ALL TOGETHER NOW - THE CIRCULAR ORGANIZATION IN A UNIVERSITY HOSPITAL.1. PLANNING AND DESIGN

During a period of significant change in health care, hospitals are be ing transformed. This article-part I-reports on one university hospita l's experience with a project funded by a Robert Wood Johnson Foundati on and Pew Charitable Trusts initiative. The article presents the hist ory and conditions that led to a planning year during which participan ts defined external and internal conditions contributing to the needs for change. Along with the driving pressures, the article addresses th e planning process and the basic design for organization change, Ackof f's idealized design and circular organization. This model had been us ed in industry, but not in a hospital. Key themes related to the desig n and start-up are offered. Part II addresses the implementation of th e model, the process of change, supports and barriers, and progress to date.