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Purpose – To offer a theoretical explanation for observed physician resistance and rejection of high reliability patient safety initiatives.

Design/methodology/approach – A grounded theoretical qualitative approach, utilizing the organizational theory of sensemaking, provided the foundation for inductive and deductive reasoning employed to analyze medical staff rejection of two successfully performing high reliability programs at separate hospitals.

Findings – Physician behaviors resistant to patient-centric high reliability processes were traced to provider-centric physician sensemaking.

Research limitations/implications – Research, conducted with the advantage that prospective studies have over the limitations of this retrospective investigation, is needed to evaluate the potential for overcoming physician resistance to innovation implementation, employing strategies based upon these findings and sensemaking theory in general.

Practical implications – If hospitals are to emulate high reliability industries that do successfully manage environments of extreme hazard, physicians must be fully integrated into the complex teams required to accomplish this goal.

Social implications – Reforming health care, through high reliability organizing, with its attendant continuous focus on patient-centric processes, offers a distinct alternative to efforts directed primarily at reforming health care insurance. It is by changing how health care is provided that true cost efficiencies can be achieved. Technology and the insights of organizational science present the opportunity of replacing the current emphasis on privileged information with collective tools capable of providing quality and safety in health care.

Originality/value – The fictions that have sustained a provider-centric health care system have been challenged. The benefits of patient-centric care should be obtainable.

This chapter describes the efforts of a team of health care workers to make a sub-acute health care facility (SCF) serving profoundly damaged children into a high reliability organization (HRO). To obtain this goal, the health care team implemented change in four behavioral areas: (1) risk awareness and acknowledgment; (2) defining care; (3) how to think and make decisions; and (4) information flow. The team focused on five reliability enhancement issues that emerged from previous research on banking institutions: (1) process auditing; (2) the reward system; (3) quality degradation; (4) risk awareness and acknowledgment; and (5) command and control. These HRO processes emerged from the change effort. Three additional HRO processes also emerged: high trust, and building a high reliability culture based on values and on beliefs. This case demonstrates that HRO processes can reduce costs, improve safety, and aid in developing new markets. Other experiences in implementing high reliability processes show that each organization must tailor make processes to its own situation (e.g. BP, U.S. Chemical Safety and Hazards Board, Federal Aviation Administration, U.S. Navy Aviation Program, and Kaiser Permanente Health Care System). Just as in the flexibility called for in organizing for high reliability operations, flexibility is called for in deciding which HRO processes work in specific situations.

Crisis management (CM) has gained prominence in the last decades, as the complex global business environment has forced executives to pay attention to practices that may safeguard organizations against potential crises. However, despite the fact that various scholars point to the need for autonomy and delegation of authority when responding to crises, it appears that the overarching rationale in the crisis literature is geared toward a centralized approach. This suggests that preventive actions and response to crises lie mainly with the leader of the organization and with designated crises teams. It is also apparent that this literature places too much weight on contingency plans and classification schemes. Although behavioral factors have been discussed by some authors as a fundamental element in dealing with crises, it is not clear how to develop these traits. It is our contention then that these conventional perspectives, although valuable to CM, are insufficient to deal with the uncertainty that characterizes global business today where firms must be prepared for the unexpected. We discuss the limitations of this traditional approach and argue for a combination of central control with decentralized execution when responding to unexpected crises situations. This enables management to better comprehend the complexity embedded in any crisis and allows adaptive practices to emerge throughout the organization. An analysis of two cases paired with empirical field studies support our proposition.

This chapter presents the major components in framing a developmental model of wise organizing in the field of higher education that proceeds along an increasingly more just and responsible path. Our argument considers individual student development theories that lead one to greater competence for wise and socially responsible interactions and engagement in society, and aligns these individual processes with the organizational scholarship emphasizing how organizations enhance their capacities for wise and socially responsible conduct. After reviewing these arguments, we frame a set of research topics required for empirically identifying how universities can cultivate wisdom.

Drawing from literature on organizations that function efficiently and effectively while maintaining low levels of errors and occupational injuries and deaths, we argue that police departments can enhance their legitimacy by adopting the practices found in such organizations because doing so can reduce the frequency of unnecessary force against citizens and lower officer injury rates.

To support our argument, we review literatures on the causes and avoidance of errors in organizations, identify how well-run organizations in high-risk environments are able to operate safely, and describe how police departments can adopt similar practices as a mechanism to enhance officer safety and lower the rate at which officers use force against citizens.

