Institutional Forces at Play: Shaping Organizational Structures in Healthcare

An external force is a critical organisational structure determinant. Some of the key reason behind this ideology include the fact that external pressures compel a population unit to be similar to other population units, which has the same environmental conditions. Therefore, from this claim, studies suggest that new forms of organisation to fill possible resource opportunity would not emerge until the organisation get legitimacy from the society (Kim et al., 2012). Moreover, acquiring legitimacy from society is very significant since it dictates the success and survival of an organisation. Furthermore, legitimacy has been proven to elevate the status of an organisation in society and as well as facilitate resource acquisition (Kim et al., 2012).

However, two significant viewpoints concerning institutional forces exist. The first viewpoint is the structure of the organisational, which changes for the organisation to acquire resources and legitimacy from the society. The other view is that since organisations which achieve legitimacy gives ‘‘guidelines for practical action’’ to other firms. The guidelines result in an organisational process dramatic shifts by interfering with staff logic, beliefs as well as sense-making. Therefore, the pressure exerted by the external forces forms the organisations to conform its requirements based on both practical and structural levels. From this fact, employees’ behaviour is routinised based on objectives of the external organisations.


Based on (Kim et al., 2012), legitimacy is very significant in getting symbolic resources which are vital for the health care system. This is due to the fact that patients do not know the prices and services of a hospital. This means that they have to rely on legitimacy, which is supplied by a healthcare accreditation agency. This means that accreditation strengthens and signifies society confidence concerning patient safety, services and care quality. Additionally, the healthcare industry has organisations which are knowledge-intensive and which continuously learn from mistakes and improve them. Therefore, mistakes in the sector act as a learning resource. In most cases, employees in the healthcare sector are mostly blamed for errors which occur and sometimes harshly punish punished. Sometimes, they are also subjected to public humiliation.

Due to this, most errors are not revealed, and the sector lacks enough data related to medical errors which can be used to promote the safety of the patient. In other cases, faulty of processes and equipment are blamed for some medical errors. Hence data concerning the error is collected; mostly, it is not utilised for patient service improvement due to lack of learning mechanisms. Most failures in the sector have revealed that inability to study from mistakes and create better patient services; therefore, most errors have just been reoccurring. With this information at hand, the Joint commission analyses the structures of patients care in hospitals to determine whether they are determined to promote the safety of patients by preventing error recurrent.

Moreover, leadership in an organisation is essential in health care. This is because external pressure to the organisation can be conflicting, therefore leaving employees with the role of leadership, especially where organisational culture is weak. Besides the behaviour of the leader signals the significance of specific expression. For instance, junior doctors do communicate effectively with their seniors for fear of appearing incompetent (sharing of knowledge) Therefore; leadership should develop an environment which enables junior doctors communication to seniors (leadership). This kind of situation allows efficient communication hence facilitating better institutional practices in the healthcare industry.

Kim et al., (2012), suggest that the institutional structure influenced the practice of sharing knowledge significantly and which in turn influenced patient safety. Lastly, structures greatly affected roles of leadership and the reduction of punitive behaviours which also influenced the safety of patients.

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Kim, Y.M., Newby-Bennett, D. and Song, H.J., 2012. Knowledge sharing and institutionalism in the healthcare industry. Journal of Knowledge Management, 16(3), pp.480-494.

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