Cargando…
Using institutional theory to analyse hospital responses to external demands for finance and quality in five European countries
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 th...
Autores principales: | , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2015
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4772277/ https://www.ncbi.nlm.nih.gov/pubmed/26683885 http://dx.doi.org/10.1177/1355819615622655 |
_version_ | 1782418538765484032 |
---|---|
author | Burnett, Susan Mendel, Peter Nunes, Francisco Wiig, Siri van den Bovenkamp, Hester Karltun, Anette Robert, Glenn Anderson, Janet Vincent, Charles Fulop, Naomi |
author_facet | Burnett, Susan Mendel, Peter Nunes, Francisco Wiig, Siri van den Bovenkamp, Hester Karltun, Anette Robert, Glenn Anderson, Janet Vincent, Charles Fulop, Naomi |
author_sort | Burnett, Susan |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-4772277 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-47722772016-03-10 Using institutional theory to analyse hospital responses to external demands for finance and quality in five European countries Burnett, Susan Mendel, Peter Nunes, Francisco Wiig, Siri van den Bovenkamp, Hester Karltun, Anette Robert, Glenn Anderson, Janet Vincent, Charles Fulop, Naomi J Health Serv Res Policy Original Research 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. SAGE Publications 2015-12-17 2016-04 /pmc/articles/PMC4772277/ /pubmed/26683885 http://dx.doi.org/10.1177/1355819615622655 Text en © The Author(s) 2015 http://creativecommons.org/licenses/by/3.0/ This article is distributed under the terms of the Creative Commons Attribution 3.0 License (http://www.creativecommons.org/licenses/by/3.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Original Research Burnett, Susan Mendel, Peter Nunes, Francisco Wiig, Siri van den Bovenkamp, Hester Karltun, Anette Robert, Glenn Anderson, Janet Vincent, Charles Fulop, Naomi Using institutional theory to analyse hospital responses to external demands for finance and quality in five European countries |
title | Using institutional theory to analyse hospital responses to external demands for finance and quality in five European countries |
title_full | Using institutional theory to analyse hospital responses to external demands for finance and quality in five European countries |
title_fullStr | Using institutional theory to analyse hospital responses to external demands for finance and quality in five European countries |
title_full_unstemmed | Using institutional theory to analyse hospital responses to external demands for finance and quality in five European countries |
title_short | Using institutional theory to analyse hospital responses to external demands for finance and quality in five European countries |
title_sort | using institutional theory to analyse hospital responses to external demands for finance and quality in five european countries |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4772277/ https://www.ncbi.nlm.nih.gov/pubmed/26683885 http://dx.doi.org/10.1177/1355819615622655 |
work_keys_str_mv | AT burnettsusan usinginstitutionaltheorytoanalysehospitalresponsestoexternaldemandsforfinanceandqualityinfiveeuropeancountries AT mendelpeter usinginstitutionaltheorytoanalysehospitalresponsestoexternaldemandsforfinanceandqualityinfiveeuropeancountries AT nunesfrancisco usinginstitutionaltheorytoanalysehospitalresponsestoexternaldemandsforfinanceandqualityinfiveeuropeancountries AT wiigsiri usinginstitutionaltheorytoanalysehospitalresponsestoexternaldemandsforfinanceandqualityinfiveeuropeancountries AT vandenbovenkamphester usinginstitutionaltheorytoanalysehospitalresponsestoexternaldemandsforfinanceandqualityinfiveeuropeancountries AT karltunanette usinginstitutionaltheorytoanalysehospitalresponsestoexternaldemandsforfinanceandqualityinfiveeuropeancountries AT robertglenn usinginstitutionaltheorytoanalysehospitalresponsestoexternaldemandsforfinanceandqualityinfiveeuropeancountries AT andersonjanet usinginstitutionaltheorytoanalysehospitalresponsestoexternaldemandsforfinanceandqualityinfiveeuropeancountries AT vincentcharles usinginstitutionaltheorytoanalysehospitalresponsestoexternaldemandsforfinanceandqualityinfiveeuropeancountries AT fulopnaomi usinginstitutionaltheorytoanalysehospitalresponsestoexternaldemandsforfinanceandqualityinfiveeuropeancountries |