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Purpose – This chapter argues that the concept of agility is an effective robust framework for designing sustainable health care systems.

Design/methodology/approach – This case study of Alegent Health was based on 7 years of data collection. It includes observations of meetings, large-group interventions, and other activities; site visits to different hospitals in the system to observe changes in practice; interviews with Alegent Health executives, primary care physicians, hospital presidents, specialist physicians and physician groups, and health systems staff and nurses; and a variety of archival data including meeting minutes, video tapes, conference proceedings, and web site material.

Findings – The Alegent Health system has evolved over time according to the principles of agility. It built a series of new capabilities that contribute to improved clinical outcomes, sustained financial results, and more socially and ecologically responsible results. Designing health care systems based on agility is a more effective and sustainable approach than relying on legislative or other criteria.

Originality/value – The discussion of sustainability in health care has focused primarily on specific projects or how to respond to specific technological, regulatory, or clinical changes. Alegent Health's experience provides important lessons, opportunities, and challenges that can help advance our understanding of effective health care and use organizational agility to create more sustainable health care systems. This chapter provides health care system administrators an alternative design option.

The increasing interest in economic, social, and ecological sustainability has important implications for the traditional views on organization effectiveness, organization design, and organization development. Managers need to design organizations to achieve a “triple bottom line.” A review of the organization effectiveness literature suggests that no single model seems to provide the necessary guidance, and there is a clear need for creation, revision, and integration. Organization effectiveness criteria in the future require a clearer modeling of the multistakeholder demands so that organization designers can specify appropriate strategies, structures, systems, and processes as well as the changes necessary to develop them. We propose an integration called “responsible progress” and suggest that it represents an important new stream of organization development theory. The relationships between this new criterion of organization effectiveness and the design features necessary to pursue them must be tested.

Organization change (OC) is increasingly important in today's volatile world. Understanding OC is a growing emphasis of management and organization (M&O) research and the singular focus of OC scholarship and practice. We show how selected M&O theories inform OC at the organization level. These theoretical perspectives diverge on issues central to OC. We explore what these conceptual differences mean for OC study and practice going forward.

This chapter introduces the volume’s theme by considering how the forces of globalization and complexity are leading organizations to reshape and redesign themselves, how meeting the challenges of sustainable effectiveness and shared value require multiorganization networks and partnerships, and how networks and partnerships develop, function, and can produce both private benefits and public goods.

We apply findings from social and political evolution frameworks, partnership and collaboration research, and design for sustainability concepts to induce the likely conditions required for sustainable effectiveness from a network perspective.

Successful partnerships and collaborations in service of sustainable effectiveness will require individual organizations to change their objective function and build new and varied internal and external capabilities.

The chapter sets the stage for the volume’s contributions.

This chapter examines the case studies in this volume with a focus on concepts and methods used in the study of multi-organization networks and partnerships, motivations to join in multi-party collaboration, how multi-organization collaborations organized and managed, what kinds of value are created by collaborations, and the role of leadership therein.

A comparative look at four vertical networks (in health care and education); two “issue” networks/partnerships (sustainable seafood and water use); and the roles of government in collaboration in horizontal, vertical, and issue-based arrangements.

The chapter describes “lessons” learned about building both sustainability and collaborative capabilities in and across partnering organizations and about improving partnership structures, processes, and results.

The chapter sums and synthesizes the volume’s contributions.

This chapter compares and discusses the 10 sustainability-oriented food supply chain innovations described in the previous chapters. Our purpose is to address and reflect on the questions and challenges introduced in the first chapter.

The cases are first analyzed in terms of the extent to which the innovations were motivated and impacted the social, environmental, and economic dimensions of sustainability. The various sustainable food supply chain practices adopted are compared. The third section explores the innovation strategies used in the cases, including the type of strategy, the breadth and level of innovativeness of the strategy, the governance approach, and the extent of capability development required. The final section presents our conclusions.

The results suggest that to become truly sustainable, companies need to adopt a broad set of practices that address all three dimensions of sustainability, and develop strategies to make the sustainability-oriented innovation economically viable. The more radical and systemic the innovation, the more difficult it is to generate these outcomes.

This chapter integrates organization design and sustainability concepts to describe an accelerated transformational change at the Fairview Medical Group (United States).

A case study of the transformation at Fairview Medical Group’s primary care clinics was developed from interviews and first-person accounts of the change. Objective data regarding outcomes was used to evaluate the effectiveness of the redesign process.

The Fairview Medical Group developed an innovation and change capability to transform 35 primary care clinics in six months. All of the clinics were certified by the state of Minnesota as complying with their healthcare standards. Clinical outcomes, costs, and employee and physician engagement also increased. All of the improved measures are sustained.

Healthcare reform in the United States struggles because the organization design challenges are great and the change difficulties even greater. Fairview’s experience provides important evidence and lessons that can help advance our understanding of effective healthcare and create more sustainable healthcare systems. This chapter provides healthcare system administrators evidence and alternatives in the pursuit of implementation.

This chapter introduces the volume’s theme by describing the challenges of sustainability in the agri-food industry and the critical role of agri-food supply chains. Following a description of traditional and sustainable supply chain management practices, we discuss the likely characteristics of sustainability-oriented innovations and how organizations pursuing higher levels of economic, social, and environmental performance will need to adapt their capabilities.

Drawing on the emerging concepts and practices from sustainable supply chain management as well as traditional and emerging concepts from innovation, we develop general propositions and expectations about how organizations might address sustainable effectiveness in their supply chains. The importance of the agri-food industry to all three pillars of sustainable effectiveness and predictions about the inability to feed future populations gives the discussion a certain urgency.

Sustainability-oriented innovations in the agri-food supply chain are different from traditional innovations. We develop propositions regarding the driving motivations, their nature and scope (i.e., more radical and systemic than incremental and focused), and the importance of a multi-stakeholder approach. The 10 cases presented in the volume are summarized.