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Power, accidents, and institutional changes: the case of a Chinese hospital in Hong Kong

Published online by Cambridge University Press:  11 April 2012

SHU-YUN MA
Affiliation:
Department of Government and Public Administration, Chinese University of Hong Kong.

Abstract

In response to the call for more investigation on ‘institutional dynamism’, this article examines the role of power and accidents in causing institutional changes, employing the theoretical perspective of historical institutionalism. The impact of two ‘accidents’ (epidemics) on the institutional setting of a hospital in Hong Kong under different power contexts (changes of political sovereignty) is analysed as a case study. The finding is that power matters more than accidents. This is not to deny the importance of accidents. Accidents matter because they produce windows of opportunity for institutional changes to take place. Through political manoeuvres powerful actors may decide which accidents should cause change.

Pouvoir, accidents et changements institutionnels: le cas d'un hôpital chinois à hong-kong

Contribuant au développement actuel des recherches sur «le dynamisme institutionnel», cet article étudie le rôle du pouvoir et des accidents conjoncturels dans les changements institutionnels, prenant l'institutionnalisme historique pour point de départ méthodologique. L'impact de deux «accidents» (en l'occurrence des épidémies), sur la structure institutionnelle d'un hôpital de Hong-Kong, dans des contextes de pouvoir différents (correspondant ici à des changements de souveraineté politique) est analysé comme étude de cas. Il en ressort que le pouvoir importe beaucoup plus que les accidents conjoncturels. Ce constat ne doit pas cependant conduire à nier le rôle des accidents: ils importent parce qu'ils créent des occasions imprévues de changements institutionnels. Par leurs manoeuvres politiques, les acteurs qui disposent du pouvoir sont à même de choisir quels accidents sont susceptibles de provoquer quelque changement.

Macht, unfälle und institutioneller wandel: der fall eines chinesischen krankenhauses in hong kong

Dieser Beitrag kommt dem Verlangen nach mehr Forschung über “institutionellen Dynamismus” nach und fragt – aus der theoretischen Perspektive des historischen Institutionalismus – nach der Rolle von Macht und Unfällen als Ursachen für den institutionellen Wandel. In einer Fallstudie wird der Einfluss zweier “Unfälle” (Epidemien) auf die institutionelle Ausrichtung eines Krankenhauses in Hong Kong in unterschiedlichen Machtkontexten (Änderungen der politischen Souveränität) untersucht. Im Ergebnis zeigt sich, dass Macht eine größere Rolle spielt als Unfälle. Damit soll die Bedeutung von Unfällen allerdings nicht in Abrede gestellt werden. Unfälle sind wichtig, weil sie neue Möglichkeiten eröffnen, um institutionelle Veränderungen in Gang zu bringen. Durch politische Manöver können mächtige Akteure darüber entscheiden, welche Unfälle zu Veränderungen führen sollen.

Type
Research Article
Copyright
Copyright © Cambridge University Press 2012

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References

ENDNOTES

1 Kathleen Thelen and Sven Steinmo, ‘Historical institutionalism in comparative politics’, in Kathleen Thelen and Sven Steinmo eds., Structuring politics: historical institutionalism in comparative analysis (Cambridge, 1992), 13–18.

2 Siobhan Harty, ‘Theorizing institutional change’, in André Lecours ed., New institutionalism: theory and analysis (Toronto, 2005), 51–79.

3 Weyland, Kurt, ‘Toward a new theory of institutional change’, World Politics 60, 2 (2008), 281314CrossRefGoogle Scholar, here 281. For detailed overviews of historical institutionalist analyses in political studies, see Thelen, Kathleen, ‘Historical institutionalism in comparative politics’, Annual Review of Political Science 2 (1999), 369404CrossRefGoogle Scholar; and Paul Pierson and Theda Skocpol, ‘Historical institutionalism in contemporary political science’, in Ira Katznelson and Helen V. Milner eds., Political science: the state of the discipline (New York, 2002), 693–721.

