Determinants of Organizational Change: The Impact of Institutional and Market Forces on Compliance with Federal Regulations in Opioid Treatment Programs

Abstract

Improving federal efforts to implement public health policy will require a better understanding of the impact of institutional and market forces on organizational change mandated by federal regulations. Previous institutional literature assumed that institutional change driven by federal regulatory agencies is relatively easy to accomplish because of the direct administrative and financial effects of politics on organizations. However, as supported by early public administration literature underlying a politics-administration dichotomy, there is a growing belief that other forces may obstruct or impede the impact of policies steered by government.

There is an extensive body of literature that examines the causes and consequences of regulatory reform as well as the environmental forces impacting organizational change; but there is limited research that examines the organizational construct and the impact of external and internal forces on organizational action toward regulatory compliance. Overall, the knowledge base lacks clarity about what explanatory factors are most important to implement and measure organizational change. This dissertation focuses on the application of organizational institutional theories to the area of federally regulated programs, specifically to opioid treatment programs in the Unites States.

Recently, the opioid dependence treatment field underwent a dramatic shift in regulatory oversight aimed at improving the quality of care provided through opioid treatment programs nationally. This shift and the subsequent mandate of new federal regulations represent a punctuated change in the field that offers a unique opportunity to study the influences of institutional and market forces on change within organizations under federal regulation.

This dissertation uses data collected through a Center for Substance Abuse Treatment funded project (Contract No. 270-97-7002 to RTI International) from 1998 to 2001. The initial assessment (1998—1999) occurred during the redesign of federal regulations overseeing opioid dependence treatment, whereas the second assessment (2000—2001) occurred after the publication for proposed rulemaking and during the publication of the final rule modifying federal regulations for treatment.

For the purposes of this study, organizational change focuses on three areas of opioid dependence treatment targeted within the federally mandated regulations for policies and practice changes: (1) take-home medications, (2) medication dosage, and (3) quality assurance systems.