Intellectual Movements, Institutional Change and Change in Profession-Level Logics in American Medicine

Abstract:     
This paper integrates research on intellectual movements and institutional change to develop a process model of change in profession-level institutional logics. Focusing on the case of the emergence of clinical guidelines and quality measures in American medicine in the 1980s and their institutionalization in the late 1990s and early 2000s, it proposes that a recursive relationship between intellectual movements within professions and system-level institutional change leads to change in profession-level logics over time. Intra-professional intellectual movements draw on mobilizing mechanisms and framing strategies to advance new intellectual paradigms. Institutional change alters the dynamics of intra-professional movements in two ways. Change in system-level logics - in this case the growth of corporate “managed care” logics - alters the resonance of frames used in intra-professional movements. New institutional actors alter the opportunity context faced by movement insiders and outsiders. Intra-professional movements can alter the institutional environment by drawing new institutional actors into the field. My research develops theory to explain how profession-level logics change. In focusing on the dual role of intra-professional movements and institutional change in altering profession-level logics, it extends our knowledge of the mechanisms by which collective action can lead to change in institutions, of how the dynamics of collective action are influenced by their broader institutional context, and of the distinctive strategies that may be appropriate for achieving intellectual change as a target of collective action.

Number of Pages in PDF File: 47

working papers series