| Hospital accreditation inspections are at once highly institutionalized and predictably cyclical, creating the potential for waves of isomorphic response (i.e. convergence around commonly legitimized standards of structure or action in a field) among accredited hospitals. Yet little is known about how – and to what extent – these isomorphic waves might impact hospital personnel and the patients who enter hospital doors seeking care. This dissertation explores these phenomena by integrating diverse theory and employing robust empirical methodology.;Following an introductory chapter, Chapter Two builds a conceptual framework to theoretically argue that triennial accreditation inspections may trigger a shift in organizational attention patterns in hospitals. This shift, the framework suggests, may impact clinical outcomes for patients and influence the attitudes of hospital personnel in ways that may affect hospital survivability.;Chapter Three presents the first of two empirical studies aimed at testing portions of the conceptual framework. In this study, monthly risk-adjusted mortality rates in fifty-eight New Jersey hospitals are observed over a ten year period to assess significant changes in mortality rates during reaccreditation cycles. The analysis reveals, in fact, that mortality rates tend to improve momentarily following inspections but that improvements tend to fade away in subsequent weeks.;Chapter Four presents the second empirical study, which examines the extent to which organizational “jolts” caused by reaccreditation inspections trigger reassessment of the legitimacy of the hospital among hospital personnel. The analysis suggests that accreditation inspections are, in fact, capable of jolting hospitals with sufficient force to trigger judgment reassessment but that individuals are not likely to retain and put into use the new judgments as hospitals likely regress toward heterogeneity following inspections.;The final chapter synthesizes the notable theoretical and empirical contributions to the academic literature offered in these papers and comprehensively discusses the practical implications of these contributions for policy makers, accrediting bodies and hospital leaders. Also, as the work represents but a first step toward understanding cyclical isomorphism and the micro-effects of hospital accreditation, the chapter concludes with a discussion of opportunities to expand on the ideas presented here and to explore new avenues of research. |
