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

Abstract

ObjectivesGiven 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.MethodsAn 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.ResultsHow 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.ConclusionsThe 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.

Explaining informal payments for health services in Central and Eastern Europe: an institutional asymmetry perspective

“…To explain such cross-national variations in the prevalence of informal payments for health services in Central and Eastern Europe, an institutionalist theory approach is here for the first time adopted. Institutionalist theory (Baumol & Blinder, 2008;North, 1990) has been widely applied in health services research, such as to explain the adoption of health information technology (Fareed, Bazzoli, Mick, & Harless, 2015;Nilashi, Ahmadi, Ahani, Ravangard, & bin Ibrahim, 2016;Sherer, 2010), healthcare reform (Contandriopoulos & Brousselle, 2010), patient-centred preventive care (Ledderer, 2010) and healthcare expenditure (Burnett et al, 2016). Therefore, following advances in institutionalist theory in relation to the wider study of the informal economy (Williams & Horodnic, 2015a, two different approaches to explaining informal payments by patients can be adopted.…”

Evaluating the prevalence of informal payments for health services in Southeast Europe: an institutional approach

“…The aim of this paper is to evaluate a new way of explaining informal payments for health services in Southeast Europe. Until now, institutional theory (Baumol and Blinder 2008;North 1990) has been used in health services research to evaluate the adoption of health information technology (Fareed et al 2015;Nilashi et al 2016;Sherer 2010), healthcare reform (Contandriopoulos and Brousselle 2010), patient-centred preventative care (Ledderer 2010) and healthcare expenditure (Burnett et al 2016). In this paper, and drawing inspiration from the application of institutional theory to the study of the wider informal economy (Author 2016;Author 2015aAuthor , 2015bAuthor , 2015cAuthor , 2016aAuthor , 2016b, we here for the first time seek to evaluate the validity of explaining informal payments to patients in Southeast Europe through the lens of institutional theory.…”

Rethinking informal payments by patients in Europe: An institutional approach

“…Until now, institutional theory [14,15] has been widely applied in health services research and related fields to evaluate for example the adoption of health information technology [16][17][18], healthcare reform policies in public systems [19], patientcentred preventive care [20] and healthcare expenditure [21]. In this paper, and drawing inspiration from the application of institutional theory to the study of informal economic practices beyond healthcare [22,23], we here for the first time analyse informal payments to patients through the lens of institutional theory.…”