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In order to implement business process reengineering successfully, organizations find that they need to combine a variety of change initiatives. Yet, most of the empirical literature dwells on a single change initiative. Integrating multiple change initiatives requires a structural learning mechanism. The learning mechanism is created to lead, design, and implement the overall change effort. This paper reports on BPR at Blue Shield of California. The theoretical implications of system‐wide transformation and learning mechanisms ‐ based on the integration of BPR with other change initiatives ‐ within the rapidly changing health care competitive context are discussed.

Academic healthcare systems face great challenges in coordinating services across a continuum of care that spans hospital, community providers, home and chronic care facilities. The Johns Hopkins Community Health Partnership (J-CHiP) was created to improve coordination of acute, sub-acute and ambulatory care for patients, and improve the health of high-risk patients in surrounding neighborhoods. The paper aims to discuss this issue.

J-CHiP targeted adults admitted to the Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center, patients discharged to participating skilled nursing facilities (SNFs), and high-risk Medicare and Medicaid patients receiving primary care in eight nearby outpatient sites. The primary drivers of the program were redesigned acute care delivery, seamless transitions of care and deployment of community care teams.

Acute care interventions included risk screening, multidisciplinary care planning, pharmacist-driven medication management, patient/family education, communication with next provider and care coordination protocols for common conditions. Transition interventions included post-discharge health plans, hand-offs and follow-up with primary care providers, Transition Guides, a patient access line and collaboration with SNFs. Community interventions involved forming multidisciplinary care coordination teams, integrated behavioral care and new partnerships with community-based organizations.

This paper offers a detailed description of the design and implementation of a complex program to improve care coordination for high-risk patients in an urban setting. The case studies feature findings from each intervention that promoted patient engagement, strengthened collaboration with community-based organizations and improved coordination of care.

The purpose of this paper is to examine the nature and development of industrial relations as a field of study. This paper employs bibliometric and social network analyses to examine the scholarly work published in the top industrial relations journals over the past 40 years. By examining the citation and co-citation patterns at the journal level and the article level, it is possible to empirically describe the field of industrial relations in terms of its parameters and its “paradigms” – the generally agreed on sets of research questions and methodologies – at different time periods throughout its development. Our findings illustrate that the intellectual base of the industrial relations field has moved from a more traditional, applied labor economics view of industrial relations to a broader “employment relations” view of the field.