Organizational Discretion in Responding to Institutional Practices: Hospitals and Cesarean Births

By Goodrick, Elizabeth; Salancik, Gerald R. | Administrative Science Quarterly, March 1996 | Go to article overview

Organizational Discretion in Responding to Institutional Practices: Hospitals and Cesarean Births


Goodrick, Elizabeth, Salancik, Gerald R., Administrative Science Quarterly


During the past 15 years, organizational theorists have sought to understand why organizations adhere to dominant practices in their interorganizational fields. Neoinstitutional theory has provided a common framework for answering this question. It suggests that organizations seek legitimacy and attain it by conforming to prevailing institutional norms for practice. Theorists have viewed institutional expectations as agreements about the correct way to do things and have investigated their impact on structural conformity and isomorphism, through mechanisms such as societal norms, professional training and accreditation, and state regulation (Meyer and Rowan, 1977; Scott and Meyer, 1983; DiMaggio and Powell, 1983).

An important aspect of these early views was that organizations and their interests were underemphasized, and in some cases discounted, as relevant to understanding institutionalized practices. More recently, theorists have sought to renew attention to interests and agency (e.g., Mezias, 1990; Oliver, 1991; DiMaggio, 1991; Brint and Karbel, 1991; Goodstein, 1994). They argue that complete and uncontested institutionalization is rare and that interests and agency play a role in determining how organizations adapt to their institutional environments. Oliver (1991), for example, noted that because institutional environments are not always unitary and organizations are not always passive, an organization may respond to institutional pressures according to its resource dependencies. Goodstein (1994) suggested that organizations respond strategically to institutional pressures, depending on their idiosyncratic constraints and incentives.

While these recent views return attention to organizational interests, they also risk discounting the social-fact quality of institutions, much as earlier theorists discounted the role of agents. In this paper, we extend arguments about interest and agency in institutional environments while preserving the essential features of an institutional perspective. We propose that institutional standards are insufficient for constraining practice when they are uncertain. As a result, practices are indeterminant, and actors will need to impose additional constraints to define a practice to follow. Because discretion is created by the resulting uncertainty (Pfeffer and Salancik, 1978), actors may use their own particularistic interests to guide their further definition of appropriate action. This discretion, however, is bounded by the institutions that gave rise to it, as will be the choices organizations make when pursuing their own interests.

We suggest that there may be a core set of institutions or institutional standards for which agreement exists and others at the margins for which it does not. By implication, organizational influences on practice will be greatest when institutional standards are most uncertain, and organizational strategic interests therefore influence practices at the margins more than at the core. Organizations thus generate variation in practice while conforming to their institutions by pursuing their strategic interests within the limits of the discretion permitted by the institutions generating it. We examine these arguments within a context of medical decisions to deliver a baby surgically rather than vaginally.

THEORETICAL BACKGROUND

Neoinstitutional theory developed in response to empirical anomalies in organizational studies - certain practices, procedures, and structures could not easily be explained by prevailing rational-actor theories (DiMaggio and Powell, 1991). A common thread of much early work was that the environment consists of taken-for-granted beliefs and rules that penetrate organizations, creating the lenses through which actors view and construct the world. Early work sought to explain structural conformity and isomorphism in areas in which technical uncertainty was high and technical rationality proved insufficient, such as in education (e. …

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Organizational Discretion in Responding to Institutional Practices: Hospitals and Cesarean Births
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.