1 / 11

4 th International Conference on OB in Healthcare, University of Calgary, 19-21 April 2004

4 th International Conference on OB in Healthcare, University of Calgary, 19-21 April 2004. Contested Restructuration: Theory Elaboration From U.S. Long-Term Care Martin Kitchener* Charlene Harrington *Department of Social and Behavioral Sciences University of California, San Francisco

yauvani
Download Presentation

4 th International Conference on OB in Healthcare, University of Calgary, 19-21 April 2004

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. 4th International Conference on OB in Healthcare, University of Calgary, 19-21 April 2004 Contested Restructuration: Theory Elaboration From U.S. Long-Term Care Martin Kitchener* Charlene Harrington *Department of Social and Behavioral Sciences University of California, San Francisco 3333 California Street, Suite 455 San Francisco, CA 94118 Tel: (415) 502 7364 Fax: (415) 476 6552 Email: martink@itsa.ucsf.edu

  2. The Restructuration ‘Project’ (1) Advance understandings of healthcare ‘restructuration’– fundamental change in social systems involving alterations among: logics, actors (individual & collective) & resource distributions (Scott et al 2000). (2) Extend institutional (archetype) analysis, drawing on other perspectives (PS, SMT & RDT) to examine: • Political inter-play between agency & structure (logics & resource distributions) • Role of powerful actors in inertia (Gouldner ‘54) & less powerful actors in change (social movements, Maguire et al 2001)

  3. The Approach: Theory Elaboration Refining (updating, specifying, contradicting) general theory (models & concepts) of a phenomenon (restructuration) through successive cases conducted at different levels of analysis (Vaughan 1992: 175). Stage 1: Select/devise ‘sensitizing’ models & concepts Stage 2: Select cases (sequentially) as potential examples of phenomenon that vary along dimensions e.g., level, size, complexity, function etc. Stage 3: Conduct cases, inductive & simultaneous ‘testing’ & elaboration of theory & findings

  4. Conceptual Framework for Institutional Analysis Institutional Environment Material-Resource Environment Focal Field Logics e.g. professional dominance, federal involvement, market managerialism Supply & Demand Factors e.g. need, finance system, supply of services Regulative e.g. laws, standards Normative Templates of structure & action Governance Systems e.g. licensing, certification Technologies e.g. equipment, IT, facilities Cognitive Socio-cultural frames Actors Individual & collective Industry/Market Structure e.g. competitors & exchange partners Developed from Scott et al (2000)

  5. Restructuration of LTC: 3 Studies Study 1: US LTC Sector (Kitchener & Harrington 2004) Study 2: Nursing Home (NH) Field, Chaining (Kitchener & Solano) Study 3: Home & Community-Based Service (HCBS) Field, Disabled (Kitchener & Harrington)

  6. The US LTC Sector: A Dialectic Analysis of Institutional Dynamics (Paper distributed) Aims 1. To provide an account of institutional dynamics (inertia & change) in a sector that: (a) has received less attention than others (hospitals, physician groups), & (b) is increasingly significant e.g., demographics, Govt. pays 57% of $123 bn expenditures, quality & cost concerns etc. 2. Extend institutional (archetype) analysis to context of conflicting logics, actors, & resource demands.

  7. Research Design & Conceptual Framework Given the early stage of institutional analysis in the area, historical analysis of 2 secondary data sources: 1. Systematic on-line literature review: (a) collections (e.g., ABI inform, PubMed), (b) terms (e.g., long-term care, institutional theory), & (c) authors (e.g., Vladeck, Scott). 2. Authors’ research library e.g., unpublished reports, working papers, press cutting etc Two boundary limits established: (1) concentrate on LTC for elderly & disabled (c.f. mental health), & (2) national patters (c.f. inter-state variation). Areas for elaboration.

  8. Analytical Approach All information initially sorted by Scott et al.’s (2000) 3 institutional eras: (1) Professional dominance, pre-1965; (2) Federal involvement, 1966-1982; & (3) Market-managerialism, post-1982. Following established qualitative coding & analytical procedures (e.g., Brock), identification of national LTC archetypes (Greenwood & Hinings 1988..): distinctive configurations of interpretive schemes, systems & structures. Analysis of ‘tracks of change’ esp. inertia and transformation. Dialectic analysis of opposing social forces (Benson 1977)

  9. LTC Fields

  10. Dynamics of Inertia & Change • Big Story: Contested emergence of insurgent HCBS field to sit alongside (not replace) traditional NH field. Conflicting logics, actors, resource demands. • Powerful actors (NH industry) peddle hard for inertia. Use political influence to: co-opt of Great Society programs, maintain weak regulation, starve competing HCBS of resources (70 % Medicaid LTC spending). • Less powerful actors (HCBS providers, consumers) pushed hard for change over 100 years. Re-theorization (from quality, social justice) to themes of market-managerialism: cost and consumerism (irony?)

  11. Elaborating the Dynamics of Inertia & Change Study 2: Nursing Home Field, Chaining Key change in NH field emergence of large chains (multi-facility) corporations through 5,000 mergers & acquisitions (not new builds) during 1990s. Compared with hospital systems we know little about process or implications. Longitudinal case studies of 2 large chains. Boom-Bust, Casino Capitalism. Funding! Study 2: HCBS Field, Disability Longitudinal analysis of: logics (e.g., independent living, consumer directed care), actors e.g. (ADAPT), ADA, Olmstead, inter-state variation. NIDDR-5 year center grant, PAS.

More Related