Openness to Institutional Change: Altered Task Responsibilities in German University Hospitals

Abstract

This study investigates under which conditions nursing professionals are open to changes in institutionalized practices. In doing so, this study addresses a gap in current research that focuses on the initiators of change in institutionalized practices and their legitimization struggles rather than the recipients of such change. Drawing on a fuzzy-set qualitative comparative analysis (fsQCA) of change projects in the internal medical departments of fourteen German university hospitals, I find three configurations of boundary conditions that foster nursing professionals’ openness to changes in their working practices. While the three types “Pragmatic Progress” (high functional and low institutional pressure), “Authorized Professionalism” (high institutional pressure and involvement of a high-status change agent in a change project with low divergence), and “Guided Professionalization” (low institutional pressure and involvement of a high-status change agent in a change project with low divergence) differ in the mechanisms that cause nursing professionals to react openly towards institutional change, results suggest that configurations of boundary conditions only foster nursing professionals’ openness towards changes in institutional practices when they provide professionals with both pragmatic and normative legitimization accounts.