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The field of Organization Development and Change (ODC) is facing the same tensions as those confronting humanity more broadly: how to build a sustainable future. There is an urgent need to preserve the viability of our species by changing our relationship to the natural environment and slowing the ravages of climate change and the degradation of the earth's resources. Simultaneously, technology advances are changing our lives, work, institutions, and culture in unpredictable ways. Social upheaval and geopolitical tensions are exposing deep fissures in values, preferences, and beliefs about what constitutes a just society and how to govern. The development needed for a sustainable future must enable us to operate in ways that are fundamentally different from the status quo – not just increase our effectiveness in the way we currently operate.

ODC will have to recontextualize its methodologies and frameworks that currently focus primarily on individual organizations to deal with the complexity and urgency of the challenges humanity is facing. In this Reflection, we consider some of the tensions and key questions that ODC faces: What does, and might, sustainable development mean in a globally intertwined world where divisions at both the macro and micro levels reflect conflicting interests, tensions, and fundamentally different aspirations for the future? How do ODC methodologies and frameworks need to change to help develop sustainable ecosystem level transformation cutting across hierarchies, institutions, geographies, and cultures? How does ODC need to design itself to operate differently with different outcomes? We suggest some possible next steps forward in addressing these tensions.

This paper proposes a framework for understanding the concept of a learning organization from a normative perspective. A questionnaire was developed to operationally measure the described management practice attributes of a learning organization. Using a sample of four organizations and 612 subjects, support was found for three a priori predictive hypotheses derived from a conceptual framework. Implications of the results and further empirical research are discussed, especially for linking learning organization attributes to performance using larger samples and multiple measures.

The need to maintain up-to-date technological skills despite an aging workforce makes it imperative that organizations increasingly focus on retraining older employees. This article develops an adult career model based on the acquisition of technological skills and gradual skill obsolescence. The model suggests the importance of retraining and provides practical implications to the development of retraining programs. Suggestions for future research are also offered.

The chapter redefines the focus of the changes required to create sustainable healthcare away from fixing healthcare organizations and toward reconfiguring the constituent elements of the healthcare ecosystem and redefining how they interrelate to yield value more sustainably.

Based on a review of recent literature on healthcare reform, we argue that unlike other sectors, healthcare organizations cannot change themselves without changing their connections to the rest of the healthcare ecosystem, including other healthcare organizations, patients, governments, research institutions, vendors, and the citizenry at large. This is because these are not only stakeholders but also integral parts of healthcare processes.

Interventions intended to create more sustainable healthcare must bring together knowledge and perspectives from across the ecosystem, and must converge different sources of information and analysis to generate novel ways of connecting across the ecosystem. Change within a healthcare system cannot achieve the magnitude of transformation needed to become sustainable.

If the healthcare ecosystem evolves in the manner described in this chapter, the healthcare ecosystem will no longer center around particular institutions and doctors’ offices but rather be defined by flexible and variable interactions between co-acting elements of the ecosystem.

The chapter treats the context as the focus of change in order to change the healthcare system. It proposes three kinds of flows: knowledge, clinical, and resource that are already beginning to change and that will eventually result in fundamentally different approaches to healthcare.

This chapter provides a reflective synopsis of six cases focused on making healthcare sustainable. The nature and value of an ecosystem perspective is explored. The intent is to apply and generate organizational knowledge to understand and guide purposeful design and learning.

From five countries where healthcare is organized differently, these cases illuminate particular approaches to develop the capabilities for healthcare to deliver greater value to society. Each case is examined through the lens of an appropriate theoretical perspective. This chapter reports the themes that were common in the six case studies.

New approaches are changing the connections in the healthcare ecosystem, including the flows of: medical knowledge, clinical information, and resources. Common themes include: the importance of networks in the emerging healthcare ecosystem; the role of governance mechanisms and leadership to align the diverse ecosystem components; the engagement of dominant ecosystem actors; the need for adaptive change capabilities, and for multi-stakeholder research collaborations to generate actionable knowledge.

Taking an ecosystem perspective enables healthcare leaders to broaden their conceptualization of the changes that will be required to be sustainable in a changing society.

