developed in OS about such matters. At the same time, some
OS academics who study healthcare have tended to ‘relegate’ policy
to the context that frames their more substantive interest in
management. Hence, Ferlie, Hartley, and Martin (2003) call for
those from an OS tradition, carrying out empirical work in
healthcare, to integrate, rather than decouple, policy with
management. So, again, a generative dance appears worthwhile
between disciplines.
Leading the dance: papers in this special issue
With the above debate in mind, and with optimism for pros-
pects of a generative dance between OS and two of the core
 G. Currie et al. / Social Science & Medicine 74 (2012) 273e280
disciplines of Social Science & Medicine, namely medical sociology
and health policy, we sent out our call for papers to connect with
OS. Reflecting our argument that, indeed there is a good deal of
cross-over and common ground between OS and medical sociology
and health policy, we received over sixty submissions, of which
thirteen of these were selected for publication, as follows.
As our first article, we present a study of an organization and
management phenomenon that appears all-pervasive across global
healthcare systems, and which draws in OS, medical sociology and
health policy concerns and literature. A Special Issue of any
academic journal purporting to engender a generative dance
between OS, medical sociology and health policy can’t ignore
leadership as a policy panacea for healthcare organization. Martin
and Learmonth (2012) article is set in the English NHS, a context
which might be considered a fast mover in leadership policy terms
(Currie & Lockett, 2011), and draws upon interviews with health-
care organization CEOs and an analysis of policy documentation
since 1997, with a particular emphasis upon the most recent
reforms. Their analysis links to our introductory contention that OS
literature is more critical than commonly assumed. In short, like
many OS scholars, their article is ‘about’ management practice,
rather than offering prescription ‘for’ management practice. Martin
and Learmonth argue, to quote, “claims made about engagement of
healthcare professionals in the design and delivery of reforms is
best understood as efforts to reconstitute these actors’ subjectiv-
ities: a co-optive means of ‘governing at a distance’ that comple-
ments more coercive modes of rule, such as performance
management and associated surveillance regimes” (2012). On the
one hand, they note the leadership label may prove attractive (it
has discursive appeal) to clinicians. On the other hand, leadership
may become a focus for dissent amongst those at whom the
discourse is aimed. Should their critique be taken seriously, this
might cause policy-makers to attend more to the nuances of
implementation and engender better understanding of the effects
of reforms.
Our second article, by McGivern and Fischer (2012), also focuses
upon a topic of exemplary interest to a reader concerned with
a generative dance between OS, medical sociology and health policy,
that of regulation and ‘spectacular’ transparency. They draw upon
‘cutting-edge’ OS literature in an approach that might be described
as (broadly) medical sociological. This has the effect promised in our
introduction of supporting novel insight across organization studies,
medical sociological and health policy. Empirically their study
examines ‘talking therapies’. Like many of the articles in this Special
Issue, their qualitative approach produces a very lively set of data.
McGivern and Fischer highlight the unintended implementation
consequences of the regulation and ‘spectacular’ transparency that
frames the delivery of talking therapies in the mental health field.
Specifically, they illustrate the professional defensiveness that such
‘spectacular’ transparency engenders.
Our third article by Ward, Smith, House and Hamer (2012) also
examines an organization and management issue of contemporary
significance in global health policy, that of knowledge mobilization,
specifically the practice of knowledge brokering. Ward et al. draw
upon the more contextualized and critical literature within the OS
tradition around mobilizing knowledge; for example, the problem
(for management purposes) of the nature of knowledge. In so
doing, they challenge some of the neat, linear or ‘technicist’ solu-
tions towards mobilizing knowledge that are dominant in global
healthcare policy. At the same time, Ward et al. combine their more
critical orientation with a real desire to effectively intervene in
a way that health services research (compared to OS) is more
inclined. Their embedding of a knowledge broker within healthcare
teams, and analysis of the impact of the knowledge brokers,
provides a good deal of insight into how those researching in the
277
knowledge mobilization area, and those aiming to impact upon
practice, might move forward. In summary, Ward et al. bridge the
academic-practice gap in way that meets criteria for academic
rigour and practical relevance.
