The appropriation dynamics of the norm LHAS: the oscillation between open and closed modes of management tools

Research on management tool appropriation examines either the components of the tool or its nature (open or closed) separately. This article aims to enhance understanding by combining both research streams.

We combine two analytical frameworks: the four-dimensional model of tool appropriation (instrumental, political, cognitive, symbolic) and the concept of open and closed tools. Using a qualitative case study design, we examine the implementation of the Lebanese Hospital Accreditation System (LHAS) in a private hospital in Beirut from 2019 to 2020. Data were collected through 63 semi-structured interviews with 21 participants across three time periods.

The study reveals that the successful appropriation of LHAS depends on alternating between open and closed tool modes. The symbolic and instrumental dimensions are primarily closed to ensure legitimacy and consistency, while the political and cognitive dimensions remain open to promote contextual adaptation and participation. This oscillation is guided by the dissemination of an organizing vision, actively shaped by the hospital's CEO and communicated by empowered middle managers.

Our study addresses a significant research gap by combining two distinct yet complementary approaches to tool appropriation that are often treated separately. Our findings reveal a unique relationship between the four dimensions of the tool appropriation process and offer a more nuanced understanding of malleable tools. Our findings enhance appropriation guided by a deliberate organizing vision and offer insights for overcoming the paradoxes of openness and closure and avoiding inconsistencies and tensions that could lead to inertia or weak arrangements when tool appropriation is deployed in pluralistic organizations.

The findings offer valuable insights for healthcare managers regarding the management of accreditation by maintaining consistency in core values while allowing flexibility in implementation. Transparent communication and empowering middle management are critical enablers.

Our case allows us to suggest managerial implications that address the societal challenge of improving patient service quality. First, CEO leadership is essential for envisioning changes through daily activities. Second, CEOs should appoint and support middle managers in both spreading the vision and facilitating negotiations.

The study introduces the concept of a "selectively open" management tool and highlights the dynamic interplay among various dimensions of appropriation. It contributes to the literature by bridging rationalist and constructivist perspectives while offering a nuanced view of organizational change in pluralistic contexts.