Os mecanismos de mudança isomórfica e respostas estratégicas aos processos institucionais: estudo em organizações hospitalares do município de Taquaritinga-SP

Abstract

The evolution of the concept of hospital has provoked changes on the focus of the provision of health services and, consequently, on its management (STUMPF, 1996). As a result of these changes, it is important to understand the construction of the institutional arrangements of the medical organizations from the evolution of the concepts of Organizational Theory and, particularly, of the concepts of the new institutionalism. Machado-da-Silva and Gonçalves (1999) state that in parallel to the stage of institutionalization there is the need to consider the mechanisms of isomorphic change and the influence exerted by the environment. The aim of this study was to elucidate the mechanisms of change that compete for the isomorphism in two hospital organizations in the town of Taquaritinga-SP as well as identify the strategic responses that are undertaken by such organizations in the face of institutional pressures, from the constructs of DiMaggio and Powell (1983), in organizational level, and Oliver (1991). Questionnaires and interviews were used as data collection technique, characterized as qualitative-quantitative research. In order to understand the significant transformations that impact hospitals, a case study was carried out to evaluate the counterpoints and limitations of theoretical approaches in the structure of the organizations analyzed, comparing the results obtained, what contributed substantially to the description of the institutionalization of hospital practices focused. The mechanisms of isomorphism were established, which were present in different intensities in both organizations and was also noted the divergence between them related to strategies against such practices. Considering the limits of the survey, it was concluded that although there is no total homogeneity in the way both organizations studied behave in the face of changes, hospital practices are partially institutionalized.