Organizations as machines, organizations as conversations: two core metaphors and their consequences

Med Care. 2011 Dec;49 Suppl:S43-8. doi: 10.1097/MLR.0b013e3181d55a05.


One factor contributing to the limited success of organizational change initiatives is the use of an outmoded conceptual model: the organization as machine. This metaphor leads to the creation of detailed blueprints for desired changes; invites unrealistic expectations of control; and creates anxiety, blame and defensiveness when events inevitably do not proceed according to plan, thus hindering the work. An alternative conceptualization--the organization as conversation--portrays an organization not as a reified object upon which we can act but as self-organizing patterns of thinking (organizational identity and knowledge) and relating (organizational culture) that exist in the medium of human interaction in which we participate. Principles of complexity dynamics (self-organization) have important implications for organizational change practices. (1) Organizational change requires mindful participation--reflecting on and talking about what we are doing together here and now, what patterns of thinking and interacting we are enacting, and what new behaviors might interrupt old patterns or give rise to new ones. (2) Diversity and responsiveness favor the emergence of novel patterns. Skilled facilitation can enhance these characteristics when novelty is desirable; checklists and protocols can diminish these characteristics when consistency and reliability are needed. (3) We cannot know in advance the outcomes of our actions so we need to hold plans lightly, value "not knowing" and practice emergent design. The organization-as-conversation perspective also has important implications for T3 translational research, redefining its purpose, suggesting new methodologies, and requiring new approaches for evaluating proposed and completed projects.

MeSH terms

  • Delivery of Health Care / organization & administration*
  • Efficiency, Organizational
  • Humans
  • Metaphor*
  • Models, Organizational
  • Organizational Innovation
  • Quality Improvement / organization & administration*
  • Quality of Health Care / standards
  • Total Quality Management / organization & administration*
  • United States