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We appreciate the editors' invitation to comment on these three papers, and we thank the authors for giving us so much food for thought. The papers linked together well conceptually. We can see an organization's mission necessitating cultural competency in service delivery and an organization's culture enhancing or hindering fulfillment of a mission or the commitment to cultural competency. In this commentary we will look at these papers from three different lenses – the nature of evidence, the role of normative admonitions in health care literature, and historical context – as a way to raise questions that link these papers to broader issues that affect health care research. Since we are commenting on the chapters “blind,” we cannot refer to the authors by name. For brevity's sake we will refer to the chapters as the Culture paper, the Mission paper, and the Competency paper.

In 2009, the Health Information Technology for Economic and Clinical Health Act (HITECH) was signed into law. This Act, part of the broader “stimulus” legislation, represents the U.S.'s largest investment in health information technology (HIT) to date. More importantly, it sets a vision and provides a plan intended to transform the U.S. health care system to a safer, more efficient place to receive care. To that end, the Act seeks to fundamentally change the path HIT applications' adoption and implementation was taking to ensure that “meaningful use” and interoperability are achieved. However, such bold and sweeping changes will not come without unintended consequences, and their broad scope makes measuring the new public policy's success a challenge.

Organizational change has been a consistent and growing theme in health care management, and research on the topic reflects this interest. Amid continuously rising health care costs, major regulatory and policy reform, and technological evolution, health care executives continue to search for effective models and methods of leading and directing change to position their organizations in an increasingly unstable industry and sector. As industry leaders look for answers, researchers have shown a growing interest in understanding how health care organizations are evolving to fit the needs of the new marketplace.

The following three articles form a sequence of sorts in addressing changes required in our prevailing health care organizations, changes of a magnitude comparable to F.W. Taylor's “scientific management” revolution at the beginning of the 20th century as we seek to “transform the fundamental O.D. paradigm.” All three are based on case studies. And each has its own prescription: three “movements” each with three “key actions” for “constructive disequilibrium”; three “essential elements” for “integrated networks”, and five “dimensions of key day-to-day behavioral practices.”

All things change, nothing is extinguished…. There is nothing in the whole world which is permanent. Everything flows onward; all things are brought into being with a changing nature; the ages themselves glide by in constant movement. (Ovid)

Organizational culture is defined as the shared values and beliefs that guide behavior within each organization, and it matters because it is related to performance. While culture is generally considered important, it is mysterious and intangible to most leaders. The first step toward understanding organizational culture is to measure it properly. This chapter describes methods for measuring culture in health care organizations and how these methods were implemented in a large academic medical center. Because of the consistent empirical link between the dimension of communication, other culture dimensions, and employee satisfaction, special attention is focused in this area. Specifically, a case study of successful communication behaviors during a major “change management” initiative at a large academic medical center is described. In summary, the purpose of this chapter is to demystify the concept of culture and demonstrate how to improve it.

Ivanitskaya, Glazer, and Erofeev (2009) suggest that “the most fundamental element of any organization that helps the organization to survive is the individual person” (p. 109). It is the motivation of human capital that makes a health care organization come to life. Health care is a unique industry; its accomplishments are directly dependent upon the competencies and technical skills of its employees. “When people in the workplace fulfill their organizational roles, then the organization thrives” (Ivanitskaya et al., 2009, p. 110). Health care systems will require organizations that thrive and exhibit characteristics of continuous growth, expressing excessive levels of energy and an immense capacity for flourishing. Anticipating the challenges of the next decade, health care organizations must achieve a higher degree of employee engagement to enhance organizational performance and profitability. The data analyzed for this chapter indicate that employees who are engaged are more enthusiastic and aspired to achieve both individual and organizational success. The chapter concludes by suggesting five operating practices to establish an employee engagement culture – defining the employee's role in fulfilling the organization's purpose, selecting employees with capability and passion, supporting and valuing the employee, creating sustainable reward systems, and developing feedback and reinforcement mechanisms.