In this paper we develop a framework for comparing changes in the management of public hospitals across different national health systems, drawing on insights from institutional theory. Using a range of secondary sources we show how one particular form of hospital management, pioneered originally at the Johns Hopkins Hospital in Baltimore, has been translated differently in four health systems: England, Denmark, Italy and France. This analysis builds on the notion of editing rules, which derive from the institutional context, and illustrates how these rules broaden our understanding of variable translations of global templates for hospital management. The paper concludes by highlighting wider implications for theory and policy.

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A central motif of health reforms around the world has been the drive to persuade doctors and other clinical professionals to become more actively engaged in the management of services. Examples include moves to extend the commissioning role of primary care doctors (such as general practitioners in the UK) and the introduction of ‘clinical directorates’ in secondary care. This strategy has been seen as a means of controlling professionals, turning ‘poachers into game keepers’, especially with regard to resource allocation. However, there is also a mounting body of evidence pointing to how clinical leadership may play a role in stimulating quality improvement and new innovations inservice design, with positive consequences for patient safety and satisfaction (1). Focusing on the top 100 hospitals in the US Goodall (2) finds a strong positive association between the ranked quality of hospitals and whether the chief executive officer was a clinician. A survey of 1200 hospitals across seven countries (UK, US, Germany, France, Italy,Canada and Sweden) conducted by McKinsey and LSE also finds that clinically qualified managers improve both the effectiveness of management decisions and clinical performance of hospitals overall (3).

Managing resources and tensions at the front line is crucial for organizational success. To advance our understanding of how frontline employees turn assets into useful resources under tensions, we draw on research on resourcing and practices of responding to paradoxical tensions. Our ethnographic study of employees in a multinational retail fashion company finds three resourcing practices – situational reframing, organizational preframing and institutional deframing – that enable frontline employees to balance tensions. We contribute to both the resourcing perspective and to research on individuals’ responses to paradoxical tensions, first, by identifying the varying scopes of meaning (situational, organizational or institutional) that employees infuse potential resources with; second, by extending the notion of framing to understand how resourcing is accomplished interactively in tension-laden situations; and third, by explaining how employees’ construction of tensions is related to their dynamic moves between resourcing practices.

Entrepreneurship has become an important issue in contemporary management practice and research. While there is much debate about the benefits of entrepreneurial behavior, its obvious pervasion in many areas of life remains largely unexplored. It is this persuasive power that inspired us to conceptualize entrepreneurship as a dominant institution in modern Western societies. In contrast to most institutional approaches which draw on entrepreneurial behavior for studying institutional change, our approach focuses on the societal preconditions for the dominance of entrepreneurship. We outline how entrepreneurship is manifested in ideals of modern Western societies, discourse and techniques of control and how individuals who are socialized into an entrepreneurial society, contribute to legitimize entrepreneurship and further its pervasiveness. Our analysis provides a framework for research on differences in the valuation of entrepreneurial behavior across societal settings, as well as for the study of mechanisms for the deepening of taken for-grantedness of entrepreneurship.