Which path dependency in a hybrid institution? Legitimacy, culture and ideology in Irish elite healthcare reform plans 2000-2017

Abstract This paper explores how political actors select reform pathways in the context of institutional hybridity, with an analysis of the cognitive and normative foundations of reform plans. Focusing on two healthcare reform plans approved by Irish governments between 2011-17, I seek to explain why political actors proposed divergent reform paths, building on different elements of the existing system. I account for the content of reform plans by analysing political actor’ accounts of the development of and context surrounding the reform plans. I conduct thematic analysis on interview data, official documents and political debates, along with secondary literature and media articles. I find that, in line with expectations derived from sociological institutionalist scholarship on hybridity, cognition and logics of appropriateness, existing hybrid institutional arrangements and changes in their legitimacy as bases for reform have considerable influence on political actors’ selection of reform plans. I also find that culture and political ideology shape the programmes, though to a lesser extent and less consistently.