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Achieving and sustaining profound institutional change in healthcare: case study using neo-institutional theory.

机译：实现和维持医疗领域深刻的机构变革：使用新机构理论的案例研究。

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Change efforts in healthcare sometimes have an ambitious, whole-system remit and seek to achieve fundamental changes in norms and organisational culture rather than (or as well as) restructuring the?service. Long-term evaluation of such initiatives is rarely undertaken. We report a secondary analysis?of data from an evaluation of a profound institutional change effort in London, England, using a mixed-method longitudinal case study design. The service had received ￡15 million modernisation funding in 2004, covering multiple organisations and sectors and overseen by a bespoke management and governance infrastructure that was dismantled in 2008. In 2010-11, we gathered data (activity statistics, documents, interviews, questionnaires, site visits) and compared these with data from 2003 to 2008. Data analysis was informed by neo-institutional theory, which considers organisational change as resulting from the material-resource environment and three 'institutional pillars' (regulative, normative and cultural-cognitive), enacted and reproduced via the identities, values and activities of human actors. Explaining the long-term fortunes of the different components of the original programme and their continuing adaptation to a changing context required attention to all three of Scott's pillars and to the interplay between macro institutional structures and embedded human agency. The paper illustrates how neo-institutional theory (which is typically used by academics to theorise macro-level changes in institutional structures over time) can also be applied at a more meso level to inform an empirical analysis of how healthcare organisations achieve change and what helps or hinders efforts to sustain those changes.
机译：医疗保健领域的变革工作有时会雄心勃勃，需要全系统参与，力求实现规范和组织文化的根本变革，而不是（或同时）重组服务。很少对此类举措进行长期评估。我们使用混合方法纵向案例研究设计，对数据进行了二次分析，该数据来自对英国伦敦深刻的制度变革努力的评估。 2004年，该服务获得了1500万英镑的现代化资金，覆盖多个组织和部门，并由定制的管理和治理基础结构进行了监督，该基础结构于2008年被拆除。在2010-11年度，我们收集了数据（活动统计，文档，访谈，问卷调查，实地考察），并将其与2003年至2008年的数据进行比较。数据分析是根据新制度理论进行的，新制度理论认为组织变革是由物质资源环境和三个“制度支柱”（规范，规范和文化认知）引起的通过人类行为者的身份，价值观和活动来制定和复制。要解释原始计划各个组成部分的长期命运，以及它们如何不断适应不断变化的环境，就必须关注Scott的所有三个支柱以及宏观制度结构和嵌入式人员代理之间的相互作用。本文说明了新制度理论（学术界通常使用它来对制度结构随时间的宏观变化进行理论化）也可以在更细观的层面上应用，以对医疗机构如何实现变化以及如何帮助进行实证分析。或阻碍维持这些变化的努力。

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