4 Peter Burnham, Karin Gilland, Wyn Grant and Zig Layton-Henry, Research methods in politics (New York, 2004), 18; Peters, B. Guy, Pierre, Jon and King, Desmond S., ‘The politics of path dependency: political conflict in historical institutionalism’, Journal of Politics 67, 4 (2005), 12751300CrossRefGoogle Scholar; Pierson and Skocpol, ‘Historical institutionalism in contemporary political science’, 718–21. For an overview of the history of ‘old’ and ‘new’ institutionalism in political studies, see B. Guy Peters and Jon Pierre eds., Institutionalism, vol. 1 to 4 (London, 2007).

5 Shu-Ma, Yun, ‘Political science at the edge of chaos? The paradigmatic implications of historical institutionalism’, International Political Science Review 28, 1 (2007), 5778CrossRefGoogle Scholar, here 63.

6 Peter A. Hall and Rosemary Taylor, C. R., ‘Political science and the three new institutionalisms’, Political Studies 44 (1996), 936–57Google Scholar, here 937–42.

7 For detailed discussions on the role of path dependency analyses in historical institutionalism, see Thelen, ‘Historical institutionalism in comparative politics’, 387–99 and Pierson and Skocpol, ‘Historical institutionalism in contemporary political science’, 699–703.

8 Mahoney, James, ‘Path dependency in historical sociology’, Theory and Society 29, 4 (2000), 507–48CrossRefGoogle Scholar, here 507–12.

9 Peters, Pierre and King, ‘The politics of path dependency’, 1282.

10 Harty, ‘Theorizing institutional change’, 59–63; James G. March and Johan P. Olsen, ‘Elaborating the “new institutionalism”’, in R. A. W. Rhodes, Sarah A. Binder and Bert A. Rockman eds., The Oxford handbook of political institutions (Oxford, 2006), 12. For other historical institutional attempts to account for institutional changes, see Boas, Taylor C., ‘Conceptualizing continuity and change: the composite-standard model of path dependence’, Journal of Theoretical Politics 19, 1 (2007), 3354CrossRefGoogle Scholar.

11 Ruth Berins Collier and David Collier, Shaping the political arena: critical junctures, the labour movement, and regime dynamics in Latin America (Princeton, 1991), 29–31.

12 Capoccia, Giovanni and Kelemen, R. Daniel, ‘The study of critical junctures: theory, narrative, and counterfactuals in historical institutionalism’, World Politics 59, 3 (2007), 341–69CrossRefGoogle Scholar.

13 Capoccia and Kelemen, ‘The study of critical junctures’, 348;.

14 Ibid., 352.

15 The power dimension is neglected not only by institutional economics, but also by rational choice institutionalism, which tends to view institutions as Pareto-optimal structures that benefit all parties concerned, instead of biased structures that reflect power relations. See Moe, Terry M., ‘Power and political institutions’, Perspectives on Politics 3, 2 (2005), 215–33CrossRefGoogle Scholar.

16 Capoccia and Kelemen, ‘The study of critical junctures’, 353–4.

17 Robert E. Goodin, ‘Institutions and their design’, in Robert E. Goodin ed., The theory of institutional design (Cambridge, 1996), 25.

18 Goodin, ‘Institutions and their design’, 24.

19 Mahoney, ‘Path dependency in historical sociology’, 527–8.

20 Paul Pierson, ‘Big, slow-moving, and … invisible: macrosocial processes in the study of comparative politics’, in James Mahoney and Dietrich Rueschemeyer eds., Comparative historical analysis in the social sciences (Cambridge, 2003), 177–89.

21 Mahoney, ‘Path dependency in historical sociology’, 514; Douglass North, Institutions, institutional change and economic performance (Cambridge, 1990), 89.

22 Kenneth Hewitt, ‘Excluded perspectives in the social construction of disaster’, in E. L. Quarantelle ed., What is a disaster: perspectives on the question (London, 1998), 77–9.

23 Gary A. Kreps, ‘Disaster as systemic event and social catalyst’, in Quarantelle, What is a disaster: perspectives on the question, 31.

24 Hewitt, ‘Excluded perspectives in the social construction of disaster’, 77 and 81.

25 Paul Pierson, Politics in time: history, institutions, and social analysis (Princeton, 2004), 52; Kathleen Thelen, ‘How institutions evolve: insights from historical analysis’, in Mahoney and Rueschemeyer, Comparative historical analysis in the social sciences, 209.

