Institutional Civil Disobedience: a case study in unintended outcomes

As industry-wide incentives and mandates increasingly influence entrepreneurial organisations to adopt efficiency-generating practices, the power of inter-organisational consensus can become ingrained to the point where illegal or unethical behaviour may become widely accepted. Using the healthcare industry as a natural experiment, we suggest that forces that promote technology adoption can also have unforeseen negative consequences as they become part of the professional institution, and may serve to have undesirable effects across a given industry. In the USA, industry-specific technology adoption mandates related to healthcare billing practices have met with some resistance from managers and professional groups, who have openly accepted a type of 'institutional civil disobedience', or ICD, in response to perceived unfair or ambiguous reimbursement policies. There is evidence, however, that such behaviour can lead to unforeseen outcomes (i.e., underbilling) that ultimately cause more harm than good for professional stakeholders. This study highlights the phenomenon of ICD and its role in generating unforeseen consequences.