Responses by professional organizations to multiple and ambiguous institutional environments: The case of AIDS

In this paper we examine responses to multiple and ambiguous pressures generated by the environmental threat of AIDS. Using an institutional theory framework and insights from professional dominance theory, we develop a two-dimensional typology, incorporating the belief systems of important constituents and the degree of institutional rules, to explain the patterns of organizational adoption of AIDS-related policies and related professional practices. Hypotheses are tested with data from a national survey of hospitals (n= 506), with interviews from administrators and chiefs of medicine. Results support the usefulness of the explanatory schema for patterns of organizational policy adoption; the schema also provides a stronger explanation of professional behaviour patterns than does the existence of policies requiring such behaviour. Theoretical and practical implications of the findings for professional organizations in the context of environmental threats are discussed.