26 Harty, ‘Theorizing institutional change’, 60. For more on the problem of endogeneity, see Hoffmann, Matthew J. and Riley, John Jr., ‘The science of political science: linearity or complexity in designing social enquiry’, New Political Science 24, 2 (2002), 303–20CrossRefGoogle Scholar, here 309–11.

27 Kreps, ‘Disaster as systemic event and social catalyst’, 35; Eric K. Noji, ‘The nature of disaster: general characteristics and public health effects’, in Eric K. Noji ed., The public health consequences of disasters (New York, 1997), 7–8.

28 Elizabeth Sinn, Power and charity: a Chinese merchant elite in colonial Hong Kong (Hong Kong, 2003), 48.

29 Hong Kong learned of the spread of SARS in the community in mid-March 2003 and during the seven months that followed, the outbreak was reported at least 19 times as ‘accidents’ in the local Chinese press. See William Chiu and Veronica Galbraith, ‘Calendar of events’, in Christine Lok and Civic Exchange eds., At the epicentre: Hong Kong and the SARS outbreak (Hong Kong, 2004), xviii; Cheng Daily (CD, ), 9 May 2003; Dagong Daily (DD, ), 18 March and 15 July 2003; Dongfang Daily (DFD, ), 2 and 8 April 2003; Dushi Daily (DSD, ), 15 September 2003; Ming Daily (MD, ), 6 May 2003; Pingguo Daily (PD, ), 8 April 2003; Taiyang Daily (TD, ), 2 April 2003; Wenhui Daily (WD, ), 3 July and 11 October, 2003; Xinbao Business News (XBBN, ), 9 and 30 April, 22 September and 31 October 2003; Xinaggang Business Times (XBT, ), 13 June 2003; Xin Daily (XD, ), 22 October 2003; Xianggang Jingji Daily (XJD, ), 28 March 2003.

30 As Capoccia and Kelemen noted, such identification of a specific ‘unit of analysis’ is important in historical institutional studies. Capoccia and Kelemen, ‘The study of critical junctures’, 349–50.

31 Richard A. Kurtz and H. Paul Chalfant, The sociology of medicine and illness (Boston, 1984), 201–10.

32 Anselm Strauss, Leonard Schatzman, Danuta Ehrlich, Rue Bucher and Melvin Sabshin, ‘The hospital and its negotiated order’, in Eliot Freidson ed., The hospital in modern society (London, 1963), 147–69.

33 For a full version of this case study, see Shu-Ma, Yun, ‘The making and remaking of a Chinese hospital in Hong Kong’, Modern Asian Studies 45, 5 (2011), 1313–36CrossRefGoogle Scholar.

34 Elisabeth Hsu, The transmission of Chinese medicine (Cambridge, 1999), 6–7; Volker Scheid, Chinese medicine in contemporary China: plurality and synthesis (Durham, NC, 2002), 3–4; Kim Taylor, Chinese medicine in early communist China, 1945–63: a medicine of revolution (London, 2005), 79–84.

35 Francesca Bray, ‘Chinese medicine’, in W. F. Bynum and Roy Porter eds., Companion encyclopedia of the history of medicine (London, 1993), vol. 1, 730–49; P. Y. Ho and F. P. Lisowski, A brief history of Chinese medicine, 2nd edn (Singapore, 1997), 9–18 and 31–43; Nianqun Yang ( ), Remaking ‘patients’: politics of space under the conflict between Chinese and Western medicine (1832–1985) [ : (1832–1985)] (Beijing, 2006), 250–9; Xiaoqing Ye, ‘Regulating the medical profession in China: health policies of the nationalist government’, in Alan K. L. Chan, Gregory K. Clancey and Hui-Chieh Loy eds., Historical perspectives on East Asian science, technology and medicine (Singapore, 2002), 198–213.

36 Hsu, The transmission of Chinese medicine, 168–224; Scheid, Chinese medicine in contemporary China, 35 and 65–71; Taylor, Chinese medicine in early communist China, 63–108 and 152.

