Towards A Comparative Institutionalism: Forms, Dynamics And Logics Across The Organizational Fields Of Health Care And Higher Education: Volume 45

Following the spirit of an earlier volume in the series focusing on ‘Comparative Approaches to Organizational Research’, the mandate of the current volume is to provide a comparative account of dynamics across two organizational fields – health care and higher education – and, subsequently, two specific types of organizational forms – hospitals and universities. In so doing, we take a broader perspective encompassing various conceptual and theoretical points of departure emanating from, mostly, the institutional literature in the social sciences (and its various perspectives), but also from public policy and administration literatures – of relevance to scholars and the communities of practice working within either field. In this introductory paper to the volume, we provide a brief overview of developments across the two organizational fields and illuminate on the most important scholarly traditions underpinning the study of both system dynamics as a whole as well as universities and hospitals as organizations and institutions. We conclude by reflecting on the implication of the volume’s key findings in regards to comparative research within organizational studies.

The paper sets forth and examines the assumptions underlying two global ideas – world class and best practices – and their application to (higher) education and health organizations. Our basic (ex-ante) assumption is that both sectors are influenced by organizational fields that embody these ideas. However, we also assume that these sectors differ, and thus, that one should find between sector variations in the influence of such ideas. The findings suggest that both sectors have been affected by hegemonic ideas, yet in rather different ways, and that these ideas, particularly the metrics being used, pose different challenges in the two sectors.

University reforms have been pervasive in European higher education over decades. Analyses of these reforms are still incomplete, however. To find a more comprehensive approach in explaining the relentless transformation of public universities, this paper suggests a novel, interactionist point of view. Drawing on ideational aspects of universities as institutions, the paper first explores the differentiation of basic, influential ideas of change. A recently developed typology is then used to further elaborate upon the composition and relation of these ideas. Finally, evidence is provided that supports a non-linear dynamic consisting of reciprocal influences, which overall indicates a recursive contingency between institutional context and coexistent frames of change.

Performance management (PM) has been developed to a central part of health care reforms. However, ideas of performance are traditionally contested in the health care sector and split up between a professional and a bureaucratic understanding of effective service delivery. With the rise of New Public Management, an additional layer of PM instruments has been put on the already existing structures. As a result, different PM regimes can be distinguished, which vary in the way they define performance, blame underperformance and design accountability instruments to ensure appropriate behaviour. The paper investigates the institutional design of PM schemes of three different cases – Denmark, Germany and England – which are representative for different PM regimes.

Adopting an agentic positioning, we question and compare competing logics hybridization within French hospitals and universities facing major reforms inspired by new public management. In addition to the resulting forms of hybridization exposed in the literature (accepted or refused), we observe four additional modes: instrumentalized, uncomfortable, reformulated, and suffered. They all reveal the varied manner with which each professional faces reform. However, we develop a new argument: the ways professionals hybridize (or do not) their prevailing logic depends on an overarching mode of hybridization that characterizes the way their organization deals with reform. We identify two contrasting modes: overarching strategic logics hybridization and overarching enforced logics hybridization. They give insight into how actors decouple structure from practices. We contribute to the literature on logics hybridization by first analyzing the role of specific actors who act as either a translator-actor or a closure-actor to respectively facilitate appropriation of the reforms or to protect professionals against the growing dominance of the new logic introduced by the law; and secondly by discussing importance of articulating higher and lower organizational levels all involved in hybridization.

In this study, we are addressing changes in managerial logics after the introduction of New Public Management (NPM)-reforms in two public sectors in Norway, namely the hospital and the university sectors. These sectors were previously dominated by professional and political logic in management, and the focus is on professionals in managerial positions. We are asking: How do professionals in managerial positions across universities and hospitals mediate between previous and newly introduced logics in management after NPM-reforms? We have chosen to compare changes in management across the hospital and the university sectors. Both sectors are largely publicly owned and dominated by professions, but their mission differs. The empirical material comprises interviews with formal leaders from dissimilar professional backgrounds, at different levels in the organisations in two cases. The findings show that management influenced by the market logic has been introduced, but in a hybrid version. The professional logic has however not been left behind, but expanded and supplied by a neo-bureaucratic logic. Leadership is functioning as a ‘catalyst’ to handle the different logics. The originality of this paper is a comparison of management in health care and higher education related to a model of hybrid management.

