title: Explaining process orientation failure and success in health care--three case studies.
abstract: OBJECTIVE
  In order to improve cooperation and collaboration between units, clinics and departments, many health care organizations (HCOs) have introduced process orientation. Several studies indicate problems in realizing these ambitions. The purpose of this paper is to explain and understand the success and failure of process orientation in HCOs.
  
  
  METHODS
  The authors conducted three case studies and applied Actor-Network Theory as an analytic lens.
  
  
  RESULTS
  The realization of process orientation is hindered by neglect or resistance from physicians, who find the process targets to be of low medical priority. However, the authors also see that medical priorities are no stable entities but are susceptible to negotiations. Over time, process organization, process mapping, process measurement activities and the acting of enroled actors may have impact on medical priorities.
  
  
  CONCLUSIONS
  Contrary to previous research, the findings indicate that New Public Management may not be the main obstacle against processes, that accounting figures may not be hard to disregard and that the role of leadership is not paramount.
authors.affiliation: Karlstad Business School, Karlstad University, Karlstad, Sweden.
authors.forename: Stefan
authors.initials: S
authors.lastname: Hellman
authors.forename: Gustaf
authors.initials: G
authors.lastname: Kastberg
authors.forename: Sven
authors.initials: S
authors.lastname: Siverbo
mesh_terms: D001291:Attitude of Health Personnel; D003662:Decision Theory; D003695:Delivery of Health Care / Q000191:economics / Q000379:methods / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000191:economics / Q000458:organization & administration / Q000592:standards; D006284:Health Plan Implementation / Q000191:economics / Q000379:methods / Q000458:organization & administration*; D006620:Hip Fractures / Q000628:therapy; D006739:Hospital Administration / Q000379:methods / Q000592:standards*; D006801:Humans; D007373:Interinstitutional Relations; D007407:Interviews as Topic; D008137:Longitudinal Studies; D019982:Organizational Case Studies; D015279:Organizational Culture; D009936:Organizational Innovation; D010564:Personnel, Hospital / Q000523:psychology*; D017064:Process Assessment, Health Care / Q000191:economics / Q000379:methods / Q000458:organization & administration*; D020521:Stroke / Q000628:therapy; D013548:Sweden
keywords: Actor Network Theory; Health care; Medical profession; Organization and control; Process orientation