The concept of quality has been one of the most dominating and influential “meta-ideas” globally over the last twenty years, invading both the private and the public sector (Czarniawska & Sevón, 1996). Akershus university hospital health trust has decided to commence on becoming ISO 9001:2000 certified, one department is certified and several departments is underway. New institutional theory presents a symbolic perspective; here organizations are seen as effective by accommodating and adapting to environmental demands and socially constructed demands. Organizational recipes are implemented by organizations not only on basis of efficiency, but also due to legitimacy. The public hospital trusts are under pressure to provide safe and high quality services, this implies a measurement of performance and systems to improve quality of care, but they also faced pressures for higher efficiency and cost control. The Norwegian knowledge center for health services presented a literature review on the basis of ISO 9001:2000, here the conclusion is that; the effects of certification and accreditation are unclear and largely unknown. Why are then an increasing number of health organizations engaging in it?
The thesis explores new institutional theory seeking to answer this question. The conclusion is that an institutional perspective provides an important complement to the instrumental perspective, findings suggests the decision to commence on ISO 9001:2000 certification had both efficiency and legitimacy reasons.