This book, "Institutional Change and Healthcare Organizations: From Professional Dominance to Managed Care," by W. Richard Scott, Martin Ruef, Peter J. Mendel, and Carol A. Caronna, is a comprehensive analysis of the historical and sociological transformations in healthcare systems, particularly in the San Francisco Bay area. The authors explore how institutional efforts have shifted from professional dominance to managed care, aiming to reduce waste, duplication, and variability in healthcare delivery. The book is a significant contribution to the study of profound institutional change, offering insights into new governance structures, logics, actors, and relations among actors. The research team, led by Scott, used a large budget to analyze healthcare systems over the past 50 years, examining three historical periods: the era of professional dominance (1945–65), the era of federal involvement (1966–82), and the era of managerial control and price competition (1983–present). The study documents the transformation from a system dominated by medical professionals to one focused on cost efficiency and integrated services. However, the book also highlights the resulting instability and confusion in the healthcare field, as well as the loss of dominance by some actors and the rise of new ones. The authors discuss the complexities of defining "integrated healthcare systems" and the challenges of measuring organizational integration at various levels. They also critique the uncritical use of commercial and political terms like "health maintenance organizations" (HMOs), which are reified into second-order constructions. Despite these challenges, the book provides valuable insights into organizational ecology, institutional change, and the dynamics of healthcare systems. The book is praised for its detailed analysis, excellent references, and appendices, making it a valuable resource for graduate students and faculty. It contributes significantly to the fields of community and organizational ecology, organizational demography, and profound institutional change. The authors' work is a masterful exploration of the historical and sociological transformations in healthcare systems, offering a deep understanding of the complexities of institutional change.This book, "Institutional Change and Healthcare Organizations: From Professional Dominance to Managed Care," by W. Richard Scott, Martin Ruef, Peter J. Mendel, and Carol A. Caronna, is a comprehensive analysis of the historical and sociological transformations in healthcare systems, particularly in the San Francisco Bay area. The authors explore how institutional efforts have shifted from professional dominance to managed care, aiming to reduce waste, duplication, and variability in healthcare delivery. The book is a significant contribution to the study of profound institutional change, offering insights into new governance structures, logics, actors, and relations among actors. The research team, led by Scott, used a large budget to analyze healthcare systems over the past 50 years, examining three historical periods: the era of professional dominance (1945–65), the era of federal involvement (1966–82), and the era of managerial control and price competition (1983–present). The study documents the transformation from a system dominated by medical professionals to one focused on cost efficiency and integrated services. However, the book also highlights the resulting instability and confusion in the healthcare field, as well as the loss of dominance by some actors and the rise of new ones. The authors discuss the complexities of defining "integrated healthcare systems" and the challenges of measuring organizational integration at various levels. They also critique the uncritical use of commercial and political terms like "health maintenance organizations" (HMOs), which are reified into second-order constructions. Despite these challenges, the book provides valuable insights into organizational ecology, institutional change, and the dynamics of healthcare systems. The book is praised for its detailed analysis, excellent references, and appendices, making it a valuable resource for graduate students and faculty. It contributes significantly to the fields of community and organizational ecology, organizational demography, and profound institutional change. The authors' work is a masterful exploration of the historical and sociological transformations in healthcare systems, offering a deep understanding of the complexities of institutional change.