Full institutionalisation requires that it be accepted and internalised by the actors creating a new set of practices, routines, vocabularies and organisational fields.
Because this exponential growth, and the institutionalisation and professionalisation that has accompanied it, has some serious downsides.
An approach based on the assumption of this binary character is limited to the understanding of institutionalisation as a process that occurs in a continuum and not crystallising from one moment to another.
This follows from a well-rehearsed critique that relates to the medicalization and institutionalisation of maternity care that took place over the twentieth century resulting in a change of place of birth from home to hospital and associated dehumanising environments and practices [ 7- 12].
The institutionalisation of accounting that this facilitated laid the basis for interventions by the imperial power intended to 'civilise' the native Gaelic population as well as recalcitrant Anglo-Irish landlords.
Although clinicians said that institutionalisation was facilitated where audit duties were included in job descriptions and where staff members were allocated work time for this, it was also stated that: "It's critically important that people don't hide behind a busy schedule to avoid doing audit.
A conference poster in September 2009 19 and a registry posting in May 2010 16 did not report details of important clinical data (ADAS-Cog, Neuropsychiatric Inventory, time to institutionalisation) but reported that there was no significant benefit of memantine on these measures at 12 months.
This research defines institutionalisation as an evolving process that produces new legitimacies, new formalised statutes, and resources that are reinterpreted and reconstructed by the actors.
The current plans include institutionalisation of a reporting system that requires facilities with user fee schemes to provide information on utilisation, exemptions, revenues, expenditures and the distribution of salary supplements on a quarterly basis.
Institutionalisation is thus a complex process that can be analysed from the combination of two central aspects: habituation and legitimisation (Berger and Luckman 1999).
