ORCHESTRATING EMERGENT CHANGE: THE ‘HOSPITALIST MOVEMENT’ IN US HEALTHCARE

The metaphor of ‘orchestration’ is applied to an emergent change whereby developing different versions of a resource to solve local problems with managing hospitalized patient care in the USA became conceived as a nationwide innovation. A pluralistic framework incorporates Abbott’s conception of a system of professions, a cultural and political perspective on interaction and the notion of ‘orchestration’ which is distinguished from leadership and management. Small‐scale research in diverse settings shows how key stakeholders including academic medical researchers orchestrated the coalescence of disparate practices into a unified movement, although working in a relatively decentralized healthcare system featuring a complex mix of public, private and voluntary sectors. Sufficient confluence between diverse interests was nurtured for widespread acceptance of a new ‘hospitalist’ role coordinating inpatient treatment. It is suggested that the metaphor of orchestration may have wider potential as a heuristic for understanding emergent change that becomes more complex as it spreads.     

Planet of Slums

The megacities arising around the planet are like the Internet where many events are taking place simultaneously. The urban scape today is becoming more a space of flows—migrants, trade, capital, information, microbes—than a space of places rooted in an historical identity. The megaurban condition today encompasses many realities, from the glittering generic city‐state of Singapore to the slums climbing up the hillsides around Mexico City or Sao Paulo. In these spaces we work, love and live out the intimate moments of our lives. In these spaces we consume and spew out climate warming gases. In this section, two of the world's “star architects”—Rem Koolhaas and Frank Gehry—the visionary “arcologist” Paolo Soleri and the Turkish novelist and Nobel laureate, Orhan Pamuk, grasp at chronicling the reality of where we live.