Dominant quality standards are present in all industries. Implicit in their use is the assumption that once adopted, there is little or no reason to replace them. However, there is evidence that, under certain circumstances, such standards do get replaced. The reasons for this action are not well-understood, either as they pertain to the displacement decision or to the selection and adoption of the alternative standard. The purpose of this study is to identify and explore these two issues (displacement and replacement) by drawing on data from the American healthcare system. This study is viewed through the theoretical lens of legitimacy theory. In addition, the process is viewed from a temporal perspective. The resulting findings are used to better understand how this displacement process takes place and to identify directions for interesting and meaningful future research.
This is an explanatory study that draws on data gathered from quality managers in 89 hospitals that had adopted a new healthcare quality standard (of these, some fifty percent had displaced the dominant quality standard – the Joint Commission – with a different standard – DNV Healthcare.
The combined literature review and case study data provide insights into the displacement process. This is a process that evolves over time. Initially, the process is driven by the need to meet customer demands. However, over time, as the organizations try to integrate the guidelines contained within the standards into the organization, gaps in the quality standard emerge. It is these gaps that motivate the need to displace standards. The legitimacy perspective is highly effective at explaining this displacement process. In addition, the study uncovers some critical issues, namely the important role played by the individual auditors in the certification process and the importance of fit between the standard and the context in which it is deployed.
The data for the propositions in this case study were derived from interviews and survey data from 89 healthcare organizations. It would be interesting to examine similar relationships with other quality standards and industries.
Our findings provide new insights related to motivations to decouple from a dominant quality standard. Results provide a cautionary tale for standards that hold a dominant market share such that perceived legitimacy of such standards is not as stable as originally thought.
This study illuminates the fragile nature of the stability of dominant standards and emphasizes the linkages between legitimacy concerns and divestiture of such standards.
