Structuring agency: Examining healthcare management in the USA and Australia using organizational theory
Journal of Health Organization and Management
ISSN: 1477-7266
Article publication date: 15 March 2013
Abstract
Purpose
Since the 1970s, the healthcare industry has undergone significant changes. Using neo‐institutional and resource dependency theories, the purpose of this paper is to explore how managers perceive constraint and enact agency amidst these historic challenges – perhaps most significantly, declining funding and increasing regulation.
Design/methodology/approach
The data come from ten interviews with healthcare managers, spanning for‐profit, non‐profit, and government legal forms and hospital and nursing home sub‐industries in both Queensland, Australia and North Carolina, USA. The authors look for patterns across the interviews.
Findings
The paper shows that governments and umbrella “parent” organizations force managers to adhere to institutional expectations in exchange for resource investment. Managers navigate these environmental obstacles using a shared business‐minded approach and competitive differentiation. Yet various interest groups – including front‐line workers, physicians, and patients – challenge this paradigm, as they demand a focus on quality of care. Managers' efforts are likewise curbed by the very resource and institutional pressures they resist.
Originality/value
The authors understand changes in the healthcare industry as resulting from an increasingly powerful managerial logic, at odds with traditional professional and societal values. Interest groups are best positioned to challenge this logic.
Keywords
Citation
Payne, J. and Leiter, J. (2013), "Structuring agency: Examining healthcare management in the USA and Australia using organizational theory", Journal of Health Organization and Management, Vol. 27 No. 1, pp. 106-126. https://doi.org/10.1108/14777261311311825
Publisher
:Emerald Group Publishing Limited
Copyright © 2013, Emerald Group Publishing Limited