ABSTRACT
The events recounted in this case began in 1989, a historic time both for American business in general and for the health-care industry in particular. At that time, slack was rapidly being drawn out of American organizations, so much so that even some of the more desperate attempts at reorganizing, downsizing, and just plain working harder usually did not work. Instead, everyone was in search of some kind of “breakthrough,” a new way of doing business that would allow them to accomplish more with less, by working smarter, not harder. Realistically, few in health care could imagine how they could even work any harder than they already were, considering labor shortages, changing roles and responsibilities, and an aging population, to name only a few key factors. At the same time, the favored institutional status of health-care organizations took a tumble (Meyer & Scott, 1983). Stake holders of all sorts, themselves squeezed by shrinking resources, began questioning the ability of formerly unquestioned professionals—physicians primarily—to deliver quality results at a good value for the money. The consequences of these pressures have been dramatic for all who come in contact with health-care institutions. Administration has been placed under enormous pressure (from government and other regulatory bodies) to control costs and to compete. At the same time, hospital employees from all professions continue to pursue their own interests, which are sometimes at odds with efficiency and are, as a rule, difficult to coordinate. Consequently, the battle for limited resources has exacerbated the traditional conflicts between departments. By 1989 these combined forces had moved hospitals and health-care providers of all kinds away from their traditional mission—the delivery of patient care. Instead they had begun to conduct themselves more like businesses than ever before.
