Peers, regulators, and professions: the influence of organizations in intensive insulin therapy adoption.
BACKGROUND
Following the landmark Leuven study in 2001, health care organizations implemented intensive insulin therapy (IIT) as the standard of care for critically ill patients. However, a recent meta-analysis showed no mortality benefit and an increased safety risk for patients treated with IIT. IIT affects labor and capital decisions related to nurses, physicians, pharmacists, managers, laboratory personnel, and informatics staff. The expenditure of labor and capital to provide IIT without corresponding outcome improvements suggests the adoption of IIT produces inefficiency in hospital.


BACKGROUND
In sociology and organizational studies, the tendency for organizations to become more similar without necessarily becoming more efficient is called normalfont institutional isomorphism. Institutional isomorphism examines the pressure that organizations encounter from peers, regulators, and professions through mimetic, coercive, and normative mechanisms, respectively. To enhance their prospects of survival, organizations establish and maintain legitimacy by adopting socially acceptable approaches to work endorsed by successful peer organizations, regulatory agencies, and professional societies. ORGANIZATIONAL INFLUENCE IN THE ADOPTION OF IIT: This paper describes how organizational influence-through the Leuven study, the Joint Commission, and professional organizations-played a role in the widespread adoption of IIT. Divergence from institutionalized forms may explain variation in IIT studies following Leuven.


CONCLUSIONS
Health care researchers practitioners, and managers should consider organizational influence when implementing large-scale clinical activities.
Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA. thomas.campion@vanderbilt.edu
Thomas R
TR
Campion
Cynthia S
CS
Gadd
D003422:Critical Care; D003659:Decision Making, Organizational; D004059:Diffusion of Innovation; D006801:Humans; D007328:Insulin / Q000627:therapeutic use*; D007591:Joint Commission on Accreditation of Healthcare Organizations; D010379:Peer Group; D014481:United States
D007328:Insulin