Kitchener M, Whipp R
Cardiff Business School, University of Wales, UK.
J Manag Med. 1998;12(4-5):241-55, 196. doi: 10.1108/02689239810248008.
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.
考察了1991年引入卫生准市场后医院出现的变革过程。将实证证据与格林伍德和欣宁斯的原型及变革概念轨迹相结合，以分析被称为准市场转型（QMT）的过程。认为在1991年之前，医院倾向于在由一种解释方案支撑的结构和系统内运作。将这些配置上的相似之处表现为直接管理（DM）医院原型。当变革举措挑战这种配置时，结果会经过协商并导致“调整性”变革。相比之下，表明准市场的引入涉及对DM原型的解释方案、系统和结构的首次转型。分析了四年的转型情况，以揭示QMT在医院内部有不同的解读。然而，提供的数据表明，现在许多医院在配置方面表现出显著的相似性。将这些相似之处表现为新兴的信托医院原型。
