All large organizations tend to become bureaucratized and stodgy over time. Institutional inertia sets in, and vested interests resist change. Yet the rapidly changing world requires constructive adaptation. The private sector relies on competition (and occasional recessions) to shake firms out of their traditional ways. The public sector relies on innovative officials, sometimes prodded by parliamentary or congressional oversight—an imperfect process, especially when it comes to international organizations. Hanrieder’s perceptive book details several failed attempts to reform the World Health Organization by aiming to reverse the organization’s fragmentation and to introduce greater coherence into its policies and practices. A functional WHO should be a wholly uncontroversial, consensus goal; after all, everyone favors good health and the containment of contagious diseases. Yet the WHO has become factionalized by region and in some places has lapsed into patronage and inefficiency, which have proved difficult to overcome. Hanrieder also looks at mostly unsuccessful reform efforts at UNESCO and the International Labor Organization. Despite the book’s excessive use of political science jargon, its discouraging analysis is valuable and applicable to many organizations.