37 Jiage Lu ( ) ed., Saving Chinese medicine ( ) (Guilin, 2006), 210, 217–18, 223–4, 250–1; Yang, Remaking ‘patients’, 284–91.

38 Andrew Cunningham and Bridie Andrews eds., Western medicine as contested knowledge, (Manchester, 1997), 11.

39 Taylor, Chinese medicine in early communist China, 88.

40 Carol Benedict, Bubonic plague in nineteenth-century China (Stanford, 1996), 131–8; Angela Ki Leung, Che, ‘Organized medicine in Ming-Qing China: state and private medical institutions in the lower Yangzi region’, Late Imperial China 8, 1 (1987), 144–50CrossRefGoogle Scholar; Yang, Remaking ‘patients’, 67–8.

41 Hsu, The transmission of Chinese medicine, 8–14; PI-1: Personal interview with a visiting professor at the School of Chinese Medicine, the Chinese University of Hong Kong, 26 April 2006; Scheid, Chinese medicine in contemporary China, 81–96.

42 Pui Yin Ho ( ), Source and flow: the formation and evolution of Tung Wah Hospital ( ) (Hong Kong, 2009), 18–19, 26 and 142; Sinn, Power and charity, 18, 30–47, 52, 60–9 and 79–81; Yongguang Xie ( ), History of Chinese medicine in Hong Kong ( ) (Hong Kong, 1998), 125–30.

43 Benedict, Bubonic plague in nineteenth-century China, 131–8; Henry Lethbridge, Hong Kong: stability and change (Hong Kong, 1978), 56–65; Runhe Liu ( ), ‘Establishing Tung Wah – The first Chinese hospital in Hong Kong’ ( ), in Elizabeth Sinn ( ) and Liu Runhe ( ) eds., Be more charitable, and follow the right way: collected essays in commemoration of the 135th anniversary of Tung Wah Group of Hospitals ( ) (Hong Kong, 2006), 32–3; Sinn, Power and charity, ch. 4; Huiling Wang ( ), ‘Hong Kong's public health and the evolution of Chinese and Western medical service in Tung Wah’ ( ), in Elizabeth Sinn ( ) and Liu Runhe ( ), Be more charitable, and follow the right way: collected essays in commemoration of the 135th anniversary of Tung Wah Group of Hospitals ( ), 40–1.

44 Sinn, Power and charity, 121–58; Joseph S. P. Ting ( ), Sharing merits – the growth of Tung Wah with Hong Kong 1870–1997 ( 1870–1997) (Hong Kong, 2010), 58–64 and 73–81.

45 Sinn, Power and charity, 159–62; Mary Preston Sutphen, ‘Rumoured power: Hong Kong, 1894 and Cape Town, 1901’, in Cunningham and Andrews, Western medicine as contested knowledge, 244–51.

46 Robin Gauld and Derek Gould, The Hong Kong health sector: development and change (Hong Kong, 2002), 40; Sinn, Power and charity, 167–83 and 196–212; Ting, Sharing merits, 82–5 and 216–35; Wang, ‘Hong Kong's public health’, 45–57; Xie, History of Chinese Medicine in Hong Kong, 138.

47 South China Morning Post (SCMP), 9 April 1970.

48 Lai-Hung Kwan, ‘The charitable activities of local Chinese organisations during the Japanese occupation of Hong Kong, December 1941 – August 1945’, in David Faure, James Hayes and Alan Birch eds., From village to city: studies in the traditional roots of Hong Kong society (Hong Kong, 1984), 178–90; Ting, Sharing merits, 243–54; Tung Wah Group of Hospitals Museum archives (hereafter TWGHMA; ), Minutes of board meetings ( ), B41/43, 00960; B44/45, 00962; B45/46, 00963; Wang, ‘Hong Kong's public health’, 69–70.

49 TWGHMA, B45/46, 00963; B46/47, 00964; Wang, ‘Hong Kong's public health’, 70–1; Xie, History of Chinese Medicine in Hong Kong, 145.

