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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...

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Autores principales: Burnett, Susan, Mendel, Peter, Nunes, Francisco, Wiig, Siri, van den Bovenkamp, Hester, Karltun, Anette, Robert, Glenn, Anderson, Janet, Vincent, Charles, Fulop, Naomi
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
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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.
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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
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