Understanding institutional conversion: the case of the National Reporting and Learning System

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Abstract

This article focuses on one type of institutional change: conversion. One innovative approach to institutional change, the “political-coalitional approach”, acknowledges that: institutions can have unintended effects, which may privilege certain groups over others; institutions are often created and sustained through compromise with external actors; and institutions’ external context can vary significantly over time, as different coalitions’ power waxes and wanes. This approach helps explain the conversion of one institution drawn from the UK National Health Service, the National Reporting and Learning System. However, the shift of this system from producing formative information to facilitate learning to promote safer care, towards producing summative information to support resource allocation decisions, cannot be explained merely by examining the actions of external power coalitions. An internal focus, which considers factors that are normally viewed as “organisational” (such as leadership and internal stability), is also required.

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Original languageEnglish
Pages (from-to)117-139
Number of pages23
JournalJournal of Public Policy
Volume32
Issue number2
DOIs
StatePublished - Aug 2012

Bibliographic note

Copyright © Cambridge University Press 2012

    Keywords

  • institutional change, institutional conversion, health care, patient safety

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