Mobilizing the logic of managerialism in professional fields: The case of academic health centre mergers

This paper presents a qualitative inductive analysis of attempts to re-order the bases of legitimacy in fields of professional organizations. Concepts from institutional theory, political science and social movement theory are integrated to provide a model of the antecedents, processes and implications of this phenomenon. Findings from a study of US academic health centre mergers illustrate each element of the model. They show that as part of the political agenda to repress the prevailing institutional logic and structures of professionalism (Scott et al. 2000), executives are expected to adopt certain managerial innovations to maintain organizational legitimacy. Against this new basis of legitimacy, powerful agents have promoted merger so successfully that it has achieved mythical attributes of widespread and uncritical adoption (Meyer and Rowan 1977). The paper explains why the intended outcomes of this innovation emerge rarely when it is 'sedimented' (Cooper et al. 1996) uncritically upon enduring aspects of the logic and structures of professionalism.