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Medical Care Research and Review, Vol. 61, No. 3, 247-331 (2004)
DOI: 10.1177/1077558704266818

Reviews

Two Decades of Organizational Change in Health Care: What Have we Learned?

Gloria J. Bazzoli

Virginia Commonwealth University

Linda Dynan

Northern Kentucky University

Lawton R. Burns

University of Pennsylvania

Clarence Yap

McKinsey and Company

The 1980s and 1990s witnessed a substantial wave of organizational restructuring among hospitals and physicians, as health providers rethought their organizational roles given perceived market imperatives. Mergers, acquisitions, internal restructuring, and new interorganizational relationships occurred at a record pace. Matching this was a large wave of study and discourse among health services researchers, industry experts, and consultants to understand the causes and consequences of organizational change. In many cases, this literature provides mixed signals about what was accomplished through these organizational efforts. The purpose of this review is to synthesize this diverse literature. This review examines studies of horizontal consolidation and integration of hospitals, horizontal consolidation and integration of physician organizations, and integration and relationship development between physicians and hospitals. In all, around 100 studies were examined to assess what was learned through two decades of research on organizational change in health care.

Key Words: organizational change • organizational restructuring • consolidation and integration


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