Dynamic Capabilities for Accreditation: Evidence in the Healthcare Sector.
| Autor | Meira, Mariana Monteiro |
Introduction
Worldwide, the healthcare macro sector is said to dynamize an economy due to its capacity for producing goods and services, creating new knowledge, and absorbing technology (Minayo, 2010). However, factors such as high costs, insufficient quality and limited access to healthcare have brought commotion, unrest and frustration to all those involved, whether patients or workers, putting the sector under pressure to provide good-quality and reliable services (Porter & Teisberg, 2006). One response to this situation is hospital accreditation, which is a periodical and voluntary assessment of institutional resources based on continued education set to guarantee the quality of assistance according to pre-established standards (Manzo, Brito, & Correa, 2012). Many organizations disseminate requisites for hospital accreditation around the world, including the Brazilian National Accreditation Organization ([ONA] Organizacao Nacional de Acreditacao, in Portuguese), which determines a sequential three-level accreditation, with requirements regarding an institution's structure, processes and outcomes. Therefore, this requires that the organization make a set of changes to meet specific demands throughout the transition between the several levels.
In turn, such changes imply altering the way things are done in the present, destroying knowledge that is no longer worth applying, and creating and--consequently--recreating and extending that which will be used in the future. Thus, the accreditation process may be understood as an outcome of changes that generate and transform resources and capabilities. Such argumentative logic adheres to the concept of dynamic capability proposed by Helfat et al. (2007, p.1), which we adopt in this paper: "the capacity of an organization to purposefully create, extend, or modify its resource base".
Although, historically, academic research investigating dynamic capabilities have covered themes such as strategy and innovation, in recent years, studies have been conducted under different perspectives, thus broadening the scope of dynamic capabilities and strengthening its explanatory power for comprehending organizational reality. In this sense, in consonance with Albort-Morant, Leal-Rodriguez, Fernandez-Rodriguez and Ariza-Montes (2018), dynamic capabilities have been used to explain, among other issues: technology transfers (Fernandes & Machado, 2019); the creation of capacities for engineering projects (Freitas & Salerno, 2018); the development of wine tourism (Lavandoski, Silva, Vargas-Sanchez, & Pinto, 2017) and supply chain collaboration (Mandal, 2017).
However, there is some complexity to the study of dynamic capabilities, especially due to the lack of consensus about a tautological definition (Tondolo & Bitencourt, 2014), due to the factors that influence their development and implications within organizations (Barreto, 2010; Cardoso & Kato, 2015; Gonzales, Saez, & Castro, 2009; Guerra, Tondolo, & Camargo, 2016; Laaksonen & Peltoniemi, 2018), in addition to their difficult identification and classification (Barrales-Molina, Bustinza, & Gutierrez-Gutierrez, 2013; Helfat & Winter, 2011). However, analyzing the process of hospital accreditation as a backdraft for the development of dynamic capabilities can mitigate such complexity, for the requisites for certification require documenting the evolution and administration of the organization, reflecting about what does and what does not contribute to the development of the organization, as well as formalizing and disseminating all activities (Vargas, Albuquerque, Erdman, & Ramos, 2007).
This approach is believed to counter criticism regarding methodological and theoretical aspects of dynamic capability studies (Barreto, 2010; Eriksson, 2013; Laaksonen & Peltoniemi, 2018), especially those associated with: (a) the necessity of investigating the relations, boundary conditions and contingency of the analyzed capabilities (whether dynamic and/or operational); (b) a more careful choice of the sample and greater consistency in terms of the level of analysis throughout the investigation; (c) the use of longitudinal data, and, finally; (d) the analysis of outcomes and learning opportunities deriving from the development of dynamic capabilities.
With this in mind, this study's research question was designed as follows: how does the development of dynamic capabilities support the process of hospital accreditation? To answer this question, the central objective of this paper is to analyze the development of dynamic capabilities in the process of hospital accreditation. More specifically, in this study, we sought to identify dynamic capability sources; investigate the lifecycle stages of the principal dynamic capabilities at each accreditation level; and describe the organizational changes resulting from the accreditation process. Thus, we conducted a qualitative research, using case study methodology in a hospital that reached the third level of hospital accreditation (the top level of accreditation as set by ONA).
