The discursive institutionalism of continuity and change: the case of patient safety in Wales (2009-2010)

Fear, William J. The discursive institutionalism of continuity and change: the case of patient safety in Wales (2009-2010). In: British Academy of Management Annual Conference (BAM 2011): Building and Sustaining High Performance Organisations In A Challenging Environment, 13-15 Sep 2011, Birmingham, UK.

Abstract

Although public actors bring about institutional change through public action, the related ideas and discourse that seek to promote change may equally have little or no effect on existing institutions. Patient Safety provides a large scale (ie. world-wide) example of just such a paradox. On the one hand Patient Safety has become a readily definable institution within its own right in the field of healthcare. But on the other hand the promised benefits of improved quality of care (improved performance), as measured by reduced ‘avoidable harm’ (a reified construct that lacks an agreed empirical base but is heavily weighted with meaning and emotion), have failed to materialise and pre-existing institutional practices are largely unchanged. Drawing on Discursive Institutionalism (DI) this paper uses the case of Patient Safety in Wales (2009-2010) to show empirically how, when, where, and why ideas and discourse matter for institutional change, and when they do not.

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