Förförande idéer - kvalitetssäkring i hälso- och sjukvården

Detta är en avhandling från Gudbjörg Erlingsdóttir, Department of Business Administration, Lund University, Box 7080, 220 07 Lund, Sweden

Sammanfattning: The aim of this study was to expand our understanding of the processes of institutionalisation both within and between organisational fields. This was done by tracing an idea – the idea of quality assurance – through the process of institutionalisation in the health care sector. The new institutional theory, which focuses on the relation between organisations and the institutions they are considered to be a part of, forms the basis of the study. Tracing two quality assurance-models back to their origins I found that the models originated from and represented two different ideas. I thus ended up having two different processes of institutionalisation to compare. The two ideas are called the idea of quality assurance and the idea of accreditation. The analysis shows, on the one hand, that the institutionalisation of the quality assurance idea has been a ”free” process in which different authorities and organisations have been able at different times to interpret the idea in different ways. On the other hand, it reveals the institutionalisation of the accreditation idea as a ”controlled” process in which the idea is literally copied by everyone who touches it. The institutionalisation of the accreditation idea thus shows that there are ideas that can not be decoupled or buffered from the actions on the shop floor. This is what I call isopraxism. The idea of quality assurance is an example of how ideas are adopted from the private sector to the public sector which is typical for the New Public Management trend. The trend has thus been described as an identity crisis in the public sector which leads organisations in the public sector to seek for images amongst those organisations that are considered successful by standards of the private sector. The idea of accreditation is, in its turn, an example of institutionalisation between different countries but in similar fields as a consequence of the EU. Such institutionalisation is meant to lead to homogenisation. Finally, it is concluded that using ideas in fields or spheres where they do not belong can constitute quite a risk – good intentions may turn into bad consequences when applied where they do not belong.

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