Our fourth article also focuses upon knowledge mobilization, and
similarly to Ward et al. above, with a more theoretical orientation
towards its challenges. Greig, Entwhistle and Beech (2012) propose
activity theory as an ‘alternative’ approach to identifying and
understanding the challenges of addressing complex healthcare
problems across diverse settings. Their study critiques the notion of
a single best practice, and uses activity theory to highlight how
efforts to reduce variation from best practice may ‘paradoxically’
remove a key source of practice improvement; i.e. knowledge and
practice are fundamentally intertwined, not separate. Greig et al.
ground their theoretical analysis through an ethnographic study of
primary healthcare teams responding to a policy aim of reducing
inappropriate admissions of older people by the ‘best practice’ of
rapid response teams.
In our fifth article, Anderson (2012) is drawn towards OS from
a more clinical concern. He starts with an examination of classic
distinction in OS between public and private organizations, an
increasingly important one given global convergence towards more
mixed provision of healthcare. For Anderson, however, this repre-
sents a simplistic dualism, which masks the diversity of organiza-
tional types that don’t fit easily into either the public or private
category. Drawing upon a policy literature, Anderson proposes
whether an organization is public or private is a matter of degree,
and that a notion of ‘publicness’ may be useful to examine the link
between organization type and performance. However, he finds
this too inadequately accommodates contemporary organizational
change. Unsurprisingly perhaps, he suggests the relationship
between organizational type and performance remains unclear.
Nevertheless, he concludes his article by reflecting upon implica-
tions of structural change in the English NHS, specifically the move
of providers towards Foundation Trust status.
The contribution from Nigam (2012), which represents our sixth
article, is the only one in the Special Issue that is hypothetico-
deductive, and draws upon quantitative data. The dearth of more
deductive, quantitatively based articles is intriguing, and perhaps
its absence reflects the more discursive turn in OS. Conceptually,
Nigam draws upon, arguably, the most dominant perspective in OS
currently, that of neo-institutional literature. Set in the USA and
focused upon Caeserean use, Nigam develops and tests a model of
the relationship between institutional change, organizational and
professional controls, public attention to cost control practices, and
patient care. She shows how institutional context, specifically
professional control and public attention to cost control practices is
an important determinant of geographic variation in healthcare.
Her essential contribution shows the diverse effects of institutional
change.
Returning to a contribution from authors located in a business
school, in our seventh article MacIntosh, Beech and Martin (2012)
examine clinical-managerial relations. Like knowledge mobiliza-
tion, this represents an exemplary boundary spanning concept to
bring together literature, specifically OS and medical sociology, in
a generative dance. Similar to many of our other contributors, they
gather their empirical evidence through a qualitative approach,
which encompasses comparative cases. They exhibit the more
theoretical inclination that characterizes much of the recent OS
literature. Specifically, MacIntosh, Beech and Martin draw on the
work of Bakhtin (1984, 1986) to consider the extent to which
clinical-managerial interactions are more dialogic or dialectic. They
conclude by offering some prescription, emphasizing organizational
or management intervention at the local level (rather than policy led
intervention) to ensure interaction is more dialogic.
278 G. Currie et al. / Social Science & Medicine 74 (2012) 273e280
Our eighth contribution from Ferlie, McGivern and FitzGerald
(2012) typifies many of the contributions from business schools
in this Special Issue, offering novel insight through a specific more
theoretical framing of an issue of importance in healthcare. Ferlie
et al., engage in Foucauldian analysis, a more critical perspective
upon governance that has enjoyed prominence recently in OS
(although we note its more longstanding (medical) sociological
application). Specifically they develop a Foucauldian analysis of
network forms of healthcare organization in cancer. As with many
of our contributors, they enact a comparative case approach in an
English NHS setting. Intriguingly, they argue that contemporary
English healthcare policy is consistent with Foucauldian gover-
nance, particularly around evidence-based medicine, which they
conceive as a power-knowledge nexus and the subjectification of
clinical-managerial hybrids. In short, Ferlie et al., apply the more
critical OS literature to problematise contemporary healthcare
policy.
In our ninth contribution, Hendy and Barlow’s (2012) perspec-
tive upon change leadership is a relatively narrow one, but never-
theless valuable, in its focus upon the role of clinical champions.
