Abstract

Over 20 years, hospitals in Italy as well as in other European countries have evolved and changed in response to institutional pressures. With the corporatization, there has been the entrance of new logics and governance structures that contributed to a transformation of the health system. The survival of healthcare organizations is dictated not only by the technical conditions, that allow efficiently and effectively operating, but also by the ability to comply with rules to get legitimacy from external institutional actors. Organizations in a population adapt to their environment, in which operate, so many other organizations adapting to it (isomorphism). The purpose of this paper is to discuss a theoretical framework based on neo-institutional approach that could explain the influence of isomorphic pressures on innovative processes in health care sector. Qualitative data from literature on neo-institutional theory applied to health care sector have been analyzed. Findings reveal institutional pressures stimulate the development of innovations and organizational learning. This concept concerns both the fit of the organization with its environment (strategic matters) and effective implementation of strategies. Hospitals must find ways to increase profit, by improving medical capabilities for payment health care services. One of the most important isomorphic pressure is the prospective payment system for health care that had effects on the choices of organizational models to adopt. The challenge for hospital administrators is to seek consistency between efficiency and quality care.

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