TY - JOUR
T1 - Using institutional theory to analyse hospital responses to external demands for finance and quality in five European countries
AU - Burnett, Susan
AU - Mendel, Peter
AU - Nunes, Francisco
AU - Wiig, Siri
AU - van den Bovenkamp, Hester
AU - Karltun, Anette
AU - Robert, Glenn
AU - Anderson, Janet
AU - Vincent, Charles
AU - Fulop, Naomi
N1 - Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The research leading to this paper received funding from the European Community?s Seventh Framework Programme (FP7/2007-2013) under grant agreement n?241724.
Publisher Copyright:
© The Author(s) 2015.
PY - 2016/4/1
Y1 - 2016/4/1
N2 - Objectives: Given 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. Methods: An 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. Results: How 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. Conclusions: The 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.
AB - Objectives: Given 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. Methods: An 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. Results: How 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. Conclusions: The 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.
KW - Finance
KW - Health care
KW - Institutional theory
KW - Quality
UR - http://www.scopus.com/inward/record.url?scp=85007575431&partnerID=8YFLogxK
U2 - 10.1177/1355819615622655
DO - 10.1177/1355819615622655
M3 - Article
C2 - 26683885
AN - SCOPUS:85007575431
VL - 21
SP - 109
EP - 117
JO - Journal of Health Services Research and Policy
JF - Journal of Health Services Research and Policy
SN - 1355-8196
IS - 2
ER -