Abraham B. (Rami) Shani

Sociotechnical Systems: A North American Reflection on Empirical Studies of the Seventies

This paper reviews the development of sociotechnical systems theory and research over the past 30 years, paying particular attention to the evolution of the paradigm in North America during the past decade. Elements of sociotechnical systems theory discussed here include the conceptualization of social systems, technical systems, and open systems, joint optimization, organizational choice, variance control, boundary location, support congruence, quality of work life, and continuous learning. A review of 134 experiments is then summarized, indicating which features of sociotechnical systems design are used most frequently, and which in turn are associated with reported success on a number of critical outcome dimensions such as productivity, costs, quality, and satisfaction. An unexpected finding of this review was that while sociotechnical system experiments have been extremely successful overall, the number of experiments involving technological innovation or change is relatively small; moreover, from the results achieved in these experiments, it is obvious that we still have much to learn regarding the design of technical systems for joint optimization. Methodological issues and areas in need of further research are explored.

Chapter 1 Organizing for Sustainable Health Care: The Emerging Global Challenge

Purpose – This chapter frames the topic of organizing for sustainable health care in terms of the environmental trends that have rendered current health care approaches unsustainable, the embeddedness of health care in societys triple bottom line, and the need to build adaptive capability within the complex health care ecosystem. Design/methodology/approach – We synthesize documented trends and empirical findings regarding the viability of current approaches to health care, and provide a theoretically framed treatment of the adaptation process in the complex health care system that can lead to the emergence of sustainable approaches. Findings – There is a misfit between current approaches to delivering health care and the requirements and trends in contemporary society. Fundamental transformation is required that entails a broadening of purpose, a future orientation, and a rethinking of how health care adds value and how it is embedded in society. Originality/value – By reconceptualizing health care reform as intricately related to societal sustainability and the triple bottom line, we open the possibility of transcending a narrow focus on reengineering to create more efficient organizations and work processes that consume fewer resources and deliver greater value. We invite health care practitioners and scholars to rethink all the connections in the health care ecosystem, and the need to build in self-organizing capabilities and adaptive capacity. The cases in this book provide knowledge from systems engaged in fundamental transformation, analyzed through the lenses of theoretical frameworks that help us better understand essential dynamics involved in creating sustainable health care systems.

Chapter 8 Learning to Organize for Sustainable Health Care: Rigor, Reflection and Relevance

Purpose – This chapter provides a reflective synopsis of the chapters in the volume and highlights the learning from the cases about the development of new orientations, design configurations, and learning mechanisms. It charts directions for further research and possible managerial actions. Design – The chapters in this second volume of the book series “Organizing for Sustainable Effectiveness” capture a rich set of cases in which organizing for sustainable health care was the central focus. Each chapter illuminated the development of a distinct health care system in a unique cultural and national context, and had a special focus on reporting theoretically informed and rigorously explored knowledge to guide purposeful design and learning approaches. Collectively the chapters highlighted the processes, organization and design, system regulation, and continuous learning approaches in complex organizational and multi-organizational health care systems that enable focus on and advancement of economic, social, and ecological outcomes. Findings – Several critical themes have emerged from the cases, and from the broader literature on health care transformation: the importance of purpose; the need to overcome fragmentation; the need for alternative business models; technology as an investment in sustainable health care; the centrality of knowledge management; the importance of partnership and collaboration; the role of self-organization and leadership; and the criticality of building change capabilities.

Chapter 8 Organizing for Sustainable Effectiveness: Reprise and Way Forward

The chapters in this first volume of the book series “Organizing for Sustainable Effectiveness” captured a rich set of cases in which sustainable effectiveness was the central focus. Each chapter illuminated the development of a distinct sustainable system, and had a special focus on reporting theoretically informed and rigorously explored knowledge to guide purposeful design and learning approaches. Collectively the chapters highlighted the processes, organization and design, system regulation, and continuous learning approaches in complex organizational and multiorganizational systems that enabled simultaneous focus on and advancing of economic, social, and ecological outcomes. In this concluding chapter, we capture, via a comparative investigation, some of the learning from the cases about the development of new capabilities, design orientations, and learning mechanisms, and we chart directions for further research and managerial actions.

Chapter 1 Organizing for Sustainable Effectiveness: Taking Stock and Moving Forward

The large number of publications about sustainability and sustainable development that have been published during the past decade has dealt largely with the science of sustainability, the content of sustainability initiatives, and increasingly with the need to more closely link the economic, environmental, and social purposes and operating logic of the firm. Recent literature stresses the inherent social nature of the challenges to aggressively moving to more sustainable ways of operating for the well-being of our planet, society, economy, organizations, and humans. Despite rich case examples, guidance on how to organize to achieve the triple bottom line is limited. We take stock of the current state of knowledge, using an adaptive complex system perspective to articulate the challenges of organizing for sustainable effectiveness. Most of the global economy and the knowledge upon which it is predicated carry a logic of resource abundance even in the face of increasing competition for scarce resources, and a singular focus on economic outcomes. We argue that the development of new capabilities to address triple bottom line sustainability requires a change in that logic and requires new rules of interaction, new organizational and interorganizational designs, and new ways of learning. The premise is that systems can build on their inherent capabilities to learn and to act collectively in order to adapt. We argue that by working together to collaboratively explore how to organize for sustainability, academics and practitioners can accelerate knowledge generation and progress. This chapter provides the theoretical framing context for the chapters to come.

Reconfiguring the Ecosystem for Sustainable Healthcare: Integrating Outside-In and Inside-Out Perspectives

Abstract Purpose This chapter provides a reflective synopsis of six cases focused on making healthcare sustainable. The nature and value of an ecosystem perspective is explored. The intent is to apply and generate organizational knowledge to understand and guide purposeful design and learning. Design/methodology From five countries where healthcare is organized differently, these cases illuminate particular approaches to develop the capabilities for healthcare to deliver greater value to society. Each case is examined through the lens of an appropriate theoretical perspective. This chapter reports the themes that were common in the six case studies. Findings New approaches are changing the connections in the healthcare ecosystem, including the flows of: medical knowledge, clinical information, and resources. Common themes include: the importance of networks in the emerging healthcare ecosystem; the role of governance mechanisms and leadership to align the diverse ecosystem components; the engagement of dominant ecosystem actors; the need for adaptive change capabilities, and for multi-stakeholder research collaborations to generate actionable knowledge. Practical implications Taking an ecosystem perspective enables healthcare leaders to broaden their conceptualization of the changes that will be required to be sustainable in a changing society. Social implications Almost every man, woman and child is affected by the healthcare system. Increasing the sustainability of healthcare is integral to increasing societal sustainability overall. Originality Viewing the ecosystem as the appropriate focus of purposeful change departs from a traditional approach that focuses on the effectiveness of each element.

Organizing for Sustainable Health Care: Introduction to Volume 2

Welcome to the second volume of the series “Organizing for Sustainable Effectiveness.” This series addresses the practical issue of how to organize for sustainability and generates theory analyses, general principles, and guidelines for action. Volume 1, Organizing for Sustainability (2011), included a rich set of cases about organizations that were making fundamental change to achieve the triple-bottom-line challenge of simultaneously achieving viable financial performance and fostering social and environmental health. Each chapter illuminated the development of a sustainable system and reported theoretically informed and rigorously explored knowledge to guide purposeful organizational design and learning for sustainability. The chapters collectively highlighted the importance of well-designed processes, organizing approaches, management systems, and continuous learning approaches in complex systems.