title: Structuring agency: examining healthcare management in the USA and Australia using organizational theory.
abstract: OBJECTIVE
  Since the 1970s, the healthcare industry has undergone significant changes. Using neo-institutional and resource dependency theories, the purpose of this paper is to explore how managers perceive constraint and enact agency amidst these historic challenges--perhaps most significantly, declining funding and increasing regulation.
  
  
  METHODS
  The data come from ten interviews with healthcare managers, spanning for-profit, non-profit, and government legal forms and hospital and nursing home sub-industries in both Queensland, Australia and North Carolina, USA. The authors look for patterns across the interviews.
  
  
  RESULTS
  The paper shows that governments and umbrella "parent" organizations force managers to adhere to institutional expectations in exchange for resource investment. Managers navigate these environmental obstacles using a shared business-minded approach and competitive differentiation. Yet various interest groups--including front-line workers, physicians, and patients--challenge this paradigm, as they demand a focus on quality of care. Managers' efforts are likewise curbed by the very resource and institutional pressures they resist.
  
  
  CONCLUSIONS
  The authors understand changes in the healthcare industry as resulting from an increasingly powerful managerial logic, at odds with traditional professional and societal values. Interest groups are best positioned to challenge this logic.
authors.affiliation: Department of Sociology and Anthropology, North Carolina State University, Raleigh, North Carolina, USA. jcpayne@ncsu.edu
authors.forename: Julianne
authors.initials: J
authors.lastname: Payne
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Leiter
mesh_terms: D001291:Attitude of Health Personnel; D001315:Australia; D003363:Cost Control; D003695:Delivery of Health Care / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D017598:Efficiency, Organizational; D005376:Financial Management / Q000379:methods / Q000592:standards; D033161:Government Regulation; D018166:Health Care Reform / Q000331:legislation & jurisprudence; D006270:Health Facility Administrators; D006801:Humans; D007407:Interviews as Topic; D007857:Leadership; D009657:North Carolina; D015279:Organizational Culture; D011793:Queensland; D040841:Resource Allocation / Q000379:methods / Q000592:standards; D014481:United States