Tracks of change in hospitals: A study of quasi-market transformation

Examines the process of change in hospitals that has emerged following the introduction of the health quasi-market in 1991. Blends empirical evidence with Greenwood and Hinings’ archetype and tracks of change concepts to analyse the process which is labelled quasi-market transformation (QMT). Argues that, before 1991, hospitals tended to operate within structures and systems underpinned by an interpretive scheme. Represents these similarities of configuration as the directly-managed (DM) hospital archetype. When change initiatives challenged this configuration, the outcomes were negotiated and resulted in “adjustmental” change. In contrast, shows the introduction of the quasi-market to have involved the first transformation of the DM archetype’s interpretive scheme, systems and structures. Analyses four years of transition to reveal that QMT has been interpreted differently within hospitals. However, presents data to suggest that many hospitals now display significant similarities in terms of configuration. Represents these similarities within the emerging Trust hospital archetype