50 Hong Kong Television Broadcasting Company (hereafter HKTVB), Documentary on combined Chinese-Western medical treatments of SARS (9 June 2003).

51 CD, 11 April 1990; DD, 23 March 1991; Fuicui Weekly (FW, ), 5 December 1986; Gauld and Gould, The Hong Kong Health Sector, 51–73; Huaqiao Daily (HD, ), 25 May 1991; Jing Daily (JD, ), 24 August 1989; Kuai Daily (KD, ), 3 December 1986; MD, 21 February 1990; WD, 18 January 1990; Ting, Sharing merits, 353–61; XD, 3 November 1989; Xianggang Times (XT, ), 26 March 1991.

52 CD, 1 March 1997; DD, 5 March 1997; WD, 5 June 1997.

53 PI-2: Personal interview with a Chief of Service at the Tung Wah Group of Hospitals, 11 May 2006; Tung Wah Group of Hospitals (hereafter TWGH), ‘Tung Wah's Chinese medical services ()’, DVD produced by the Medical Section ( ) of TWGH (Hong Kong, 2006); DD, 19 July and 13 December 2000; MD, 11 December 2000; SCMP, 14 December 2000.

54 Thomas Abraham, Twenty-first century plague: the story of SARS (Hong Kong, 2004).

55 HKTVB, Documentary on combined Chinese-Western medical treatments of SARS. From the Western medical perspective, it is problematic to classify a new disease under a general category, and then claim experience in handling it. It resembles Western medical doctors who are experienced in treating pneumonia patients but cannot claim that the experience is applicable to cases of atypical pneumonia (another name for SARS). [See K. S. Derrick ( ), When Chinese medicine meets Western medicine – history and ideas ( ) (Hong Kong, 2004), 486.] But for Chinese TCM practitioners, there is no problem to claim that TCM does provide effective treatment to SARS. [See Tietao Deng ( ) ed., History of Chinese epidemic prevention ( ) (Nanning, 2006), 701–6; Tian Hai ( ) and Xiaowei Yi ( ), Calamity of Chinese medicine: a century-long debate about the preservation and abolition of Chinese medicine ( ) (Beijing, 2008), 216–27].

56 DD, 7 May 2003; XBT, 8 May 2003.

57 HKTVB, Documentary on combined Chinese-Western medical treatments of SARS.

58 XD, 25 February 2004.

59 TD, 28 November 2004; XBT, 18 December 2004; XD, 6 May 2004; Xingdao Daily (XDD ), 14 March 2006.

60 Yang, Remaking ‘patients’, 263–6.

61 Alexander L. George and Andrew Bennett, Case studies and theory development in the social sciences (Cambridge, 2005), 229.

62 Hong Kong Museum of History (hereafter HKMH), ‘We shall overcome: plagues in Hong Kong’ (Leaflet distributed in the special exhibition ‘We shall overcome: plagues in Hong Kong’, HKMH, 2003).

63 Christopher Hamlin, Public health and social justice in the age of Chadwick: Britain, 1880–1854 (Cambridge, 1998); Dorothy Porter, History, civilization and the state: a history of public health from ancient to modern times (London, 1999), 118–21.

64 Porter, History, civilization and the state, 121–34.

65 HKMH, ‘We shall overcome’; Sinn, Power and charity, 65–7.

66 Ruth Rogaski, Hygienic modernity: meanings of heath and disease in treaty-port China (Berkeley, 2004), 101.

67 Benedict, Bubonic plague in nineteenth-century China, 146; Wang, ‘Hong Kong's public health’, 49 and 60.

68 Benedict, Bubonic plague in nineteenth-century China, 149.

69 Porter, History, civilization and the state, 143.

70 Ian Scott, Political change and the crisis of legitimacy in Hong Kong (Hong Kong, 1989), 171–219.

71 HD, 12 February 1984; 9 September 1987; Renmin Daily (RD, ), 31 January 1985; Ting, Sharing merits, 372–8; TWGH, Ten years after handover; mind connected for hundred years – Tung Wah's dream of motherland ( , : ) (Hong Kong, 2008), 15 and 34–6; WD, 13 February, 15 and 19 September 1984; 3 May 1985; XBT, 6 September 1984.

