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The large number of publications about sustainability and sustainable development that have been published during the past decade has dealt largely with the science of sustainability, the content of sustainability initiatives, and increasingly with the need to more closely link the economic, environmental, and social purposes and operating logic of the firm. Recent literature stresses the inherent social nature of the challenges to aggressively moving to more sustainable ways of operating for the well-being of our planet, society, economy, organizations, and humans. Despite rich case examples, guidance on how to organize to achieve the triple bottom line is limited. We take stock of the current state of knowledge, using an adaptive complex system perspective to articulate the challenges of organizing for sustainable effectiveness. Most of the global economy and the knowledge upon which it is predicated carry a logic of resource abundance even in the face of increasing competition for scarce resources, and a singular focus on economic outcomes. We argue that the development of new capabilities to address triple bottom line sustainability requires a change in that logic and requires new rules of interaction, new organizational and interorganizational designs, and new ways of learning. The premise is that systems can build on their inherent capabilities to learn and to act collectively in order to adapt. We argue that by working together to collaboratively explore how to organize for sustainability, academics and practitioners can accelerate knowledge generation and progress. This chapter provides the theoretical framing context for the chapters to come.

Purpose – This chapter frames the topic of organizing for sustainable health care in terms of the environmental trends that have rendered current health care approaches unsustainable, the embeddedness of health care in society's triple bottom line, and the need to build adaptive capability within the complex health care ecosystem.

Design/methodology/approach – We synthesize documented trends and empirical findings regarding the viability of current approaches to health care, and provide a theoretically framed treatment of the adaptation process in the complex health care system that can lead to the emergence of sustainable approaches.

Findings – There is a misfit between current approaches to delivering health care and the requirements and trends in contemporary society. Fundamental transformation is required that entails a broadening of purpose, a future orientation, and a rethinking of how health care adds value and how it is embedded in society.

Originality/value – By reconceptualizing health care reform as intricately related to societal sustainability and the triple bottom line, we open the possibility of transcending a narrow focus on reengineering to create more efficient organizations and work processes that consume fewer resources and deliver greater value. We invite health care practitioners and scholars to rethink all the connections in the health care ecosystem, and the need to build in self-organizing capabilities and adaptive capacity. The cases in this book provide knowledge from systems engaged in fundamental transformation, analyzed through the lenses of theoretical frameworks that help us better understand essential dynamics involved in creating sustainable health care systems.

Purpose – This chapter provides a reflective synopsis of the chapters in the volume and highlights the learning from the cases about the development of new orientations, design configurations, and learning mechanisms. It charts directions for further research and possible managerial actions.

Design – The chapters in this second volume of the book series “Organizing for Sustainable Effectiveness” capture a rich set of cases in which organizing for sustainable health care was the central focus. Each chapter illuminated the development of a distinct health care system in a unique cultural and national context, and had a special focus on reporting theoretically informed and rigorously explored knowledge to guide purposeful design and learning approaches. Collectively the chapters highlighted the processes, organization and design, system regulation, and continuous learning approaches in complex organizational and multi-organizational health care systems that enable focus on and advancement of economic, social, and ecological outcomes.

Findings – Several critical themes have emerged from the cases, and from the broader literature on health care transformation: the importance of purpose; the need to overcome fragmentation; the need for alternative business models; technology as an investment in sustainable health care; the centrality of knowledge management; the importance of partnership and collaboration; the role of self-organization and leadership; and the criticality of building change capabilities.

The chapters in this first volume of the book series “Organizing for Sustainable Effectiveness” captured a rich set of cases in which sustainable effectiveness was the central focus. Each chapter illuminated the development of a distinct sustainable system, and had a special focus on reporting theoretically informed and rigorously explored knowledge to guide purposeful design and learning approaches. Collectively the chapters highlighted the processes, organization and design, system regulation, and continuous learning approaches in complex organizational and multiorganizational systems that enabled simultaneous focus on and advancing of economic, social, and ecological outcomes. In this concluding chapter, we capture, via a comparative investigation, some of the learning from the cases about the development of new capabilities, design orientations, and learning mechanisms, and we chart directions for further research and managerial actions.

We argue that in order to address the contemporary challenges that organizations and societies are facing, the field of organization development (OD) requires frameworks and skills to focus on the eco-system as the level of analysis. In a world that has become economically, socially, and technologically highly connected, approaches that foster the optimization of specific actors in the eco-system, such as individual corporations, result in sub-optimization of the sustainability of the natural and social system because there is insufficient offset to the ego-centric purposes of the focal organization. We discuss the need for OD to broaden focus to deal with technological advances that enable new ways of organizing at the eco-system level, and to deal with the challenges to sustainable development. Case examples from healthcare and the agri-foods industry illustrate the kinds of development approaches that are required for the development of healthy eco-systems. We do not suggest fundamental changes in the identity of the field of organizational development. In fact, we demonstrate the need to dig deeply into the open systems and socio-technical roots of the field, and to translate the traditional values and approaches of OD to continue to be relevant in today’s dynamic interdependent world.