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To treat childhood obesity, health education interventions are often aimed at the whole family. However, such interventions seem to have a relatively limited effect on weight loss. The purpose of this paper is to examine how families enrolled in a family-based health education intervention manage the intervention in their daily lives and to understand how and why intra-familial conflicts may occur.

Data consist of 10 in-depth semi-structured family interviews with 25 family members (10 children, 15 parents), who were enrolled in a family-based health education intervention for families with an obese child.

Actively involving all family members in the intervention proved difficult in many families. Often, the children experienced inconsistent family support, which led to intra-familial conflicts. When parents were unsuccessful in changing unhealthy habits, the responsibility for healthy living was often passed on to the obese child. Thus, several families managed the intervention by making specific rules that only the obese child was required to adhere to. This resulted in several children feeling stigmatized in their own family.

Professionals working with family-based health education interventions should understand that, in order to minimize the risk of intra-familial conflicts and stigmatization of the obese child, all family members must be equally committed to the lifestyle intervention.

The study contributes to the existing literature by adding specific knowledge about how and why conflicts occur in these families and what the consequences of these conflicts are.

Purpose – This chapter examines the developmental journey toward a sustainable health care system in the West of Skaraborg County in Sweden from 2008 to the present by proposing and illustrating the concept of a clinical microsystem to capture the work of a mobile team to care for elderly people with multiple diseases in its embedded context.

Design – An action research approach was adopted that entailed four researchers, one of whom was also a health care practitioner, engaging in iterative dialogues with the mobile team. This aimed at catalyzing joint learning in repeated action-reflection cycles at least three times a year over a period of 3 years. Data from patient databases were also drawn upon as additional resources for reflection.

Findings – The outcome of the initial periods of the team's work in the microsystem dramatically improved the care of these patients, significantly increasing quality of life and stabilizing their medical situation. It has also led to decreased resource utilization, not just by the team, but elsewhere in the wider health system.

Originality/value – We draw on and develop the concept of clinical microsystems to argue that such systems have a team at their core, but their work practices and patient outcomes require us to look beyond the team itself and take into account its interactions with patients and actors in the wider health care system. We also draw on the framework of Christensen, Grossman, and Hwang (2009) to propose that each microsystem has three distinct value configurations, namely shops, a chain, and a network. In terms of design, we suggest that the clinical microsystem can be seen as a parallel learning structure to that of the established health care bureaucracy.

Higher education institutions have undergone a transformation over the past few decades, from loosely coupled systems to more centrally managed organizations. Central to this ongoing development is the increasing competition for resources and reputation, driving higher education institutions to rationalize their structures and practices. In our study, we focused on changes in job advertisements for professorships in Germany from 1990 to 2010. Findings showed that the requirements stipulated by universities for professorial positions have become increasingly differentiated (and measurable) over time. In this context, competitive aspects, such as third-party funding, international orientation, or publications, have particularly come to the fore and grown significantly in importance. We discuss these findings in light of an increasing managerialization of higher education institutions, which has a direct effect on collegiality. We argue that the differentiation of professorial job profiles leads to even more formalized appointment processes and may push collegial governance into the background.

People with complex health conditions must often navigate landscapes of uncoordinated public, private and voluntary health-care providers to obtain the care they need. Complex health conditions frequently transcend the scope of typical health-care service systems. The purpose of this paper is to explore and characterize such unique assemblages of actors and services as “user-defined ecosystems”.

Building on literature on customer ecosystems, this paper introduces the concept of the user-defined ecosystem (UDE). Using an abductive approach, the authors apply the concept in an interpretive, qualitative study of ten families with special needs children.

This study uncovers complex UDEs, where families actively combine a broad range of services. These ecosystems are unique for each family and extend beyond the scope of designed service ecosystems. Thus, the families are forced to assume an active, coordinating role.

This paper shows how to identify ecosystems from the user’s point of view, based on the selected user unit (such as a family) and the focal value-creating function of the ecosystem for the user.

This paper highlights how service providers can support and adapt to UDEs and, thus, contribute to user value and well-being. This can be used to understand users’ perspectives on service and systems in health and social care.

This study develops the concept of the UDE, which represents a customer-focused perspective on actor ecosystems and contrasts it with a provider-focused and a distributed perspective on ecosystems. This study demonstrates the practical usefulness of the conceptualization and provides a foundation for further research on the user’s perspective on ecosystems.

This paper aims to ascertain whether and to what degree universities are becoming organizational actors globally. Utilizing an original dataset of a sample of 500 globally oriented universities, we explore how universities have increasingly become organizational actors as is the case of American universities. We consider the following indicators of university transformation into organization actors: development or institutional advancement, diversity or inclusion, legalization, and internationalization goals and structures. We find that these globally oriented universities have created international, development, and legal offices. Surprisingly, nearly half of the universities in our sample also have diversity offices. These “getting organized” indicators are somewhat similar to what holds for American universities, suggesting that there is globalization of organizational actorhood among universities. At the same time, however, we find that there are pronounced regional differences, especially when it comes to organizing around diversity and legal affairs.

