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.

It is widely recognized that social movements may spread - or "diffuse" - from one site to another. Such diffusion, however, is a complex and multidimensional process that involves different actors, networks, and mechanisms. This complexity has spawned a large body of literature on different aspects of the diffusion process, yet a comprehensive framework remains an elusive target. This book is a response to that need, and its framework focuses on three basic analytical questions. First, what is being diffused? This question directs attention to both the protest repertoires and interpretive frames that actors construct to define issues and mobilize political claims. Second, how does diffusion occur? This book focuses attention on the activist networks and communication channels that facilitate diffusion, including dialogue, rumors, the mass media, the internet, NGOs, and organizational brokers. Finally, what is the impact of diffusion on organizational development and shifts in the scale of contentious politics? This volume suggests that diffusion is not a simple matter of political contagion or imitation; rather, it is a creative and strategic process marked by political learning, adaptation, and innovation.

It is widely recognized that social movements may spread - or 'diffuse' - from one site to another. Such diffusion, however, is a complex and multidimensional process that involves different actors, networks, and mechanisms. This complexity has spawned a large body of literature on different aspects of the diffusion process, yet a comprehensive framework remains an elusive target. This book is a response to that need, and its framework focuses on three basic analytical questions. First, what is being diffused? Second, how does diffusion occur? Finally, what is the impact of diffusion on organizational development and shifts in the scale of contentious politics? This volume suggests that diffusion is not a simple matter of political contagion or imitation; rather, it is a creative and strategic process marked by political learning, adaptation, and innovation.