Designing the Social Architecture of Participation in Large Groups to Effect Organizational Change

Health care organizations are facing dramatic changes. Given their complexity and the value of autonomy held by many of the key professional groups, much of the adaptation to these changes will require working in large groups with multiple levels and different units present. Yet it is known that leading large groups is difficult. They are either over structured, thereby reducing the learning component, or they are under structured, thereby allowing participants `anxieties to lead to dysfunctional splitting, fight/flight, or dependency. This article addresses the challenge of structuring large groups, what the authors term the social architecture for participation.