By adopting the practices of successful organizations in other fields, police departments and their officers can promote and enhance their safety while simultaneously reducing their use of force against citizens. By doing so, police can raise the level of legitimacy they hold in the eyes of the American public, which has arguably decreased in the wake of recent events involving police gunfire.

Our ideas contribute to the policing literature by: (1) highlighting a preexisting body of literature and outlining its application to police organizations and (2) detailing how both the police and the public can benefit from improved police practices.

Routines are the very material of human organization. But there is little guarantee that routines will be enacted flexibly enough to ensure that organization survives. Mindfulness has been offered as a guarantor of sorts, but it remains unclear exactly what people mean by mindfulness and how mindfulness might relate to routines. This chapter reviews evolving conceptions of mindfulness and routines—from Langer’s early work to routine dynamics to Levinthal and Rerup’s seminal debate with Weick and Sutcliffe. It puts forth the argument that the recent theory of mindfulness as metacognitive practice retains important insights from throughout this conceptual evolution, while resolving ambiguity and debate about the relation between mindfulness and routines in at least four critical areas related to agency, duality, flexibility, and social organization. This resolution, in turn, opens up further avenues to understand the social processes by which people come to understand their minds—and how this understanding embeds within organization itself.

This chapter elaborates on the usefulness of embracing complexity theory, modeling outcomes rather than directionality, and modeling complex rather than simple outcomes in strategic management. Complexity theory includes the tenet that most antecedent conditions are neither sufficient nor necessary for the occurrence of a specific outcome. Identifying a firm by individual antecedents (i.e., noninnovative vs. highly innovative, small vs. large size in sales or number of employees, or serving local vs. international markets) provides shallow information in modeling specific outcomes (e.g., high sales growth or high profitability) – even if directional analyses (e.g., regression analysis, including structural equation modeling) indicate that the independent (main) effects of the individual antecedents relate to outcomes directionally – because firm (case) anomalies almost always occur to main effects. Examples: a number of highly innovative firms have low sales while others have high sales and a number of noninnovative firms have low sales while others have high sales. Breaking-away from the current dominant logic of directionality testing – null hypothesis significance testing (NHST) – to embrace somewhat precise outcome testing (SPOT) is necessary for extracting highly useful information about the causes of anomalies – associations opposite to expected and “statistically significant” main effects. The study of anomalies extends to identifying the occurrences of four-corner strategy outcomes: firms doing well in favorable circumstances, firms doing badly in favorable circumstances, firms doing well in unfavorable circumstances, and firms doing badly in unfavorable circumstances. Models of four-corner strategy outcomes advance strategic management beyond the current dominant logic of directional modeling of single outcomes.

This chapter traces the author's journey of change research from positivism to pragmatism and how different types of “engaged scholarship” shape how we know and do change. It takes readers through the ontology, epistemology, and methodology of different types of research and how these were expressed in studies of planned change interventions, mergers and acquisitions (M&A), cynicism and its consequences, “soul work” and community building in business, organizational transformation, and the development of more socially and environmentally conscious people, purposes, and practices. The paper reflects on the author's research as it relates to regulatory versus radical change and whose interests are and might be served by change research.

The chapter summarizes key literature, including emerging ideas, that is pertinent to the question of how organizations and their leadership deal with and are resilient through crises – highlighting what works in surviving unexpected crises. The chapter presents an illustration of organizational response; it concludes with an analysis of what is missing from the literature and recommends a path forward to expanding actionable knowledge in this area. Multiple, interdependent factors that foster resilience are identified including (1) being sensitive to possible threats – even seemingly small failures, (2) not relying on simple interpretations of events but rather seeking diversity to create a complete view of the environment, (3) leadership that embraces communication, transparency, and continuous learning, (4) valuing expertise and allowing expert staff to make decisions during a crisis, and (5) a cultural commitment to a resiliency mindset that accepts failures as opportunities to learn and improve. Emerging concepts that may foster resilience but require more research include managing paradox, emotional ambivalence and diversity. Additional areas for fruitful research include: the impact of short-term versus long-term, or successive, crises; external versus internal shocks and the framing of the source of shocks; how crisis affect the pace of innovation and change; the role of diversity in organizational responses to crises; and a set of methodological opportunities to leverage natural experiments or simulations in ways that allow for longitudinal data illuminating the full cycle of crises across organizations from anticipation, to response, to longer-term adaptation to the new normal.