ABSTRACT
While institutional analyses of organization settings including healthcare provide important advances to knowledge, two main weaknesses persist. First, studies of institutional change tend to confl ate the infl uence of actors’ motivated actions (agency) and the structures in which they are embedded (Fleetwood, 2005). Second, the uncritical acceptance of managerial explanations of motive and causality has produced accounts that fail to investigate both deeper processes at play, and the ways that organizations wield political power to shape their environment (Barley, 2007). This chapter suggests that Leca and Naccache’s (2006) critical realist model of institutional analysis presents a useful basis for non-confl ationary and critical studies of institutional change in healthcare fi elds. The potential is illustrated using an historical analysis of the development of large multifacility corporations (chains) in the US nursing home industry.
