Bibliographic record
Abstract
Calls for change to fundamentally transform health care fields are increasing. Health care fields are highly institutionalized, meaning that actors in these fields face a paradox of embedded agency. If behavior and action conforms to institutional pressures, when and how and which actors can step away from pressures to pursue and implement change? In this paper, we conduct a review of the empirical literature on institutional change in health care fields to examine when, who, and how intentional change is pursued. Our review of the literature uncovers six themes around intentionally pursuing change. The themes that emerged suggest that changes and actions that fit health care fields’ constellations of logics are better suited to changing long standing arrangements and practices. The review also shows that change involves a variety of actors some that leverage preferred social positions and some that used nuanced change action to overcome other’s embeddedness in health care fields.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.025 | 0.043 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.004 | 0.005 |
| Science and technology studies | 0.006 | 0.030 |
| Scholarly communication | 0.024 | 0.032 |
| Open science | 0.002 | 0.005 |
| Research integrity | 0.006 | 0.006 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".