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Nigam, Amit 2013. How institutional change and individual researchers helped advance clinical guidelines in American health care. Social Science & Medicine. [2011 JCR impact factor 2.699] .
Nigam, A. 2012. Changing Health Care Quality Paradigms: The Rise of Clinical Guidelines and Quality Measures in American Medicine. Social Science & Medicine. 75(11): 1933‐1937. [2011 JCR impact factor 2.699].
Clinical guidelines and quality measures are important new paradigms for conceptualizing and managing quality in the United States. Researchers have proposed that professional elites-including members of academic medicine-were an important cause of the shift to guidelines and measures. This paper draws on content analysis of abstracts focused on quality in major American medical journals between 1975 and 2009 to empirically assess whether and how paradigms for managing quality changed in academic medicine. The content analysis shows that guidelines- and measures-based approaches to quality increased in prominence. Individual expertise-based approaches to quality, however, remain important. Concurrent with changing paradigms in academic medicine, there was a reorientation of policy toward increased use of guidelines and measures the late 1980s and early 1990s in the United States. This policy reorientation was informed by earlier work by medical researchers proposing new approaches to quality. The policy reorientation was followed by an increase in the prominence of guidelines and measures in medical research.
Dokko, G., Nigam, A. & Rosenkopf, L. 2012. Keeping Steady as She Goes:A Negotiated Order Perspective on Technological Evolution. Organization Studies 33(6‐7):681‐703.[2011 JCR impact factor 2.328].
A central idea in the theory of technology cycles is that social and political mechanisms are most important during the selection of a dominant design, and that eras of incremental change are socially uninteresting periods in which innovation is driven by technological momentum and elaboration of the dominant design. In this essay, we overturn the ontological assumption that social order is inherently stable, drawing on Anselm Strauss’s concept of negotiated order to analyze the persistence of a dominant design as a social accomplishment: an outcome of ongoing processes that reinforce or challenge a socially negotiated order. Thus, we shift focus from battles over standards to periods of normal innovation. We extend the technology cycles model to explain social dynamics in periods of incremental change, and to make predictions specifying how contextual conditions in standards-setting organizations affect social interaction, leading to reinforcement or challenge to a socio-technical order.
Nigam, A. 2011. The effects of institutional change on geographic variation and health services use in the USA. Social Science & Medicine. 74(3):323-331. [2011 JCR impact factor 2.699].
This paper examines the impact of institutional change on patient care. Using panel data on obstetric deliveries from the state of California in the United States between 1983 and 2001, it develops and tests hypotheses predicting impacts of three features of institutional change-managed care insurance, changing professional controls and public attention to cost-control practices-on cesarean use and geographic variation in cesarean deliveries. It finds that managed care insurance promotes the diffusion of cost-effective patient care practices, reducing cesarean use and increasing variation. I found that over time, managed care patients experience continued lower use and reduced geographic variation as new practices become established. The combined effects of changing professional controls-the growing importance of clinical guidelines-and public attention to cost-control practices also diffuses cost-effective practices, increasing variation and decreasing cesarean use. Cesarean use increases and geographic variation declines in a period of managed care retreat in the late 1990s. The analysis extends prior research by documenting the impact of institutional change on health services use and variation and by suggesting that geographic variation is caused, in part, by the diffusion of new patient care practices
This paper develops theory to explain the process by which organizations define and attempt some changes in routines and not others in the pursuit of organizational goals. We identify three processes that shape which changes in routines are attempted. First, individuals, influenced by their professional perspectives, frame problems and solutions in ways they claim will advance the organization‘s goal. Second, jurisdictional conflict and differences in professional roles lead to framing conflict, framing gaps, and political silences. Third, communication and political processes across professional roles lead to three distinct outcomes: adoption of proposed changes, abandonment of proposed changes, and formal diagnosis.
Nigam, Amit. and Ocasio, William. 2010. Event Attention, Environmental Sensemaking, and Change in Institutional Logics: An Inductive Analysis of the Effects of Public Attention to Clinton's Health Care Reform Initiative. Organization Science. Vol. 21, No. 4, July-August 2010: 823-841 .
We explore attention to Clinton's health care reform proposal, ongoing debates, and its political demise to develop theory that explains how events create opportunities for cognitive realignment and transformation in institutional logics. Our case analysis illustrates how a bottom-up process of environmental sensemaking led to the emergence and adoption of a logic of managed care, which provided new organizing principles in the hospitals' organizational field. In addition to theorization, highlighted by prior research, we propose a second mechanism of environmental sensemaking: representation of change through exemplars and environmental features. The interplay between theorization, representation, and ongoing event attention can lead to change in institutional logics over an event's life course. We found that the managed care logic did not emerge in a fully formed fashion, but that actors theorized individual dimensions of the logic consistent with changing representations of hospitals' relationships with other actors in the field. As the event unfolded, the individual dimensions came to be theorized as part of an overall managed care logic. The label "managed care," previously understood as a specific organizational form, took on a new meaning to symbolize the organizing principles for hospitals' relationships with a variety of institutional actors as alternative models not congruent with the changing organizational field were abandoned.
Nigam, A. 2010. Intellectual Movements, Institutional Change and the Redefinition of Health Care Quality in American Medicine. SSRN Working Paper.
Nigam, Amit, Ruthanne Huising, Esther Sackett, and Brian Golden. 2010. The Strengths of Strangers: External Facilitators. (Working Paper).
Nigam, A., Denys, L. & Banaszak-Holl, J. 2007. Perception and Use of Guidelines and Inter-professional Dynamics: Assessing their Roles in Guideline Adherence in Delivering Medications in Nursing Homes. Quality Management in Health Care.16(2): 135-145. 2007.
Purpose: Focusing on guidelines governing medication use in nursing homes, in this study we explore the ways in which clinical professionals perceive and apply treatment guidelines, and how interprofessional interactions shape the delivery of pharmacotherapies to residents.
Design and Methods: Seventeen semistructured interviews were conducted with physicians, nursing staff, and consultant pharmacists in 4 purposefully selected nursing homes in Michigan.
Results: Perceptions of guidelines varied by clinical groups, with physicians perceiving them as reference tools, whereas nurses and consultant pharmacists saw them as rules to which clinical practices should adhere. Key external factors including resident and family demands, economic constraints, limited face-to-face contact, and the organizational hierarchy further drove clinical personnel to use guidelines differently and induced interprofessional conflicts. These negative interactions make facility-wide guideline adherence challenging by undermining the regulatory role of consultant pharmacists.
Implications: This study provides important insight on work-related factors that hinder the implementation of treatment guidelines in nursing homes.
Denys, Lau. Banaszak-Holl, Jane. Nigam, Amit. 2007. Perception and use of guidelines and inter-professional
dynamics: assessing their roles in guideline adherence in delivering medications in nursing homes.. Quality Management in Health Care. 16(2):135-145.
DESIGN AND METHODS: