When organizations byte back - producing health and care as policy puzzlement

While reforms and other major policy shifts in healthcare aim at transforming health systems and improving care delivery and access, little attention is paid to the landing ground of these changes, namely health organizations and practice settings. Among the toolkit of policymakers, organizations themselves can be seen as one of many policy instruments. However, organizations are a relatively newcomer for policymakers. We explore how organizations as policy instruments can support the creation of new organizational forms to achieve policy goals. The potential to improve health systems of three organizational forms, namely clinical networks, accountable care organizations and learning health systems and organizations are assessed. Issues of power, learning dynamics and implementation challenges are considered.