title: Managing in the context of healthcare's escalating technology and evolving culture.
abstract: OBJECTIVE
  As healthcare has become more scientifically based and far more sophisticated in terms of technology, it has become more fragmented in terms of care-giving, and less personal. The purpose of this paper is to discuss the challenging task of leading and managing in the gap between the existing and emerging cultures of healthcare.
  
  
  METHODS
  This paper considers the literature on culture, how it exists at many levels and in multiple forms, and the impacts it has on the US healthcare system. Further, the paper explores foundations of the current healthcare culture and attempts to forecast features of the emerging culture, incorporating examples of advances in scientific knowledge and technology.
  
  
  RESULTS
  System change will continue to be problematic until leaders and change agents find ways to operate effectively in the gap between the existing cultural tenets and those emerging as the result of scientific and technological advancements.
  
  
  CONCLUSIONS
  Punctuated equilibrium theory serves as a main tenet for describing how changes will continue to push the USA towards a cultural tipping point. This paper contends that leaders and managers can succeed only by understanding and respecting both cultures and calls for improved theory development and research to help find creative ways to advance the new culture without trampling the old.
authors.affiliation: Healthcare Policy & Economics, Johnson & Johnson, Highlands Ranch, Colorado, USA. dawn.bowden@gmail.com
authors.forename: Dawn E
authors.initials: DE
authors.lastname: Bowden
authors.forename: Stanley J
authors.initials: SJ
authors.lastname: Smits
mesh_terms: D020811:Biomedical Technology / Q000639:trends; D003695:Delivery of Health Care / Q000639:trends; D058016:Health Facility Administration; D015279:Organizational Culture; D014481:United States