From Patient Surveys to Organizational Change : Rational Change Processes and Institutional Forces

From a rational perspective, patient surveys should be tools for purposeful planned change. They are feedback on performance and provide input to problem-solving processes. However, in public health care there are well-documented institutional forces, including doctors’ and nurses’ norms, which might complicate a rational change process. To understand the dynamics, a rational perspective must include the institutional context. From this perspective, the aim of this article is to compare the use of patient surveys in different hospital units in order to understand why some units are able to use the information to change procedures and increase patient satisfaction. Thus, the article analyses the local adoption of semi-customized patient surveys and actor responses to survey results. Patient survey data from 100 Danish wards are related to ex post comments from department heads/hospital managers and to follow-up interviews with key employees and managers in four hospitals. The results indicate that gaining legitimacy of initiatives is crucial and point to three conditions for rational change: (1) key professionals perceiving the surveys to be of sufficient technical quality, (2) ward-specific negatively deviant scores, and (3) obvious actions to deal with the problems