Antecedents and Consequences of Hospitals’ Responses to Institutions: Three Contemporary Essays Concerning Ontario Reforms
Abstract
This dissertation contributes new insights on the antecedents and consequences of hospitals’ responses to institutions. It consists in three essays that collectively explore why and how hospitals balance their technical requirement of providing high-quality and affordable healthcare with an evolving constellation of institutional demands. The collective findings provide a contemporary perspective on the reconditioning of decoupling as a multi-form process, and a nuanced conception of factors affecting the institutionalization and deinstitutionalization of practices within hospitals.
Extending research on institutional leadership, Essay 1 examines hospitals’ approaches to an external mandate for energy conservation and climate mitigation. Through a qualitative investigation, it demonstrates how hospitals infused energy conservation values into the core structures and processes of their organization. It presents a distributed process model of institutional leadership wherein members of the organizational base create and maintain value systems in support of energy conservation, while disrupting pre-existing patient care routines that undermine value-infusion.
Essay 2 leverages recent advances in configurational methods to investigate how hospitals responded to a dual-pronged reform seeking to simultaneously reduce healthcare costs and improve the quality of clinical services. It finds that hospitals differed in their political, cultural and technical responses to this institutional change, and that four meta-configurations of responses accounted for a significant proportion of change in clinical outcomes in hospitals. A typology is developed to explain how each configuration likely affected clinicians’ use of best clinical practices and pathways.
Essay 3 integrates social identity-based leadership theory with resource dependence theory to develop and test predictions about hospitals’ responsiveness to women’s health issues. Using latent growth curve modelling, it analyzes baseline reporting levels and change in medical failures affecting women patients during childbirth in each hospital, and the effects of various covariates on these growth parameters. Findings show that female CEO-led hospitals have greater levels of commitment to women’s health issues, but that the effect of gender is attenuated by female CEO’s perception of resource dependence.