Explaining health system responses to public reporting of cardiac surgery mortality in England and the USA

Abstract Public reporting of clinical performance is increasingly used in many countries to improve quality and enhance accountability the health system. The assumption that greater transparency will stimulate improvements by clinicians response peer pressure, patient choice or competition. international diffusion public might suggest similarity between systems. Alternatively, national local contexts (including system imperatives, professional power organisational culture) continue shape its form impact, implying continued divergence. paper considers USA England through lens Scott's ‘pillars’ institutional framework. was arguably first country adopt systematically late 1980s. a more recent adopter; it now being widely adopted National Health Service (NHS). Drawing on qualitative data from California England, this compares behavioural policy responses stakeholders at micro, meso macro levels intersection ideas, interests, institutions individuals through. interplay regulative, normative cultural-cognitive pillars helps explain observed patterns on-going