The aim of this paper is to analyze responses of public universities to the introduction of New Public Management (NPM) as the outcome of balancing between the managerial logics endorsed by NPM and the academic professional logics. Building on the institutional logics approach, we develop a framework concerning how universities will achieve compliance to conflicting claims by strategies like compartmentalization and blending stipulations of both logics. Empirical results based on a large-scale survey of 26 universities in eight European countries display how compatibility is achieved through highly differentiated adoption of logics that depends on the task considered. The results reveal that the strength of NPM pressures strongly affects the adoption of managerial practices within universities yet has no significant effect on the academic characteristics.

Integration between primary and secondary healthcare services and institutions has been at the core of health policy in Scandinavian countries over the last decade. This paper is based on an explorative case study of recent reforms in the healthcare sector and their outcomes in Denmark, Norway and Sweden. We discuss the possibilities of and problems for integrating the healthcare sector through the coordination mechanisms of hierarchy, market and network. The paper also discusses whether the institutional logic of the healthcare field is moving from a dual logic of ‘cure’ and ‘care’ towards a unifying logic of ‘integrated care’. We find that although the organisational principles that regulate the relationship between actors in the healthcare field in the three countries have changed, the challenge of achieving a mix of coordinative mechanisms that promote, rather than weaken, integration remains. However, the new organisational and regulative arrangements are an arena for increased interaction and collaboration between the actors, and thus a foundation for change towards the institutional logic of integrated health care.

Quality management is high on the reform agenda of both universities and hospitals. This paper studies how quality management is implemented: who is responsible for QM and which instruments are used? The guiding research question is whether these two very distinct professional organizations respond in similar or different ways to a common reform trend. To analyze the extent of isomorphic tendencies a cross-sectoral, descriptive data analysis with data from 135 hospitals and 83 universities in Germany has been conducted. The results show that QM in hospitals is more elaborated in terms of quality instruments and at the same time more standardized. Universities, in contrast, follow quite individualistic ways to organize quality management.

The reforms that have been promoted in public organisations in developed countries since the 1970s are said to impose changes in professional bureaucracies by promoting self-governance and institutional autonomy and by challenging professionals’ status and their values and standards. Taking the specific case of Portugal, this paper intends to contribute to understanding to what extent professional bureaucracies, like hospitals and Higher Education Institutions (HEIs), have been affected by changes in state policies and how the professionals involved have responded to these organisational changes. Based on an empirical qualitative study the paper concludes that there are significant differences in the way the state changed the regulatory framework and the professional archetypes in hospitals and HEIs and that professionals give heterogeneous responses to these changes.

The aim of this study was to analyse strategic planning practices in complex systems by investigating the experiences of Brazilian non-profit hospitals. Growing pressures have been imposed upon hospitals to improve the quality of their services, to increase access to them by reducing costs and to improve their reliability. In order to respond to these demands, managerial approaches such as strategic planning based on business-sector practices have been adopted by non-profit hospitals. The purpose of this study was to identify the most significant results of the experience with strategic planning in two non-profit hospitals. The study is a qualitative one, and the research was based on the concepts of organizational complexity, strategic planning and managerialism in non-profit hospitals. Data were collected by non-participant observation, from documents and in interviews and were analysed using narrative analysis and document-analysis techniques. Three main factors related to strategic planning in non-profit hospitals were identified: firstly, the unsuitability of strategic planning for hospitals given that they are complex, professional organizations, something that was disregarded by managers; secondly, the significant role played by core operating professionals in strategy making; and thirdly, the representation of strategic planning as fancy management in the eyes of internal and external stakeholders, conferring legitimacy on and generating trust in the hospital. The findings indicate that strategic planning as a traditional managerialist approach applied in a hospital context was dysfunctional and failed to produce a significant contribution to organizational performance.

Purpose of this paper is to explore how resistance of individual and collective actors play role in maintenance and change of institutions. Framing tactics of two emerging social movements in Istanbul Technical University and Middle East Technical University, which emerged against institutional changes in Turkish higher education, were examined by hybrid ethnography, using both online and offline data sources. Findings show that framing tactics of institutional entrepreneurs comprise different discourses and different forms of power, which also vary during different life stages of these movements. This paper contributes to existing literature in three ways. First power dynamics in institutional change, which is mostly disregarded in institutional theory, is taken into consideration. Second, with a longitudinal comparative study, it is shown that outcomes of social movements with similar demands may diverge according to different framing tactics based on power mechanisms that appealed at different stages of their life cycle. Third, this paper, as one of the few examples of a hybrid ethnographic approach, underlines the key role of considering both offline–online data sources, as an important part of actors’ life that take place in the online world.