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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 study focuses on a particular type of public organization characterized by weak boundaries and strong informal relationships, elements that have assisted in driving the reform of an entire national public management system. The case is the Public Healthcare System of the Southern Italy in the period beginning in the early 1990s through the beginning of the new millennium, with particular emphasis on the Sicilian region, selected since it represents an extreme case of informal networks that affect organizational boundaries and governance functions.

This paper focuses on the strategic role of elites in managing institutional and organizational change within English public services, framed by the wider ideological and political context of neo-liberalism and its pervasive impact on the social and economic order over recent decades. It also highlights the unintended consequences of this elite-driven programme of institutional reform as realized in the emergence of hybridized regimes of ‘polyarchic governance’ and the innovative discursive and organizational technologies on which they depend. Within the latter, ‘leaderism’ is identified as a hegemonic ‘discursive imaginary’ that has the potential to connect selected marketization and market control elements of new public management (NPM), network governance, and visionary and shared leadership practices that ‘make the hybrid happen’ in public services reform.

The devastating 2014 Ebola outbreak caused human and economic loss, but it also resulted in remarkable improvement in healthcare leadership. The impact is most evident in the affected West African countries of Guinea, Liberia and Sierra Leone. In this chapter, the Ebola experience is used as a framework to explore the essential elements of healthcare leadership, with particular attention to healthcare crises in under-resourced communities. Overall, healthcare leadership presents unique challenges. In common with leaders of other industries, healthcare leaders must inspire others, create a sense of purpose, make difficult decisions and collaborate with a range of people. But, because their focus is on complex systems that aim to improve people's physical and mental well-being, expectations of healthcare leaders are especially high. Their work can be a matter of life or death. For the leader in an under-resourced area, the challenge and expectations are even higher, particularly in the face of new or emerging health threats. The key to effective healthcare leadership is systems thinking which involves looking at the entire system of care as an integrated whole, rather than discrete parts that operate in isolation. Healthcare leaders must understand that health means mobilizing multisectoral knowledge and resources and applying innovative and multiactor approaches to prevent, detect and address health problems. Since the 2014 Ebola crisis, healthcare leaders are increasingly using a systems approach by looking at the culture of health systems, the impact of diseases locally and globally, and the applicability of health interventions in different environments. In the post-Ebola era, steps to strengthen the healthcare system are described which includes the roles of healthcare leaders. These steps include deployment of field epidemiologists and community health agents, community education and fuller use of the One Health Platform, which allows actors from different sectors (human health, animal health and environmental health) to collaborate. Finally, suggestions for healthcare leadership training are offered.

This chapter proposes a global agenda to eliminate racism in nursing by targeting reform at nursing education administration internationally. First, the history of racism in nursing is reviewed, along with two models – the diversity model and the cultural competence model – that were applied unsuccessfully to counteract racism in nursing. Second, a description of how racism is entrenched in nursing leadership globally is presented. Third, the recalcitrant structures that serve to maintain institutionalized racism (IR) in the international nursing education system are carefully examined. Specifically, the components and constructs involved in IR in nursing education are delineated, and the way in which these negatively impact both ethnic minority (EM) students and faculty are explained. Based on this, a global agenda to eliminate racism in nursing education internationally is proposed. Eliminating racism in higher education in nursing is a mandatory social responsibility if global healthcare is ever to be equitable. Five actionable recommendations are made to eliminate racism in higher education are summarized as follows: (1) components of nursing programs which are designed to eliminate racism in nursing education should be governed at the country level, (2) to design and implement a system of surveillance of the global nursing community to enable standardized measurement to ensure nursing education programs in all countries are meeting anti-racism benchmark targets, (3) nursing education programs should be established worldwide to provide individual pipeline and mentorship programs to ensure the career success of EM nursing students and faculty, (4) nursing education programs should be conducted to reduce barriers to EM participation in these individual support programs, and (5) nursing education programs are required to teach their nursing faculty skills in developing anti-racist curricula that seeks to eliminate implicit bias.

This chapter explores distributed leadership in volunteer multistakeholder groups tackling complex problems, focusing on community organizing practices to bridge the gap between health and health care in Columbia, South Carolina. Columbia faces increasing chronic disease, high rates of uninsured, unequal access to healthcare services, and rising costs. Regional leaders periodically tackled these problems together but faced challenges common to multistakeholder groups. In 2010, leaders from Columbia partnered with the authors in a learning enterprise to find new, more sustainable ways to address these challenges. Together we adapted a community organizing approach to develop distributed leadership skills necessary to overcome the challenges of volunteer multistakeholder groups and transform the health system in a local area. In the first year, teams provided health screenings to over 1,000 residents; over 3,000 residents exercised leadership to improve community health; over 5,000 residents pledged to improve their health. Clinic hours were extended; new health coaches focused on primary care and wellness programs. Providers and payers committed to reinvesting a share of savings in the community, which has a voice in their use. We show that developing distributed leadership via community organizing offers an approach to solving seemingly intractable community problems.