The influence of health care organizations on well-being

Human beings can be proactive and engaged or, alternatively, passive and alienated, largely as a function of the social conditions in which they develop and function.1(p68) Within health care organizations of all sizes—from large academic medical centers to independent solo practices—many people are experiencing distress. Some of this is appropriately attributed to such external factors as payment reductions, regulation, and the business practices of insurers. Less well recognized is the contribution of factors internal to the organizations: styles of leadership and management, administrative policies and procedures, and organizational culture. As compared with external factors, these internal characteristics have more direct, immediate, and powerful effects and are far more amenable to change at a local level. The goal of this article is to call attention to these internal factors to enable people involved with health care organizations to pursue constructive change that will improve their own well-being and that of others.