preprints.org > public health and healthcare > public health and health services > doi: 10.20944/preprints202310.2041.v2

Preprint Article Version 2 Preserved in Portico This version is not peer-reviewed

Version 1 : Received: 30 October 2023 / Approved: 31 October 2023 / Online: 31 October 2023 (08:51:57 CET)
Version 2 : Received: 28 November 2023 / Approved: 29 November 2023 / Online: 29 November 2023 (11:09:33 CET)

Background: Hospital accreditation has become ubiquitous in developing countries. Although studies recognize that accreditation can improve healthcare quality, efficiency, and safety, there are doubts about how hospitals deal with conflicts caused by the different institutional logics that inhabit this process. Therefore, this study aimed to investigate how professional and market logics, as well as the conflict between institutional demands, affect compliance with hospital accreditation. Methods: To this end, we developed a multiple case study in four Brazilian hospitals through in-depth interviews with sixteen participants (managers, physicians, nurses, physiotherapist) and on-site observation by the triangulation between the analysis of the narratives and the results of the multiple correspondence analysis. The interpretation and subsequent categorization of the interviews were guided by the study's analytical categories: institutional logics (professional and market); adoption objectives (legitimacy and efficiency); strategic responses to adoption (conformity, non-conformity, and customization); nature of demands (origin in the means and in goal). Results. The data showed that when professional logic is prominent, there is a greater tendency to customize activities, as there are conflicts in the means by which activities can be developed. When market logic stands out, there is a risk of non-conformity, mainly because the focus falls exclusively on goals. Finally, the data point to the absence of conflicts between justifications related to efficiency and legitimacy. Conclusion. We conclude the study by highlighting the theoretical and practical implications of recognizing the conflict between logics, contributing to a deeper understanding of how logic influences the attention given to specific demands and, more significantly, how they affect compliance with hospital accreditation standards, expanding the body of knowledge in the area.

hospital accreditation; institutional logics; organizational practices; strategic responses; institutional theory

Public Health and Healthcare, Public Health and Health Services

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