Paradigms of change: How 16 organizations transformed prescriber-industry interactions

Academic medical centers (AMCs) and other healthcare organizations are notoriously conservative and resistant to change. Explanations for this conservatism vary, from the ingrained habits of tenured faculty to systems of training and promotion that privilege individual accomplishment over collaboration and teamwork. Whatever the reasons, healthcare organizations emerge as the picture of organizational entrenchment. Against this backdrop, an extraordinary change is underway: A number of healthcare organizations have taken bold steps to reform clinicians' relationships with drug and device companies. They have implemented stringent policies to control an array of conflicts of interest in clinical care (COIC), including bans on company-funded gifts and meals, limits on outside consulting and speaking, and public disclosure of physicians' industry ties. These sweeping initiatives are all the more remarkable in that they are not cost-neutral. To be sure, these organizations are unusual. Yet their outlier status makes them all the more vital as examples of organizational change. What drove them to break from their peers and begin this transformation? How were they able to implement policies which, in many ways, run counter to organizational and individual self-interest? To answer these questions, we conducted case studies at 16 institutions with exemplary COIC policies, using semi-structured interviews with leaders, administrators, faculty, and staff at all organizational levels so as to investigate the origins and dynamics of policy change. Our findings suggest ways in which healthcare institutions can overcome self-interest, entrenched habits, and other challenges to reframe their interactions with industry and affirm their core values and organizational commitments.