The Challenge to Change

There is constant pressure on hospitals to improve health care delivery and increase cost effectiveness. New initiatives are the order of the day in the dramatically different health care systems of the United States and Great Britain. Often, as we know all too well, these efforts are not successful. In The Challenge to Change, Rebecca Kolins Givan analyzes the successes and failures of efforts to improve hospitals and explains what factors make it likely that the implementation of reforms will rewarded by positive transformation in a particular institution's day-to-day operation. Givan's in-depth qualitative case studies of both top-down initiatives and changes first suggested by staff on the front lines of care point clearly to the importance of all hospital workers in effecting change and even influencing national policy.

Givan illuminates the critical role of workers, managers, and unions in enabling or constraining changes in policies and procedures and ensuring their implementation. Givan spotlights an Anglo-American model of hospital care and work organization, even while these countries retain their differences in access and payment. Entrenched professional roles, hierarchical workplace organization, and the sometimes-detached view of policymakers all shape the prospects for change in hospitals. Givan provides important examples of how the dedication and imagination of the people who work in hospitals can make all the difference when it comes to providing quality health care even in a challenging economic environment.

Rebecca Kolins Givan is Associate Professor in the School of Management and Labor Relations at Rutgers University. She is coeditor of The Diffusion of Social Movements.

Rebecca Kolins Givan's book is a must-read for all who are committed to positive health system change. Rarely does a book capture the essential takeaways of complex reform initiatives as does The Challenge to Change. Frontline workers—nurses, physicians, and other health care staff—actually do know more about how to improve quality and productivity than their bosses. Givan tells us how and why we should listen to them.

Paul F. Clark, Professor and DirectorSchool of Labor and Employment Relations, Penn State University, author of Building More Effective Unions:

In The Challenge to Change, Rebecca Kolins Givan makes the case that frontline health care workers should be part of any effort to reform the health care workplace. The book, and in particular the case studies, makes the point that these workers have considerable experience and knowledge, a deep commitment to patient care, and unique insights that can make health care institutions function more effectively. Giving nurses, technicians, and other hands-on workers a voice in decisions concerning patient care can only benefit health care systems. I hope practitioners—in the United States, the United Kingdom, and beyond—will read this book and then take steps to give these workers a greater voice in the health care workplace. Patients will thank them.