Abstract
Objective: to analyze how institutional change from hand hygiene protocol implementation, regulated by RDC 36, affects the governance structure and incentives in hospital organizations.
Method: multi case studies were realized at tree hospitals.
Theorical foundations: this article developed a conceptual model from organizational design literature, incentive practices and institutional change.
Results: an emergent and exploratory framework was proposed on how organizations manage their incentive practices in institutional change scenarios.
Contributions: processes of adherence to change were identified. These could serve as guides for agencies and health care organizations to manage hand hygiene protocols and reduce nosocomial infections’ indicators.