Created by Thomas Lawrence and Roy Suddaby, today's definition of institutional work largely refers to the broad spectrum of proactive action aimed at making, preserving, and transforming businesses and institutions. While it has often been called "the lost art of business", this term is now widely used and understood throughout business and society. This increased usage is largely a result of two factors. The first factor is the fact that the term is now well established and well understood by people from all sectors of business and the second is the fact that many businesses are now setting up their own internalised systems of management to ensure quality and standards at all levels of the organisation.
The definition of institutional work covers a vast array of activities that involve individuals, teams, organisations, and even whole governments. Within this broad arena there are two types of actors: the administrators and the managers. The administrators act as the heads of bodies such as boards, commissions, or other governing bodies. These administrators may be employed directly by the institution or may be employed through agencies of the state such as the Department of Labor.
Managers are usually employed by large organisations or by government departments. They are the ones responsible for running and organising the day-to-day workings of institutions such as hospitals, schools, and universities. They report directly to the boards of directors of these institutions. As leaders they are charged with ensuring that the work of the institutions runs smoothly and that quality is maintained at all times. They are also charged with looking after recruitment of new staff and with budgeting the resources of the institution.
Another aspect of institutional work involves the creation of policies. Policies are generally made by governing bodies and are implemented through formal processes in association with other stakeholders. Policy makers then take responsibility for the implementation of the plans laid out by the governing body or their successors. One of the main arguments of those who oppose the institutionalisation of healthcare is that health care is a collective action and that the creation of a single policy will not ensure that the desired goals are achieved.
Another facet of this type of work involves the collection of diverse activities or services provided by many people or institutions under one organisation. An example of this is the procurement process of services by a hospital or other public sector organisation. Somehow this needs to be organised so that there is uniformity in the manner in which the various services or activities are obtained. A very important aspect of the collective management of the institutional work of the world today is the need for increased productivity and efficiency.
The ability to achieve greater levels of productivity and efficiency can only be facilitated if institutions are more cohesive and are able to coordinate the efforts of their members more efficiently and effectively. This is why a variety of approaches to organizing healthcare institutions is needed. Some proponents of this idea argue that increased collaboration between different parts of the institution, through the development of interdepartmental coordination and information sharing, is necessary if the modern organisation is to continue to provide high quality health care services. These arguments are not unique and are in fact widely accepted by a wide range of researchers in the field of organizational psychology.