U.S. Health-Care Organizations: Complexity, Turbulence, and Multilevel Change

The focus of this review is macro-level organizational change in U.S. health-care organizations, with a special emphasis on turbulent changes in the environments of health-care organizations. We examine several contemporary theories used to study health-care organizations (institutional theory, complexity theory, and multilevel approaches). These and other theories may be helpful in framing investigations that emphasize key environmental changes of the 1990s and the first decade of the twenty-first century, which in turn have led to changes in health-care systems and macro-level structures. Those key changes include advances in health-care technologies, changes in the systems of care, and of course, changes in health-care policy.