Conceptually, its reach is rather broader, as they apply a strategic
management literature, again they invoke Weick’s concept of
sense-making (Weick, 1995), to produce a grounded approach
to the introduction of tele-care in the English NHS through
a comparative case approach. Their analysis helps explain an
implementation gap in policy aspiration, but at a more strategic
level of analysis than is commonly evident in Social Science &
Medicine. Drawing on an OS literature, they present a more critical
view of the rather normative notions of the role of clinical cham-
pions. They argue that clinical champions may not drive strategic
change in the way expected by policy makers because they do not
identify with their role. In terms of prescription, they suggest
change efforts need to move beyond the single champion role, and
engage a critical mass of actors.
Similarly to Martin and Learmonth, and Hendy and Barlow, our
tenth contribution by Lockett, Currie, Waring, Finn and Martin
(2012) examines leadership of change. As already highlighted, we
should not be surprised by the focus upon leadership, given its
global policy reach. However, and perhaps of more interest, Lockett
et al. conceive of leadership in terms reflective of the aforemen-
tioned institutional turn in OS, specifically as ‘institutional entre-
preneurship’ (Beckert, 1999). This allows them to take a more
sociologically informed view of management practice in the
contemporary health policy setting. Further, the generative dance
between literature is highlighted, as not only are implications for
health policy derived, through revealing and explaining an imple-
mentation gap, but the more generic literature about institutional
entrepreneurship is extended in the healthcare setting.
Nearing the end of our Special Issue, Radnor, Holweg and
Waring (2012) present findings from a qualitative approach to
research design, which encompasses comparative cases, as applied
to the English healthcare system. As with many of the contributions
in the Special Issue, Radnor et al. reveal and explain an imple-
mentation gap in contemporary health policy. In this case, they
focus upon value-based approaches, privileging ‘customer-defined’
notions of service, to the redesign of healthcare pathways
(commonly called ‘lean’), which are enjoying renewed global
popularity in the current austere climate. They argue the lean
approach as practised in English healthcare remains tool-led, and
merely produces localized and limited gain that focus on waste.
They advocate that lean practice needs to move towards a system
level approach, and needs to be contextualized, rather than
generically transplanted intact to its original principles. They
highlight, perhaps counter-intuitively, that breaches of the lean
principles, are not down to professional resistance, but more about
organizational and managerial weaknesses in determining
customer value and influencing demand for healthcare.
As our penultimate article, we present another study from the
USA, empirically focused upon the emergent profession of dental
hygiene. Kitchener and Mertz (2012) exemplify the theoretical aims
of our Special Issue through combining literatures from organiza-
tion studies and sociology to advance understanding of institu-
tional change processes in healthcare that emerge from the
professionalization projects of occupations. Of particular interest is
their historical analysis of the process of the professionalization of
dental hygienists. This allows them to engage in systematic analysis
of the highly contested process through which a new organiza-
tional form emerges to support attempts at professionalization.
As our final article, we present the study of HIV/AIDS services
in Lesotho by Biesma, Makoa, Mpemi, Tsekoa, Odonkor and Brugha
(2012). Whilst the OS perspective is particularly evident in
healthcare studies of the USA (due to its marketised and managed
care dimensions), and England (due to it being a ‘fast mover’ in
policy reforms concerned with organization and management),
the dominance of English and US based empirical studies in the
Special Issue raises concern, particularly about the paucity of
studies of healthcare organization and management in developing
countries. Arguably, in the face of resource constraints, more
severe than those in OECD countries such as the USA and England,
policy makers in developing countries might turn to more effec-
tive organization and management as a means of leveraging
limited budgets to produce enhanced outcomes. In this light,
examination of organization and management of HIV/AIDS
services in Lesotho within this Special Issue by Biesma et al. is
particularly welcome. Further, as with the other substantive
organization and management issues presented in this Special
Issue, Biesma et al. focus upon an OS concept that spans bound-
aries of OS and health policy, that of knowledge mobilization.
