The problems facing many US health care organisations may prove critical for survival for many of them. The article outlines the nature of the problems: increased patient demands, tensions among personnel, technological innovation, cost‐conscious purchasers of care, the need to improve cost‐efficiency, and barriers to change within organisations. This last presents a number of problems that may often seem intractable and are peculiar to this type of organisation. This is discussed.
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Johnson et al. (1991) studied this question.