Normal practice: The institutionalization of a professional activity
Goodrick, Elizabeth
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Permalink
https://hdl.handle.net/2142/20842
Description
Title
Normal practice: The institutionalization of a professional activity
Author(s)
Goodrick, Elizabeth
Issue Date
1992
Doctoral Committee Chair(s)
Leblebici, Huseyin
Department of Study
Business Administration
Discipline
Business Administration
Degree Granting Institution
University of Illinois at Urbana-Champaign
Degree Name
Ph.D.
Degree Level
Dissertation
Keyword(s)
Business Administration, Management
Sociology, General
Health Sciences, Health Care Management
Language
eng
Abstract
This study examines why the prevalence of a professional practice, cesarean sections, increased over a twenty year period. Today almost 1 in 4 babies born in the United States are delivered surgically compared to only 5.5% in 1970 (Placek and Taffel, 1988). Using organizational theory, three explanations for the diffusion of cesarean sections were examined: technical efficiency, i.e. adoption of the most efficient technology, institutionalization, i.e. adoption of practices in response to norms, and interest motivated institutionalization, i.e. adoption in response to norms reflecting self interests. To evaluate these three perspectives, a variety of types of data related to the increases in cesarean sections were examined.
This study found both some support for and some evidence inconsistent with each of these perspectives. For example, clinical research indicating improved outcomes with cesarean delivery supported a technical efficiency perspective but evidence that the increases were greater than warranted by research did not. An institutional model was supported by article trends in the popular press consistent with the argument that the medical model had become more technologically oriented and cesareans more accepted by women. However, evidence that self interests impacted standard setting activities and that cesareans diffused slower to hospitals with incentives inconsistent with this trend supported an interest motivated institutional perspective instead of an institutional model. And an interest motivated institutional perspective was contradicted by the finding that for-profit hospitals did not drive the increase in cesarean sections.
These contradictions were resolved by placing the increases in cesarean sections within its institutional context, the medical model of childbirth. Interests and technical efficiency criteria get played out within the institutional environment in which a practice is embedded. The movement to cesareans was consistent with the underlying assumptions of the medical model, its new emphasis on the fetus and technological intervention, and was supported by some evidence that the change was beneficial. Interests were able to impact the diffusion of cesareans only in ways that were consistent with the logic of this institutional framework. Within this framework, interests constrained but did not directly motivate the increase because to do so would not have been appropriate.
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