Almost every man, woman and child is affected by the healthcare system. Increasing the sustainability of healthcare is integral to increasing societal sustainability overall.

Viewing the ecosystem as the appropriate focus of purposeful change departs from a traditional approach that focuses on the effectiveness of each element.

We argue that in order to address the contemporary challenges that organizations and societies are facing, the field of organization development (OD) requires frameworks and skills to focus on the eco-system as the level of analysis. In a world that has become economically, socially, and technologically highly connected, approaches that foster the optimization of specific actors in the eco-system, such as individual corporations, result in sub-optimization of the sustainability of the natural and social system because there is insufficient offset to the ego-centric purposes of the focal organization. We discuss the need for OD to broaden focus to deal with technological advances that enable new ways of organizing at the eco-system level, and to deal with the challenges to sustainable development. Case examples from healthcare and the agri-foods industry illustrate the kinds of development approaches that are required for the development of healthy eco-systems. We do not suggest fundamental changes in the identity of the field of organizational development. In fact, we demonstrate the need to dig deeply into the open systems and socio-technical roots of the field, and to translate the traditional values and approaches of OD to continue to be relevant in today’s dynamic interdependent world.

The large number of publications about sustainability and sustainable development that have been published during the past decade has dealt largely with the science of sustainability, the content of sustainability initiatives, and increasingly with the need to more closely link the economic, environmental, and social purposes and operating logic of the firm. Recent literature stresses the inherent social nature of the challenges to aggressively moving to more sustainable ways of operating for the well-being of our planet, society, economy, organizations, and humans. Despite rich case examples, guidance on how to organize to achieve the triple bottom line is limited. We take stock of the current state of knowledge, using an adaptive complex system perspective to articulate the challenges of organizing for sustainable effectiveness. Most of the global economy and the knowledge upon which it is predicated carry a logic of resource abundance even in the face of increasing competition for scarce resources, and a singular focus on economic outcomes. We argue that the development of new capabilities to address triple bottom line sustainability requires a change in that logic and requires new rules of interaction, new organizational and interorganizational designs, and new ways of learning. The premise is that systems can build on their inherent capabilities to learn and to act collectively in order to adapt. We argue that by working together to collaboratively explore how to organize for sustainability, academics and practitioners can accelerate knowledge generation and progress. This chapter provides the theoretical framing context for the chapters to come.

This chapter describes two change efforts involving participatory action research within the pharmacy operations division of Kaiser Permanente. Focus is on a parallel learning mechanism that has been used to support communications and change during two large-scale information technology interventions. It begins with basic background information on participatory action research in organizations. Since the case setting is Kaiser Permanente, the chapter provides some information on the U.S. healthcare industry context and then shifts to Kaiser’s communication forum, a learning mechanism that has been in place for 35 years. Cognitive, structural, and procedural aspects of the learning mechanism are explored, and the chapter features interviews with some of the key forum players. Both in the forum’s infancy and in its current more institutionalized state, the pharmacy organization has been in crisis. Implications for the use of parallel learning structures on a long-term basis to support long-term participatory action research are explored along with contributions to theory on insider/outsider action research.

Purpose – This chapter provides a reflective synopsis of the chapters in the volume and highlights the learning from the cases about the development of new orientations, design configurations, and learning mechanisms. It charts directions for further research and possible managerial actions.

Design – The chapters in this second volume of the book series “Organizing for Sustainable Effectiveness” capture a rich set of cases in which organizing for sustainable health care was the central focus. Each chapter illuminated the development of a distinct health care system in a unique cultural and national context, and had a special focus on reporting theoretically informed and rigorously explored knowledge to guide purposeful design and learning approaches. Collectively the chapters highlighted the processes, organization and design, system regulation, and continuous learning approaches in complex organizational and multi-organizational health care systems that enable focus on and advancement of economic, social, and ecological outcomes.

Findings – Several critical themes have emerged from the cases, and from the broader literature on health care transformation: the importance of purpose; the need to overcome fragmentation; the need for alternative business models; technology as an investment in sustainable health care; the centrality of knowledge management; the importance of partnership and collaboration; the role of self-organization and leadership; and the criticality of building change capabilities.