72 DD, 30 August 1999; Gauld and Gould, The Hong Kong health sector, 90–1; Hokari Hiroyuki, ‘The presentation of traditional Chinese medicine (TCM) knowledge in Hong Kong’, in Chan, Clancey and Loy, Historical perspectives on East Asian science, technology and medicine, 222–35.

73 Hiroyuki, ‘The presentation of traditional Chinese medicine (TCM) knowledge in Hong Kong’, 223, 233–4; HKTVB, Documentary on regulating Chinese medicine practitioners in Hong Kong (9 September 2002); Taylor, Chinese medicine in early communist China, 86–7; WD, 1 April 1999.

74 DD, 11 June 2005; MD, 4 February 2006; PD, 4 February, 2006; XDD, 14 March 2006.

75 HKTVB, Documentary on combined Chinese-Western medical treatments of SARS; PI-2.

76 Jared Diamond, Guns, germs, and steel: the fates of human societies (New York, 1997); Mark Harrison, Disease and the modern world: 1500 to the present day (Cambridge, 2004); J. N. Hays, The burdens of disease: epidemics and human response in Western history (New Brunswick, 2000); William H. McNeill, Plagues and peoples (New York, 1998); Sheldon Watts, Epidemics and history: disease, power and imperialism (New Haven, 1997).

77 Ma, ‘Political science at the edge of chaos’, 57–78.

78 I am indebted to Jester Chan Ka Ho for his assistance in the following review of literature on the role of accidents in social and political theories.

79 Judith Green, 1997, Risk and misfortune: the social construction of accidents (London, 1997); Smith, Mike, ‘Changing sociological perspectives on chance’, Sociology 27, 3 (1993), 513–31CrossRefGoogle Scholar.

80 Edward Banfield, ‘In defense of the American party system’, in Bradbury Seaholes ed., Voting, interest groups, and parties (Glenview, IL, 1996), 126–30.

81 McCormick, John P., ‘Addressing the political exception: Machiavelli's “accidents” and the mixed regimes’, American Political Science Review 87, 4 (1993), 888900CrossRefGoogle Scholar.

82 Michael Cox ed., Rethinking the Soviet collapse: sovietology, the death of communism and the new Russia (London, 1998); Caroline Kennedy-Pipe, , ‘Getting it right, getting it wrong: the Soviet collapse revisited’, International Affairs 75, 2 (1999), 369–75CrossRefGoogle Scholar.

83 Bryce, James, ‘The relations of political science to history and to practice: presidential address, fifth annual meeting of the American Political Science Association’, American Political Science Review 3, 1 (1909), 119CrossRefGoogle Scholar; Carpenter, William S., ‘Methods of political reasoning’, American Journal of Sociology 31, 2 (1925), 213–26CrossRefGoogle Scholar; Robert Dahl, Polyarchy (New Haven, 1971); Hall, Arnold B., ‘Introduction to the reports on the national conference on the science of politics’, American Political Science Review 18, 1 (1924), 119–22CrossRefGoogle Scholar.

84 Harty, ‘Theorizing institutional change’.

85 This research appears to be in line with the ‘top-down’ approach to institutional changes, which looks for ‘presidents, judges, high-level bureaucrats, and the intellectuals and business aristocracy who advise and inform them’ as ‘prime movers’ of institutional formation and changes (Elizabeth Sanders, ‘Historical institutionalism’, in Rhodes, Binder and Rockman, The Oxford handbook of political institutions, 44). However, since our case study finds that resistance and bargaining play an unneglectable role even when there is a power change at the highest level, we fall closer to the ‘collective-choice theories of institutional change’, which ‘treat institutional change as a centralized, collective-choice process in which rules are explicitly specified by a collective political entity, such as the community or the state, and individuals and organizations engage in collective action, conflict, and bargaining to try to change these rules for their own benefit’ [Kingston, Christopher and Caballero, Gonzalo, ‘Comparing theories of institutional change’, Journal of Institutional Economics 5, 2 (2009), 155CrossRefGoogle Scholar].

86 Capoccia and Kelemen, ‘The study of critical junctures’.