The outcomes of this paper advance the understanding about the capability lifecycles (proposed by Helfat & Peteraf, 2003), as they explain and exemplify how the principal capabilities of hospital accreditation are created and evolve along their different ways. The empirical evidence also complements the findings of other research about constructing a formative path of dynamic capabilities and their impacts on organizational performance (Gelhard & von Delft, 2016; Gelhard, von Delft, & Gudergan, 2016; Mikalef & Pateli, 2017); the duality between operational and dynamic capabilities (Helfat & Winter, 2011); and understanding the learning and relationship mechanisms through which capabilities are developed (Meirelles & Camargo, 2014).
Following this introduction, the next section provides a brief background on organizational changes and dynamic capabilities. After that, we outline our methodological procedures, and discuss our results. Finally, we present the outcomes for this research.
Organizational Changes and Dynamic Capabilities
The hospital accreditation process implies changes in several areas of an organization, such as: administration and management, medical staff organization, system reviews, organization of infirmary, facilities and security, as well as defining and planning the role of the hospital (Juul et al., 2005). In addition, it is necessary to define new performance indicators, transform the medical practice, set new procedures, replace functions and assess the very relation of the hospital with the setting (Greenfield & Braithwait, 2008; Pomeyet, Contandriopoulos, Francois, & Bertrand, 2004). Therefore, the theme change assumes a prominent role in the process of accreditation and may be understood in three different dimensions: content (what will be changed), process (how it will be changed) and context (why change is necessary) (Pettigrew, 1987).
From a procedural standpoint, there are four principal theoretical frameworks of change: Lifecycle, Teleology, Dialectics and Evolution Theories (Van De Ven & Poole, 1995). This paper adopts an Evolutionary framework, which considers change to be a recurrent progression in three phases within the organization: variation (random change); selection (selecting the best change to adjust to the setting); and retention (maintaining the selection to counter variations) (Nelson & Winter, 1982).
Nevertheless, the way change takes place within an evolutionary framework is not yet at a consensus and has generated three principal types of evolutionary theories: ecological, adaptative and transformational. In an effort to relate them, Tushman and Romanelli (1985) proposed the punctuated equilibrium model, which understands organizational progress by means of convergent periods punctuated by reorientations that influence the next period of convergence.
To said authors, the causes that lead to crossing from one period to another result from two forces: inconsistency in the activities due to a misalignment with strategic orientation, which causes low performance; profound changes in social, legal, competitive and technological conditions that make the former strategic orientation obsolete. These two forces lead to a period of reorientation, which implies fundamental changes in the following domains: strategy, structure, power distributions, control systems and beliefs/values. Therefore, the changes made for accreditation are believed to follow the behavior predicted by the punctuated equilibrium model (Assumption 1).
The transition between periods requires creating different capabilities due to the need to forge new consistency, structure and processes (Tushman, Newman, & Romanelli, 1986). Change is allowed, then, by the generated capabilities (Wu, Qile, Yanqing, & O'Regan, 2012). In turn, capabilities evolve over time to adjust to settings characterized by constant transformations, behaving in different ways throughout the periods.
In this perspective, the dynamic capabilities (DC) approach is believed to have the potential to elucidate how the capabilities necessary for hospital accreditation are developed, since they are skills used to create, integrate, build and reconfigure resources that enable detecting and exploring opportunities and responding, in due time, to the changes imposed by the environment (Adner & Helfat, 2003; Andreeva & Chaika, 2006; Teece, 2007; Teece, Pisano, & Shuen, 1997). Thus, during the accreditation process, capabilities are believed to behave dynamically (Assumption 2)
Due to such characteristics, the DC are categorized as superior or higher-order capabilities (Winter, 2003). They differ, therefore, from operational, ordinary or zero-level capabilities (Winter, 2003), because, while the former capabilities involve committing to strategic changes, the latter capabilities reflect an ability to perform the basic functional activities of the...
Para continuar a ler
PEÇA SUA AVALIAÇÃOCOPYRIGHT GALE, Cengage Learning. All rights reserved.
