Rebels Gone ‘Cuckoo' with Institutional Causes: The Case of Taiwan's Psychiatric Clinics
Author
Abstract
Under the prevailing regulation of global budget payment, hospitals in Taiwan have been expanding in scale to increase market share. Consequently, the big hospitals get bigger, with their various medical departments growing in parallel. However, psychiatrics departments in hospitals have not expanded; instead, it is the number of psychiatric clinics that has been growing dramatically. Using qualitative research procedures, we draw on the institutional entrepreneurship perspective to explain this anomaly. We focus on three research questions: First, why have psychiatric clinics proliferated? Second, who were most likely to become institutional entrepreneurs leading changes in the psychiatric field? Third, what kind of strategies did the institutional entrepreneurs employ to deal with institutional pressures? Our findings show that the main factors that led psychiatrists to engage in entrepreneurial activity were ‘regulation-push force' and ‘market-pull force'. The chiefs of psychiatric departments, and specifically those within regional hospitals, have a tendency to become leading institutional entrepreneurs. We also found that, in responding to institutional pressures, these entrepreneurs mainly deployed three strategies: the formation of associations and coalitions of various kinds; the drawing and linking of external resources, and the engagement with discursive and pedagogic practices.
Key Words
institutional entrepreneurship, psychiatric clinics, global budgets, national health insurance
