Shame and institutional stability – or – change in healthcare

The purpose of this paper is to help introduce the empirical study of emotion within an institutional framework by examining shame and shaming as drivers of institutional stability and change, respectively.

The author conducted a qualitative study of 101 US print media articles generated by major US news publications and trade magazines from 1999 to 2011 in the wake of the Institute of Medicine’s (IOM) 1999 report To Err is Human: Building a Safer Health System.

This study resulted in two major findings. First, this research found that the institutions constituting the collective professional identity of physicians persisted via institutionalized shame inculcated in physicians during their extensive socialization into the medical profession. Potential shame over medical error served to reinforce institutionalized cultures which exacerbated medicine’s problems with error reporting. Second, this study reveals that field-level actors engage in shaming to affect institutional change. This research suggests that the IOM report was in effect a shaming effort directed at physicians and the institutions constituting their collective identity.

This study provides some verification of recent theoretical works incorporating emotion into institutional theory and also illustrates how shame can be incorporated into collective identity as an institutional imperative.

This study provides a rare empirical investigation of emotion within an institutional framework, and illuminates ways in which the emotion of shame interacts with institutional processes. This research also focusses on collective identity and institutional stability, two topics which are largely ignored by contemporary institutional researchers but are integral aspects of social life.