While the university as an institution is a great success story, one hears the constant chatter of the crises in higher education usually associated with the organizational transformation of universities. Regardless of one’s normative assessment of these observations, the institutional success of the university has been accompanied by the emergence of universities as organizational actors. I reflect on how these changes could alter the university as an institution, using the Australian higher education sector as an example. In doing so, I explore how universities as organizational actors, in responding to the demands of their external environment, set in motion a series of changes that redefine highly institutionalized categories, and, in doing so, radically remake the university as an institution.

Collegiality is often discussed and analyzed as a challenged form of governance, a form of working that used to function well in universities prior to the emergence of contemporary and modern forms of governance. This seems to suggest that collegiality used to dominate, while other forms of governance are now taking over. The papers in volume 86 of this special issue support the notion of challenged collegiality, but also show that for the most part, nostalgic notions of “the good old days” are neither true nor helpful if we are to revitalize academic collegiality. After examining whether a golden age of collegiality ever existed, we discuss why collegiality matters. Exploring what are often described as limitations or “dark sides” of collegiality, we address four such “dark sides” related to slow decision-making, conflicts, parochialism, and diversity. This is followed by a discussion of how these limitations may be handled and what measures must be taken to maintain and develop collegiality. With a brief summary of the remaining papers under two headings, “Maintaining collegiality” and “Revitalizing collegiality,” we preview the rest of this volume.

The study discusses the professionalization of academic leadership in Israel by analyzing and comparing two different training programs: the Hebrew University of Jerusalem’s (HUJI) program and the CHE-Rothschild program. The HUJI program began in 2016 to train the professoriate to take charge of leadership positions alongside a separate program for administrative staff, while the CHE-Rothschild program was launched in 2019 to train academic leaders, both professors and administrators from universities and colleges nationwide. The analysis reveals two “ideal types” of collegiality: While Model A (exemplified by the HUJI program) bifurcates between the professoriate and administrative staff, Model B (exemplified by the CHE-Rothschild program) binds administrative and academic staff members through course composition, pedagogy, and content. The study suggests a pattern of redefinition of collegiality in academia: we find that while academic hierarchies are maintained (between academic faculty and administrative staff and between universities and colleges), collegiality in academia is being redefined as extending beyond the boundaries of the professoriate and emphasizing a partnership approach to collegial ties.

Traditional studies in the sociology of science have highlighted the self-organized character of the academic community. This article focuses on recent interrelated changes that alter that distinctive governance structure and its related patterns of competition and cooperation. The changes that we identify here are contractualization and large-scale cooperative research. We use different data sources to exemplify these new patterns and discuss the illustrative role of research clusters in German academia. Research clusters as funded by the German Research Foundation (DFG) are both a highly prestigious scarce good in the competition for reputation and resources and a means of fostering cooperation. Our analysis of this German example reveals that this new institutional configuration of universities as organizations, academic researchers, and the state has a profound effect on organizational practices. We discuss the implications of our empirical findings with regard to collegiality in academia. Ultimately, we anticipate a further weakening of collegial bonds, not only because universities and the state have become more active in shaping the nature of academic competition and cooperation but also because of the increasing strategic and individualistic orientation of academic researchers. In the final section, we summarize our findings and address the need for further research and an international comparative perspective.

Purpose – This chapter frames the topic of organizing for sustainable health care in terms of the environmental trends that have rendered current health care approaches unsustainable, the embeddedness of health care in society's triple bottom line, and the need to build adaptive capability within the complex health care ecosystem.

Design/methodology/approach – We synthesize documented trends and empirical findings regarding the viability of current approaches to health care, and provide a theoretically framed treatment of the adaptation process in the complex health care system that can lead to the emergence of sustainable approaches.

Findings – There is a misfit between current approaches to delivering health care and the requirements and trends in contemporary society. Fundamental transformation is required that entails a broadening of purpose, a future orientation, and a rethinking of how health care adds value and how it is embedded in society.

Originality/value – By reconceptualizing health care reform as intricately related to societal sustainability and the triple bottom line, we open the possibility of transcending a narrow focus on reengineering to create more efficient organizations and work processes that consume fewer resources and deliver greater value. We invite health care practitioners and scholars to rethink all the connections in the health care ecosystem, and the need to build in self-organizing capabilities and adaptive capacity. The cases in this book provide knowledge from systems engaged in fundamental transformation, analyzed through the lenses of theoretical frameworks that help us better understand essential dynamics involved in creating sustainable health care systems.