Institutions and non‐linear change in governance

Viola Burau (University of Aarhus, Aarhus, Denmark)
Karsten Vrangbæk (University of Copenhagen, Copenhagen, Denmark)

Journal of Health Organization and Management

ISSN: 1477-7266

Publication date: 8 August 2008



The paper aims to account for the substance of non‐linear governance change by analysing the importance of sector‐specific institutions and the pathways of governing they create.


The analysis uses recent reforms of the governance of medical performance in four European countries as a case, adopting an inductively oriented approach to comparison. The governance of medical performance is a good case as it is both, closely related to redistributive policies, where the influence of institutions tends to be pertinent, and is subject to considerable policy pressures.


The overall thrust of reforms is similar across countries, while there are important differences in relation to how individual forms of governance and the balance between different forms of governance are changing. More specifically, sector‐specific institutions can account for the specific ways in which reforms redefine hierarchy and professional self‐regulation and for the extent to which reforms strengthen hierarchy and affect the balance with other forms of governance.


The recent literature on governance mainly focuses on mapping out the substance of non‐linear change, whereas the development of explanations of the substance of governance change is less systematic. In the present paper, therefore, it is suggested coupling the notion of non‐linear change with an analysis of sector specific institutions inspired by the historical institutionalist tradition to better account for the substance of non‐linear governance change. Further, the analysis offers interesting insights into the complexity of redrawing boundaries between the public and the private in health care.



Burau, V. and Vrangbæk, K. (2008), "Institutions and non‐linear change in governance", Journal of Health Organization and Management, Vol. 22 No. 4, pp. 350-367.

Download as .RIS



Emerald Group Publishing Limited

Copyright © 2008, Emerald Group Publishing Limited

Please note you might not have access to this content

You may be able to access this content by login via Shibboleth, Open Athens or with your Emerald account.
If you would like to contact us about accessing this content, click the button and fill out the form.
To rent this content from Deepdyve, please click the button.