Vicious cycles in healthcare organization integration: The case of Midwest Health System

We report on the findings of an eight-year longitudinal field study of events as they unfolded in developing a large vertically-integrated health care system of hospitals, clinics and a health insurance plan from the time of its merger in 1994 until 2001. What began as a study of healthcare organization integration and change turned out to be a study of organizational entrapment and disintegration. Adopting a systems perspective of action loops, we found vicious cycles among recurrent integration events across different organizational levels. These events dealt with symptomatic actions and responses that distracted participants from addressing the fundamental structural parameters that produced and perpetuated the vicious cycles. These previously unreported processes call attention to organizational double binds that lead seemingly competent, well-intentioned and well-resourced organizational participants to become entrapped in vicious cycles of pathological organizational behavior.