Issues in the creation of organizations: initiation, innovation, and institutionalization

Kimberly presents a case study of the birth and early development of an innovative medical school. When the school opened in 1971, the existing 86 medical schools all offered similar programs: two years of basic science training in lecture halls and laboratories, followed by two years of direct contact with patients in clinical settings. In the new school, students were taught didactically only during the first year. During the second year, each student was assigned to a community physician who acted as an advisor and who discussed with students those patients afflicted with the diseases the student was currently studying. Available evidence indicated that the school's innovative curriculum was favorably received by the students and that they performed as well as their peers on standardized year-end exams. The author found the case of this medical school to be of particular interest from an organizational viewpoint in that: (1) the early development of the school was shaped by the first dean's entrepreneurial activity, ambitions, visions, strengths, and weaknesses; (2) the uncertainty resulting from the school's novelty forced individuals to assume new roles and face unclear performance criteria; and (3) the transition of an innovative school to an institutionalized one was problematic because it modified the decision-making process. The author suggests that those things which lead to an organization's success during its early years are not the same as those that lead to longer-run success. He says that a new organization creates new norms, values, and procedures whereas the elements of an existing organization interact within an established culture. He concludes that organizational birth is a phenomenon about which relatively little is known, but which may be an important constraint on later development. A comparative analysis of the birth, life, and death of organization is advocated.