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Understanding institutional conversion: the case of the National Reporting and Learning System

  • Anneliese Dodds (a1) and Naonori Kodate (a2)


This article focuses on one type of institutional change: conversion. One innovative approach to institutional change, the “political-coalitional approach”, acknowledges that: institutions can have unintended effects, which may privilege certain groups over others; institutions are often created and sustained through compromise with external actors; and institutions’ external context can vary significantly over time, as different coalitions’ power waxes and wanes. This approach helps explain the conversion of one institution drawn from the UK National Health Service, the National Reporting and Learning System. However, the shift of this system from producing formative information to facilitate learning to promote safer care, towards producing summative information to support resource allocation decisions, cannot be explained merely by examining the actions of external power coalitions. An internal focus, which considers factors that are normally viewed as “organisational” (such as leadership and internal stability), is also required.


Corresponding author

Anneliese DoddsLecturer Department of Sociology and Public Policy Aston University Aston Triangle Birmingham B4 7ET UK Tel.: +44 (0)121 204 3067 Fax: +44 (0)121 204 3696 Email:
Naonori KodateLecturer School of Applied Social Science University College Dublin Belfield, Dublin 4 Republic of Ireland Tel.: +353 (0)1 716 8472 Fax: +353 (0)1 716 1197 Email:


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