This paper depicts the progress of a hospital management quality pilot project through the lens of institutional theory. Nine hospital departments were chosen to change their management control system from a strict top-down productivity focus to a locally developed performance measurement system based on a patient focus. Thus, the management control system was changed with the aim of enhancing the social impact of the provided hospital services by integrating a patient focus. The paper portrays a three-year evolution through management narratives. Findings evidence initial embracement of the project followed by gradual operational management discouragement due to external productivity pressures and internal data issues. Despite these challenges, the regional management highlighted the project as a success and expanded it to the remaining departments. Thus, we find that the project became decoupled rather than institutionalized due to a sustained productivity logic. Through the lens of institutional theory, we argue that a decoupling of the patient focused project happens because of a surprisingly strong institutionalized productivity logic. We suggest that in this context of strong coupling of previous systems, organizations may paradoxically engage in decoupling practices that are intended to support their professional core practices but instead protect the administrative logic of efficiency and productivity.

本文从制度理论的角度描述了医院管理质量试点项目的进展。选择了九个医院部门，将他们的管理控制系统从严格的自上而下的生产力重点转变为基于患者重点的本地开发的绩效衡量系统。因此，管理控制系统发生了变化，旨在通过整合患者关注来增强所提供医院服务的社会影响。该论文通过管理叙事描绘了三年的演变。调查结果表明，最初接受了该项目，随后由于外部生产力压力和内部数据问题逐渐阻碍了运营管理。尽管面临这些挑战，区域管理层强调该项目是成功的，并将其扩展到其余部门。因此，我们发现由于持续的生产力逻辑，该项目变得脱钩而不是制度化。从制度理论的角度来看，我们认为以患者为中心的项目脱钩的发生是因为制度化的生产力逻辑非常强大。我们建议，在以前系统强耦合的背景下，组织可能会自相矛盾地从事旨在支持其专业核心实践的解耦实践，而是保护效率和生产力的管理逻辑。我们认为，以患者为中心的项目的脱钩是由于制度化的生产力逻辑惊人的强大。我们建议，在以前系统强耦合的背景下，组织可能会自相矛盾地从事旨在支持其专业核心实践的解耦实践，而是保护效率和生产力的管理逻辑。我们认为，以患者为中心的项目的脱钩是由于制度化的生产力逻辑惊人的强大。我们建议，在以前系统强耦合的背景下，组织可能会自相矛盾地从事旨在支持其专业核心实践的解耦实践，而是保护效率和生产力的管理逻辑。