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Organizational change is a key mechanism to ensure the sustainability of healthcare systems. However, healthcare organizations are persistently difficult to change, and literature is riddled with examples of failed change endeavors. In this chapter, we attempt to unravel the underlying causes for failed organizational change. We distinguish three types of change with different levels of depth that require different change approaches. Transformations are the deepest forms of change where beliefs and principles need to be modified to successfully influence routines. Renewals are deep forms of change where principles need to be modified to successfully influence routines. Improvements are shallow forms of change where only modifications at the level of routines are needed. Using deoxyribonucleic acid (DNA) as our metaphor, we propose a theory of “organizational DNA” to understand organizations and these three types of organizational changes. We posit that organizations are made up of a double helix consisting of a so-called “social string,” which contains the “soft” interaction or communication among the organization's members, and a so-called “technical string,” which contains “hard” organizational aspects such as structure and technology. Ladders of organizational nucleotides (i.e., Routines, Principles, and Beliefs) connect this double helix in various combinations. Together, the double helix and accompanying nucleotides make up the DNA of an organization. Without knowledge of the architecture of organizational DNA and whether a change addresses beliefs, principles, and/or routines, we believe that organizational change is constrained and based on luck rather than change management expertise. Following this metaphor, we show that organizational change fails when it attempts to change one part of the DNA (e.g., routines) in a way that renders it incompatible with the connecting components (e.g., principles and beliefs). We discuss how the theory can be applied in practice using an exemplar case.

At the beginning of the 21st century, multiple and diverse social entities, including the public (consumers), private and nonprofit healthcare institutions, government (public health) and other industry sectors, began to recognize the limitations of the current fragmented healthcare system paradigm. Primary stakeholders, including employers, insurance companies, and healthcare professional organizations, also voiced dissatisfaction with unacceptable health outcomes and rising costs. Grand challenges and wicked problems threatened the viability of the health sector. American health systems responded with innovations and advances in healthcare delivery frameworks that encouraged shifts from intra- and inter-sector arrangements to multi-sector, lasting relationships that emphasized patient centrality along with long-term commitments to sustainability and accountability. This pathway, leading to a population health approach, also generated the need for transformative business models. The coproduction of health framework, with its emphasis on cross-sector alignments, nontraditional partner relationships, sustainable missions, and accountability capable of yielding return on investments, has emerged as a unique strategy for facing disruptive threats and challenges from nonhealth sector corporations. This chapter presents a coproduction of health framework, goals and criteria, examples of boundary spanning network alliance models, and operational (integrator, convener, aggregator) strategies. A comparison of important organizational science theories, including institutional theory, network/network analysis theory, and resource dependency theory, provides suggestions for future research directions necessary to validate the utility of the coproduction of health framework as a precursor for paradigm change.

This chapter explores the disruptive potential of the Internet to transform illicit drug markets while also challenging stereotypical depictions and superficial understandings of supply and demand. It argues that the digital transformation of illicit drug markets combines, on one hand, a reconfiguration of the scope and impact of how sellers, buyers, and other actors interact within and upon digitally mediated retail drug markets and, on the other hand, continuing trends in the embeddedness of market structures in cultural, economic, political, and legal realms. We develop conceptual ideas for studying the architecture of digital drug markets by drawing on interdisciplinary approaches to digitalisation, markets, and drugs. To understand the functioning of online drug markets, we first need to understand digitalisation. Thus, we draw on scholarship on the digital transformation of society and, second, put forward an understanding of markets that considers how personal relations and social structures enhance and restrict market exchange. Thus, we draw on economic sociology. Third, we build on and extend social science research on illicit drug markets which points out that drug markets exhibit significant variations over time and across jurisdictions. The introduction aims to provide a research agenda that can help us to explore ongoing digital transformations of illicit drug markets. It expands and deepens scholarship on the technological, structural, economic, and cultural factors underlying the resilience and growth of digital drug markets. It also goes beyond a concern with just one type of digital drug market into wider forms of digital environments.