Addressing the Causal Complexity of Institutional Change: A Configurational Analysis in the Field of Hospitals

The abundance of literature on institutional change in management studies poses a vexing problem: how to address the complex causal relations that institutional change entails? In this paper, we tackle that question by investigating through configurational analysis on the causal relations between the individual, organizational, and field-level drivers of institutional change. For that purpose, we develop an integrative framework for the study of institutional change and apply that framework in order to identify the configurations of conditions that lead to diverge from or converge with the institutionalized patterns of organizing in the field of hospitals. Our Qualitative Comparative Analysis of 115 cases of projects that were aimed at implementing a divergent template for organizing in French hospitals – namely: the Outpatient Shift – reveals four configurations of conditions that propelled that institutional change from 2015 to 2017, and three configurations of conditions that reinforced preexisting patterns of organizing during that period of time. Our work advances research on the drivers of institutional change in three ways. Firstly, our results contribute to bridging lasting gaps in the theory of institutional change, by demonstrating that institutional change results from interaction patterns between the different types of drivers that this theory has successively emphasized. Secondly, we provide evidence-based guidance for designing and implementing successful change strategies that integrate those drivers into the organizational context in which they take place. Thirdly, we propose a replicable method for exploring the new research avenues that our configurational perspective opens up for future studies on institutional change.