Rowe, Emily Melissa (2021) Embeddedness & the institutionalisation of new practices among healthcare professionals. PhD thesis, University of Warwick.

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Abstract

In institutional theory, there is a long-standing puzzle regarding embeddedness and the microprocesses of institutional change. One main argument is that actors are constrained by their embeddedness and are unable to enact change. However, this wrongly portrays actors as over-socialised and subject to institutional norms without question and not purposive agents who re-evaluate institutional practices. Therefore, this research aims to examine actors’ attempts to institutionalise new practices by interrogating the link between embeddedness and micro-institutional change. Such a study is important as traditional views of embeddedness are conflated and do not explain this process, even though we know it occurs. This research shows that embeddedness serves as a foundation to support micro-institutional change, rather than a mechanism that constrains it. This research draws data from five National Health Service (NHS) organisations where actors actively learn and engage with new practices to facilitate micro-institutional change. The NHS is a highly institutionalised medical context and provides an appropriate setting to draw on healthcare professionals' social networks to explore embeddedness and its association with the institutionalisation of new practices.

This research’s methodological approach was novel as Exponential Random Graph Models (ERGMs), an emerging social network analysis method, were used to examine joint effects between actor roles and relationships to understand institutional embeddedness and interactions among change agents. The findings provide evidence that forms of embeddedness contribute to the institutionalisation of new practices differently. Two forms of embeddedness, non-collaborative and non-institutional, decrease the likelihood of micro-institutional change, whereas collective institutional embeddedness increases the likelihood of micro-institutional change. The main conclusion is at odds with and contributes to the existing literature by illustrating that the lack of embeddedness among institutional actors constrains micro-institutional change, and the presence of both structural and institutional embeddedness enables this process.

Item Type:	Thesis (PhD)
Subjects:	H Social Sciences > HD Industries. Land use. Labor H Social Sciences > HM Sociology R Medicine > RA Public aspects of medicine
Library of Congress Subject Headings (LCSH):	Organizational change, Medical personnel, National health services -- Great Britain, Business networks, Organizational effectiveness, Organizational sociology, New institutionalism (Social sciences)
Official Date:	March 2021
Dates:	Date Event March 2021 UNSPECIFIED
Institution:	University of Warwick
Theses Department:	Warwick Business School
Thesis Type:	PhD
Publication Status:	Unpublished
Supervisor(s)/Advisor:	Croft, Charlotte ; White, Leroy
Format of File:	pdf
Extent:	xiv, 200, lxxi leaves : illustrations
Language:	eng

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