From their location in a medical discipline, Biesma et al examine
the implementation of a global fund grant in Lesotho, aimed at
HIV/AIDS intervention, with a specific concern with knowledge
absorptive capacity. Certainly, in practical terms, from an OS
perspective, as outlined in the article, absorptive capacity of the
recipient country is a crucial issue in effectively implementing
healthcare reform that follows external funding.
Next steps: areas for developing organization studies, medical
sociology and health policy
This introductory paper has argued that the concerns of Social
Science & Medicine might benefit from a more integrated approach,
which draws upon the respective theoretical and empirical
contributions of OS, health policy and medical sociology to
understanding health and healthcare in contemporary society. Note
we use the term, ‘inter-disciplinary’, rather than multi-disciplinary,
since we prescribe an interaction that couples previously disparate
perspectives in way that provides synergy and insight beyond that
produced through a more silo-ed mentality. In our call for
a generative dance, aligned with the common ground we describe
above, the collection of articles in this Special Issue represent
a response from those within an OS tradition, to engage more
explicitly with the broader social science and medicine community.
Collectively, these works suggest a number of areas for develop-
ment that seem particularly suited to elaborations from
sociologically-informed studies of healthcare settings: boundaries,
strategies, power processes, and links with other areas of sociology
(Bazzoli, Dynan, Burns, & Yap, 2004; Shortell, 2004).
Inspired by Weber (1924/1968), organizational boundaries have
figured centrally in OS. As the field has increasingly moved away from
views of ‘closed’ social relations within organizations to adopt a more
 G. Currie et al. / Social Science & Medicine 74 (2012) 273e280
open systems perspectives, it has been reported that the boundaries
of healthcare organizations have become (generally) more open and
flexible, as evidenced by the growth of strategic alliances and
networks of independent or semi-independent entities. As the
network perspective introduced earlier has shown, participation in
networks involves significant alterations to scope, composition,
duration and enforcement mechanisms associated with organiza-
tions boundaries. These are likely to have consequences for issues
such as work roles and distributions of power and resources. Explo-
ration of these issues is well suited to studies of healthcare settings
such as UK clinical networks (Addicott, McGivern, & Ferlie, 2007).
During the latter decades of the twentieth century it was
generally reported that organizations were moving from internal-
ization strategies e based on absorbing additional technologies,
processes, and personnel e to externalization strategies involving
disposing of/out-sourcing such resources. While sociologists have
examined the implications of externalization strategies for indi-
viduals in commercial settings, studies of similar processes in
healthcare (e.g., development of Independent Sector Treatment
Centres in the UK) provide the opportunity to consider a broader
range of social implications and consequences (Kitchener &
Harrington, 2004; Waring & Bishop, 2011).
Both OS and medical sociology recognize that the uses and
modes of power are changing in organizations. The dynamics of
power is key to medical sociology. However, limited studies aside
(e.g. Waring, 2007), despite many predictions concerning the
demise of professional-bureaucratic organization modes, it is far
from clear to what extent this has occurred in individual healthcare
fields, what it has been replaced with, and what the implications
are (Kitchener & Exworthy, 2008).
Contributing to the growth of critical management studies,
some organizational analysts have explored the political activity of
healthcare entities (Kitchener & Leca, 2009). Following Mills (1956),
developments including growth in the size and number of for-
profit operators in fields such as UK elderly care present a real
need for studies of corporate power and political influence in
contemporary healthcare (Learmonth, 2003).
Organizational scholars have engaged productively with other
subfields of sociology including political sociology, law and society,
and social movements. A recent collection on social movements
and organizational analysis in healthcare well illustrates the
potential that setting presents for future development (Banaszak-
Holl, Levinsky, & Zald, 2010). But we feel there is need for further
and more sustained theoretical and conceptual synergy between
OS, medical sociology and health policy, which provides, on the
one-hand a cutting-edge and thought-provoking basis for the
analysis of contemporary health reforms, and on the other hand
enables the development and elaboration of theory. This intro-
duction has emphasized that sociologists and policy analysts in
healthcare have been leading contributors to our understanding of
organizations in modern society, that OS enhances our under-
standing of medical settings, and that organizations remain one of
the most influential actors of our time. Let’s Dance.
Appendix. Supplementary data
Supplementary data related to this article can be found online at
doi: 10.1016/j.socscimed.2011.11.002.
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