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Despite the continuation of hospital mergers in many western countries, it is uncertain if and how hospital mergers impact the quality of care. This poses challenges for the regulation of mergers. The purpose of this paper is to understand: how regulators and hospitals frame the impact of merging on the quality and safety of care and how hospital mergers might be regulated, given their uncertain impact on quality and safety of care.

This paper studies the regulation of hospital mergers in The Netherlands. In a qualitative study design, it draws on 30 semi-structured interviews with inspectors from the Dutch Health and Youth Care Inspectorate (Inspectorate) and respondents from three hospitals that merged between 2013 and 2015. This paper draws from literature on process-based regulation to understand how regulators can monitor hospital mergers.

This paper finds that inspectors and hospital respondents frame the process of merging as potentially disruptive to daily care practices. While inspectors emphasise the dangers of merging, hospital respondents report how merging stimulated them to reflect on their care practices and how it afforded learning between hospitals. Although the Inspectorate considers mergers a risk to quality of care, their regulatory practices are hesitant.

This qualitative study sheds light on how merging might affect key hospital processes and daily care practices. It offers opportunities for the regulation of hospital mergers that acknowledges rather than aims to dispel the uncertain and potentially ambiguous impact of mergers on quality and safety of care.

The purpose of this paper is to scrutinize Geert Hofstede’s conceptualization of national culture and provide an alternative beyond purely constructivist conceptualizations of culture for cross-cultural management scholars and practitioners.

Hofstede’s conceptualization of national culture is discussed and criticized. Subsequently, alternatives are being discussed. Eventually, a more feasible alternative is suggested and the ways in which it can be applied are briefly mentioned.

Several objections to Hofstede’s idea and measurement of national culture are listed: it assumes people are cultural dopes, it ignores the influence of non-cultural factors, it reifies culture, it assumes internal coherence, it does not account for change, it arbitrarily uses the nation-state as the preferred locus of culture, and it has an in-built Western bias. Several authors have argued for a constructivist conceptualization of culture, which sees culture as a repertoire, from which ideas and possible actions can be selected. The downside, however, is that it has no practical value for managers. In an attempt to solve this, the paper explores the possibilities of using the concept of national habitus, which shows how dispositions are shaped on a national level and how these dispositions change under the influence of other, non-national social forces.

The paper briefly explores how a national habitus-centered approach can help cross-cultural managers.

The paper’s added value lies in the use of a relatively recently extended sociological concept for cross-cultural management.