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In the context of organizational change, identifying, and organizing the various roles of change agents remains a challenge for practitioners and scholars alike. This chapter examines how different agents can enable an effective change process. Empirical evidence from three hospitals illustrates the process of transformation and its underlying arrangements to identify agents and their roles. The findings underline the importance of designing a coherent system of agents, determining where they come from, their role during the process, and how this may change throughout the change process. Managerial choices in the cases are discussed, leading to implications for theory and practice.

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 study aims to add to the knowledge of governance and control aspects of intrafirm relationships by exploring a transaction costs economics perspective (TCE perspective) on governance and management control structure choices related to the development of a shared service center (SSC).

The notion of governance and control in SSC organizations is explored and a TCE model is developed to analyze management control structure choices for SSC governance. The nature of internal transactions is related to the dimensions of transactions. Then an example case study is used to illustrate the application of the theoretical model.

The theoretical analysis broadens existing frameworks of management control structures by particularly pointing to the possibility of including governance structures for internal transactions and exit threats (connected to a market mechanism) in the management control structure of an organization. Confrontation with the case example illustrates that the possibility of an exit threat was not explicitly considered by top management (“the designer” of management control). Although the TCE model may be a useful tool for analysis purposes, it has little explanatory power in this particular case. Organizational change processes toward SSCs are complex and can only partly be examined with conventional economics-based approaches such as TCE.

Governance and control of SSCs is conceptually theorized, using an instrumental economics approach. The case study is not generalizable but illustrates the use of the model in a particular situation. To understand governance and control change within SSC organizations, more longitudinal case studies are needed.

A TCE approach to governance and control choices regarding SSCs might provide practitioners with insights into the efficiency of specific management control structures.

This chapter contributes to the extant knowledge by both exploring and challenging a TCE perspective on SSC-related changes in management control.

A number of theoretical paradigms provide a networking space for the trio and complementary fields of comparative, international, and development educational (CIDE) research. Critics periodically attribute the field's lack of a sound theoretical base or commitment to one area of scientific research or another as a primary weakness in the field.¹ Espoused theoretical paradigms often provide the knowledge debate arena in which academic fields interact and build together. In an alternative perspective from this criticism, we argue that the strength of the CIDE field resides in its ability to combine multiple theoretical perspectives that offer researchers a variety of potentially fruitful metatheoretical analyses. Thus, we do not view this lack of theoretical specification as a weakness; it is the very fabric that enables CIDE educationists to study and represent increasingly complex global and local education systems.

In this chapter, the authors theorize organizational integration by extending, elaborating, and combining various theoretical perspectives, such as structural contingency theory, organization economics, and organizational culture. The aim of this study is to provide the foundation for a holistic theory of integration that examines the different relevant facets of integration and a comprehensive set of tools – integrative devices – by which integration can be sought by those who design the organization. To this end, the authors examine the integration challenge that arises from various types of subunit interdependence – pooled, sequential, and reciprocal – and theorize which configurations of integrative devices are more likely to be effective in a given task environment. The authors close by discussing directions for future research on organizational integration.

Recent events such as the terrorist attacks of September 11, 2001 against the United States and the national disaster of Hurricane Katrina demonstrated the acute need for interagency collaboration. Using a semi-inductive method, we conducted two studies with senior homeland security leaders to learn more about organizations’ collaborative capacity during the early planning stages. In study One, we used an interorganizational systems perspective to identify factors that create or deter effective collaboration. Study Two elicited vignettes from a second group of senior homeland security leaders to gain further insights into the ways in which their organizations are successfully building collaborative capacity.

People have worked together since the beginnings of human time. Since then the forms of collaboration have barely changed. While a group of laborers building the pyramids of Egypt might seem to bear little resemblance to a team of machine operators working in a plant, they actually have much in common. Both groups are made up of people of similar backgrounds with clear loyalties and interests, interacting face-to-face to perform relatively well-defined tasks in pursuit of a shared goal.