Fads, fashions, and bandwagons in health care strategy

Abstract

Many observers have alleged that "fads," "fashions," and "bandwagons" (imitation strategies) are prominent feature of the health care organizational strategy landscape. "Imitation behavior" may fulfill symbolic functions such as signaling innovativeness but results in the adoption of strategies that are effective for some organizations but not for many organizations that adopt them. We seek to identify and recognize the extent of fads, fashions, and bandwagons in health care strategy, understand the rationale for such imitation behavior, and draw implications for practice, education, and research. We examine theoretical arguments for imitation and evidence on imitation strategies in health care organizations, based on literature review, interviews with health care managers in two different metropolitan areas, and a case example of the purchase of medical group practices by hospitals. Fads, fashions, and bandwagons can be distinguished from strategic responses to regulatory requirements and efficient strategic choices that are the result of systematic analysis. There are substantial theoretical reasons to expect imitation behavior. Imitation strategies can derive from copying the behavior of "exemplar" organizations or from "keeping up" with competitive rivals. Anecdotal and empirical evidence points to a significant amount of imitation behavior in health care strategy. The performance effects of imitation behavior have not been investigated in past research. The widespread existence of fads and fashions is an argument for evidence-based management. Although it is essential to learn about strategies that have worked for other organizations, managers should carefully take account of the quality of evidence for the strategy and their organizations' distinctive local conditions. Managers should beware of the tendency of individuals and groups to move too readily to the solution stage of problem solving.