The role of institutional entrepreneurs in reforming healthcare

Institutional Change of Accounting Systems: The Adoption of a Regime of Adapted International Financial Reporting Standards

“…are they able to envision new practices and then subsequently get others to adopt them. (Garud, Hardy, & Maguire, 2007, p. 961) In particular, our analysis of the processes of change enhances knowledge of the reasons, ways, and means used by actors at the centre of a highly institutionalised field (and privileged by existing institutional arrangements) to enact change in a national accounting system (Battilana et al, 2009;Greenwood & Suddaby, 2006;Lockett, Currie, Waring, Finn, & Martin, 2012). We argue that embeddedness in wider social structures is fundamental to understanding entrepreneurial action and how institutional change evolves.…”

The roles of specialisation and evidence-based practice in inter-professional jurisdictions: A qualitative study of stroke services in England, Sweden and Poland

“…The fact that the clinical lead in all the sites was a doctor and audit data shows that this is the case in 97% of SUs (RCP, 2014) is testament of this. Doctors derive this jurisdictional power due to the fact that they originate from and continue their affiliation to the dominant profession of medicine (Abbott, 1988) and maintain their dominance through their high structural legitimacy in these formal institutional structures (Lockett et al, 2012). Degrees of specialisation and EBP are more important for the subordinate healthcare professions of nursing and the therapies.…”

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

“…24,25 At the organisational level of analysis, it has been demonstrated that patient safety is moulded by culture, capacity, processes and governance systems, [26][27][28] and that each is enhanced by distributed (shared, see Glossary) leadership. [28][29][30][31][32][33][34][35][36] At the level of health-care practice, it is known that patient safety is informed by the beliefs and values of health-care professionals, [37][38][39][40][41] and is ultimately underpinned by their personal commitment to care. 42,43 The extent and burden of the problem Despite growing awareness of the challenges posed by patient safety, [44][45][46] and concerted improvements efforts within some health-care systems, 47,48 considerable hospital patient safety problems persist.…”

“…This issue is compounded when viewing (as we do) health-care organisations as comprising multiple cultures/cultural frames, rather than as a single culture of care. These points notwithstanding, research indicates that five aspects of culture are of particular salience to patient safety: (1) the need for a culture of compassion in care; 81 (2) the problematic intra-and interprofessional hierarchies, which privilege a perceived elite at the expense of the broader health-care team; 41,[90][91][92] (3) the culture of blame that retards the promotion of adverse incident reporting and disclosure of harm to patients; 42,[93][94][95] (4) the culture of bullying [96][97][98] that, regrettably, appears to be widespread across the NHS; [99][100][101][102][103][104] and (5) the culture of unrelenting pressure to attain government targets, which creates a range of unintended and dysfunctional consequences.…”