Format

Send to

Choose Destination
J Health Serv Res Policy. 2016 Apr;21(2):109-17. doi: 10.1177/1355819615622655. Epub 2015 Dec 17.

Using institutional theory to analyse hospital responses to external demands for finance and quality in five European countries.

Author information

1
Researcher, Department of Surgery, Faculty of Medicine, Centre for Patient Safety and Service Quality, Imperial College London, UK s.burnett@imperial.ac.uk.
2
Senior Sociologist, Rand Corporation, Santa Monica, CA, USA.
3
Assistant Professor of Human Resources and Organizational Behaviour, ISCTE, Lisbon University Institute, Portugal.
4
Professor of Quality and Safety in Healthcare Systems, Department of Health Studies, University of Stavanger, Norway.
5
Associate Professor of Public Administration in Health Care, Institute of Health Policy & Management, Erasmus University Rotterdam, The Netherlands.
6
Assistant Professor, The Jönköping Academy for Improvement of Health and Welfare, Sweden.
7
Professor of Healthcare Quality & Innovation, Florence Nightingale Faculty of Nursing and Midwifery, King's College London, UK.
8
Senior Lecturer, Florence Nightingale Faculty of Nursing and Midwifery, King's College London, UK.
9
Professor of Psychology, Department of Experimental Psychology, Oxford University, UK.
10
Professor of Health Care Organisation and Management, Department of Applied Health Research, University College London, UK.

Abstract

OBJECTIVES:

Given the impact of the global economic crisis, delivering better health care with limited finance grows more challenging. Through the lens of institutional theory, this paper explores pressures experienced by hospital leaders to improve quality and constrain spending, focusing on how they respond to these often competing demands.

METHODS:

An in-depth, multilevel analysis of health care quality policies and practices in five European countries including longitudinal case studies in a purposive sample of ten hospitals.

RESULTS:

How hospitals responded to the financial and quality challenges was dependent upon three factors: the coherence of demands from external institutions; managerial competence to align external demands with an overall quality improvement strategy, and managerial stability. Hospital leaders used diverse strategies and practices to manage conflicting external pressures.

CONCLUSIONS:

The development of hospital leaders' skills in translating external requirements into implementation plans with internal support is a complex, but crucial, task, if quality is to remain a priority during times of austerity. Increasing quality improvement skills within a hospital, developing a culture where quality improvement becomes embedded and linking cost reduction measures to improving care are all required.

KEYWORDS:

finance; health care; institutional theory; quality

PMID:
26683885
PMCID:
PMC4772277
DOI:
10.1177/1355819615622655
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Atypon Icon for PubMed Central
Loading ...
Support Center