Table 2 Prospective application of organizational theory to SafeCare©

Transaction cost economics—explains how organizations decide whether to “make” a good or service internally or “buy” (i.e., acquire externally) a needed good or service.

Implementation may be outsourced if doing so is more efficient than implementing in-house. Implementation strategies should be selected to minimize transaction costs, which are positively associated with transaction frequency and uncertainty and asset specificity and likely negatively associated with implementation.

Bidding processes that minimize the frequency and uncertainty of the transactions required for SafeCare contracting will promote implementation by allowing organizations to commit resources to implementation instead of transaction costs.

Institutional theory—explains how organizations are motivated to align their structures and behaviors with the values, norms, and expectations espoused by institutions in their environments (e.g., government, client groups, accrediting bodies), as opposed to being primarily motivated by demonstrating superior outcomes or performance, to maintain legitimacy.

Implementation is likely to be influenced by coercive, normative, mimetic pressures from institutions within an organization’s environment. Implementation strategies should seek congruence with the values, norms, and expectations of relevant institutions in the implementing organization’s environment.

Staying attuned to the priorities of institutions in organizations’ environments will promote SafeCare implementation directly (e.g., institutions advocating for SafeCare implementation) and indirectly (e.g., organizations perceive institutions as approving of SafeCare implementation).

Contingency theories —explain how organizations’ actions are contingent upon an organization’s internal and external contexts, which influence the organizations’ structure and development.

Organizations’ structure is a critical determinant of implementation, and organizations’ structure continuously changes in response to dynamic internal and external contexts. Implementation strategies should be regularly revisited to address organizations’ dynamic internal and external contexts.

Designing SafeCare explicitly for adaptation will promote implementation by allowing organizations to accommodate their unique and dynamic internal and external contexts.

Resource dependency theory—explains how organizations structure themselves and associate with each other in order to acquire and maintain autonomy and the resources necessary to survive.

Implementation will be impeded to the extent that it limits organizations’ ability to acquire resources or maintain autonomy. Implementation strategies should address potential constraints of implementation on resource acquisition or autonomy.

Organizations will forge relationships to implement SafeCare insofar as doing so will yield resources that are worth more than the related decrease in autonomy.