Home birth and the NHS: Exploring the dynamics of institutional change in the context of health care.
Healthcare systems are notoriously difficult to change. Even where evidence-based interventions exist, change can often be impeded by policy imperatives, institutional pressures and professional cultures. This doctoral study will develop new theoretical and empirical insight into the strategies and activities involved in making and inhibiting localised or 'bottom-up' institutional change within healthcare settings.
In developing its theoretical analysis, the study draws upon and makes connections between sociological and organisational theories of institutional work, focusing in particular on the strategies used by service leaders to a) identify new institutional opportunities for change, b) mobilise different rhetorical arguments for change among stakeholders, and c) utilise additional social networks and resources. With specific reference to home birth this includes a) the new opportunities created by recent healthcare reforms with respect to Any Qualified Providers (AQPs), b) the different forms of evidence and knowledge pertaining to home birth, and c) the development of new inter-organisational networks and supplier confederations to introduce new services. These strategies highlight the important 'institutional work' of various leaders to confront, change and maintain established institutions.
This study's contribution to knowledge will be to produce new theoretical insights relevant to broader organisational and medical sociology questions about occupational relationships and priorities that frame the allocation and management of health care resources. Further, the strategic impact will be the development of specific evidence for healthcare leaders interested in understanding the barriers and drivers to change. At an operational level, it should inform conversations that seek to increase the plurality of choice for pregnant women, assisting commissioners and providers of maternity services who may be striving to develop models of care to support home birth that deliver quality, safety and cost savings for the NHS.
Supervisors: Professor Justin Waring, Dr Emma Rowley and Dr Melanie Jordan