ORGANIZATIONAL DISCRETION IN RESPONDING TO INSTITUTIONAL PRACTICES - HOSPITALS AND CESAREAN BIRTHS

While others have tried to accommodate agency and interests within ins titutional theory by directly incorporating a strategic choice perspec tive, we propose here that institutions are primary and exist as the c ontext within which interests operate. We argue that uncertainty provi des discretion, implying that organizational influence on practice wil l be greatest when institutional standards are most uncertain. We exam ine these arguments in the context of cesarean section surgeries in ho spitals with different ownership and teaching structures. As expected, we found that hospitals' characteristics were influential in determin ing the use of cesareans only when the level of institutional uncertai nty was high, that is, when patient risk was at an intermediate rather than a high or low level.