From Professional Dominance to Market Mechanisms: Deinstitutionalization in the Organizational Field of Health Care

The concept of deinstitutionalization is central to institutional theory. It represents the process by which the legitimacy of an established or institutionalized organizational practice becomes eroded or discontinued (Oliver, 1992, p. 564). Deins-titutionalization witnesses the delegitimization of institutionalized organizational practices as political, functional and societal forces conspire to destabilize and reproduce previously legitimated or taken-for-granted organizational action and behaviour (Oliver). Research studies on the processes of deinstitutionalization remain relatively few, despite the vast interest in how and why institutionalized practices atrophy and change (Greenwood, Suddaby, & Hinings, 2002; Tolbert & Zucker, 1996). This paper is a five-year study on the processes of deinstitutionalization in the UK health care sector, where the National Health Service (NHS) was established in 1948 to offer free health care at the point of delivery to all citizens. Over the past six decades, the NHS has been subjected to numerous government interventions ranging from radical change programs to incremental tinkering around the edges (Webster, 2002). Observations over a 50-year period show that the organizational field of health care has moved from one of professional dominance by clinicians from the 1950s to early 1980s, to one where institutional logics supporting the virtues of market mechanisms have been encouraged by politicians ever since (Bloomfield, 1991; Burgoyne, Brown, Hindle, & Mumford, 1997; Currie W.L. & Guah, 2006). Part of this move is to create a market for elective health care provision, where patients are given greater powers to make choices about competing health care options (Laing & Hogg, 2002; Raey & Hinings, 2005).