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The Stanford School of Organizational Sociology has influenced the development and direction of healthcare organizations as a field of research in several very significant ways. This chapter will provide a focused review of the major paradigms to develop from work at Stanford from 1970 to 2000, much of which involved the study of processes and structures within and surrounding healthcare organizations during this period. As a subarea of organizational theory and health services research, healthcare organizations embrace both theory-based research and applied research, and they borrow concepts, theories, and methods from medical sociology, organizational theory, healthcare administration and management, and (to a more limited extent) health economics and decision theory. The bulk of this chapter will focus on four major themes or paradigms from research on healthcare organizations that grew from work by faculty and students within the Stanford School of Organizational Sociology: Health Care Outcomes, Internal Organizational Dynamics, Organizations and Their Environments, and Organizational Systems of Care and Populations of Care Providers. Following our examination of these four paradigms, we will consider their implications for current and future debates in health services research and healthcare policy.

Community-based service providers (such as home health agencies, rehabilitation and mental health services) have found it necessary to cope with extremely uncertain and turbulent environments due to a changing regulatory environment and restructuring of the acute health care system. This paper discusses three types of survival strategies adopted by community-care service providers in a medium-sized city in the Northeast. These agencies provide long-term social and health services to the disabled and frail elderly with chronic care needs. The implications of each strategy for service provision to people with chronic care needs are discussed.

Most of my work focusing on educational systems – including universities, public elementary schools, private schools, and training programs in organizations – was supported by Stanford University centers and grants separate from the Training Program, for example, the Stanford Center for Research and Development in Teaching (1968–1977) and the Institute for Research on Educational Finance and Governance (1979–1986). Faculty collaborators in these studies included Elizabeth Cohen and Terrence Deal in the School of Education, and John W. Meyer, my colleague in Sociology. A number of NIMH trainees participated in these studies, including Andrew Creighton, Margaret Davis, and Brian Rowan. Other doctoral students involved in this research included Sally Cole, Joanne Intili, Suzanne E. Monahan, E. Anne Stackhouse, and Marc Ventresca.

The social organization of work has become more entrepreneurial and less bureaucratic over the past 20 years. How is this development consistent with managerial control over the labor process? This paper develops a professional autonomy perspective to explain the acceptance of new management ideas in the United States, including the recent turn away from bureaucratic organizational forms. The focus on professional autonomy helps to create a theoretical link between past and current managerial practices, including the latest anti-bureaucratic phase that we label neoentrepreneurialism. We conclude by exploring future research implications of studying managerial practice from a professional autonomy perspective.

What makes organizations so similar? We contend that the engine of rationalization and bureaucratization has moved from the competitive marketplace to the state and the professions. Once a set of organizations emerges as a field, a paradox arises: rational actors make their organizations increasingly similar as they try to change them. We describe three isomorphic processes-coercive, mimetic, and normative—leading to this outcome. We then specify hypotheses about the impact of resource centralization and dependency, goal ambiguity and technical uncertainty, and professionalization and structuration on isomorphic change. Finally, we suggest implications for theories of organizations and social change.

Autonomy has long been established as a critical component of professional work. Traditionally, autonomy has been examined as the extent to which an individual or a professional group controls the decisions and knowledge used in their work. Yet, this framework does not capture the additional work activities that professionals are increasingly expected to perform. Therefore, this chapter argues for theoretically expanding our understanding of professional autonomy by bringing in the concept of articulation work. Using the case of healthcare organisational change, this study assesses how shifts in work practices impact autonomy. Data come from longitudinal ethnographic fieldwork and in-depth interviews conducted at a Neonatal Intensive Care Unit as it underwent significant structural changes. Findings show that professionals were forced to change articulation work strategies in response to new organisational structures. This included changes in the way professionals monitored, assessed, coordinated and collaborated around patient care. Furthermore, these shifts in articulation work held important implications for both workplace and professional autonomy, as professionals responded to changes in their work conditions.