Judith D. de Jong: “Explaining medical practice variation–Social organization and institutional mechanisms,” Utrecht, 2007

Excerpt

In the last 15 years, the quality movement has addressed the variation between medical practices at all levels: between physicians within the same department, between departments, between hospitals and between countries. Variation is something like the smoke in the heurism: “Where there is smoke, there is fire”: if medical decision making is rational, how can there be variation in practice? However, the issue of medical practice variation has long drawn attention from researchers from outside the quality movement. Researchers assuming social conditions, financial incentives or training are interested in variation. Of course, policy makers are stakeholders in this variation debate. Judith de Jong (2007) studies variation following Freidson (1975) and Westert and Groenewegen (1999), assuming that especially social conditions influence physicians’ medical behavior. The prediction is that physicians' ways of working are more similar if they share their work environment (a practice or hospital). Social circumstances do more to shape their behavior than their individual preferences. These ‘shaping’ processes are considered to be institutional. In describing these, she uses Scott’s (2001) distinction among three institutional mechanisms: the regulative, normative and cultural-cognitive mechanisms. De Jong's idea is that once the influence of a certain mechanism has been determined, it should be possible to influence variation. To test her hypotheses, De Jong uses secondary data from three different databases: two from national surveys held among general practitioners in The Netherlands and one from hospitals in the United States. …