Quasi-market transformation: An institutionalist approach to change in UK hospitals

Quasi-market transformation (QMT) refers to the process by which the dominant organizational form in a field is replaced, following the introduction of a quasimarket. In this article, analysis of comparative case-study data reveals that, until the early 1990s, a common interpretive scheme, or set of values and norms, underpinned a set of structures and systems in many UK hospitals. These similarities of form are represented as the directly managed (DM) hospital archetype. When change initiatives challenged this archetype, the outcomes were negotiated and the interpretive scheme remained largely unscathed. Following the introduction of a quasi-market in 1991, a new trust hospital interpretive scheme has emerged. For the first time, UK hospitals have experienced transformation and now display an alternative set of structures and systems. This article explains how the trust hospital archetype has become legitimized through different tracks of change within individual hospitals