Quality management in higher education from the perspective of institutional isomorphism: a scoping review

Objective: This article presents a scoping review of academic literature on quality management in higher education, using a neo-institutionalist methodological approach.

Methodology: A systematic search was conducted in Scopus, Web of Science, and Google Scholar, complemented by gray literature on university quality from institutional reports, regulations, and documents produced by national and international organizations. The analysis was based on a sample of 113 scientific articles.

Results: The findings were structured around four axes: (1) theoretical approaches to institutional isomorphism in higher education; (2) quality management and assurance systems; (3) educational policies and their isomorphic effects; and (4) rankings and accreditation processes.

Conclusion: The implementation of quality management systems has significantly influenced university governance and academic practices. This review shows that quality assurance processes and governance reforms in higher education not only generate structural convergence but also transform the institutional culture of universities, shaping their values, practices, and priorities. From a neo-institutionalist perspective, both isomorphic pressures and forms of organizational adaptation, negotiation, and resistance were analyzed. Finally, the review highlights the utility of case studies as a methodological tool for examining how institutional arrangements are adopted and reinterpreted in different contexts, enabling a situated connection between theory and organizational reality.

1 Introduction

This scoping review examines the literature on higher education and quality assurance from a neo-institutionalist perspective. The current model is characterized by a regulatory focus on quality agencies that exert pressure to implement regulations and standards. This configuration suggests that although normative isomorphism is a common phenomenon in multiple contexts, its dynamics require closer examination.

The central objective is to identify and analyze academic production that addresses the interaction between institutional isomorphism and quality management in higher education, as well as the effects derived from the convergence driven by the European Higher Education Area (EHEA) and the impact of the Bologna Process. To this end, a search was carried out followed by a systematic review of titles, abstracts, and keywords, allowing the documents to be organized into four thematic axes: (1) theoretical approaches to institutional isomorphism; (2) quality systems and assurance processes; (3) educational policies and reforms with isomorphic effects; and (4) rankings and accreditation. Additional documents not directly linked to these themes were also reviewed.

This review addresses three questions: (1) How is institutional isomorphism used to interpret quality assurance in higher education? (2) What mechanisms are most frequently identified in the literature? (3) How do quality systems contribute to organizational convergence across contexts?

Higher education today is influenced by external pressures that tend to generate organizational homogenisation between institutions. Among other global processes, New Public Management, commodification, and privatization have introduced principles of efficiency, performance monitoring, and accountability that, while presented as modernisation strategies, in practice, operate as vectors of institutional isomorphism. In particular, they generate coercive and normative pressures that lead to the homogenisation of organizational structures and management practices, regardless of the local context. This logic tends to reduce institutional diversity, replicating organizational models guided by business criteria that are far removed from traditional academic missions.

However, alongside structural convergence processes, neo-institutionalist literature emphasizes the importance of “institutional decoupling.” This concept, developed by Meyer and Rowan (1977), describes the gap that often occurs between the formal structures that organizations adopt to obtain legitimacy–for example, quality standards, evaluation models, or assurance systems–and the actual practices they develop in their daily operations. In the field of higher education, this means that universities and agencies can incorporate internationally approved standards, metrics, or procedures, but without these necessarily transforming internal processes, academic culture, or management decisions. Decoupling thus helps us understand why many institutions are formally similar to each other but maintain diverse internal dynamics that are even contradictory to the regulatory frameworks they claim to comply with.

We differentiate between institutional culture (the wider normative and regulatory environment) and organizational cultures (internal values and routines), as both shape how universities respond to isomorphic pressures.

Drawing on insights from organizational sociology, neo-institutionalism has established itself as a central analytical framework for understanding processes of change and homogenisation in highly regulated sectors, such as higher education. Unlike classical institutionalism, which emphasized formal structures and rational decisions, the neo-institutional approach stresses that organizations operate within environments laden with norms, social expectations, regulatory frameworks and discourses of legitimacy that profoundly condition their practices. Meyer and Rowan (1977) introduce the idea that organizations adopt formalized structures not necessarily for efficiency, but to gain cultural legitimacy. Later, DiMaggio and Powell (1983) describe the coercive, mimetic and normative mechanisms through which organizational fields tend toward structural convergence.

For clarity, we distinguish between quality assurance (external and internal procedures ensuring standards), quality management (institutional strategies for improvement), and quality systems (the structures combining both). Evaluation refers to specific assessment activities. These definitions guide the terminology used throughout the review.

This approach is particularly relevant to the study of quality in higher education because it explains why conceptually similar models such as audits, accreditations, standards, rankings, or continuous improvement systems are spreading globally, even in contexts with divergent academic traditions. From a neo-institutionalist perspective, quality is not just a set of technical procedures, but a device laden with social meanings that operates as a requirement for legitimisation before governments, agencies and external audiences. Neo-institutionalism also provides tools for analyzing the proliferation of intermediate actors–evaluation agencies, international organizations, consultancies, professional networks–that shape the field of quality through standards, indicators, and rhetoric that generate patterns of isomorphism. Finally, this approach allows us to interpret the tensions between adaptation and resistance, as well as the processes of quality models, which are fundamental aspects for understanding how these policies transform the institutional culture of universities.

These changes have been reinforced by the expansion of quality assurance systems, the rise of international rankings, and reforms promoted by national and transnational organizations. Since the Bologna Declaration (Bologna, 1999), the EHEA has promoted convergence between university systems, emphasizing evaluation, accreditation and continuous improvement as pillars of a new institutional culture. A shift toward this new institutional culture enables for a deeper understanding of how universities, as organizations situated in complex institutional fields, reconfigure their norms, values, and practices in response to environmental pressures. From the perspective of organizational fields, these spaces comprise multiple actors–evaluation agencies, international organizations, governments, media, and businesses–who define legitimate performance criteria and generate common expectations.

The interaction with and pressure from these agencies induces the adoption of formal structures and simultaneously transforms organizational cultures, promoting orientations toward efficiency, quality measured by external standards, and strategic management. In this sense, the new institutional culture does not emerge spontaneously but rather, functions as an adaptive and performative response to an environment regulated by dynamics of competition, transparency, and accountability.

This process has transformed academic planning, internal management, and accountability, generating both significant progress and debate about its implications. Among the most significant changes are the consolidation of evaluation and continuous improvement mechanisms, strengthening of accountability to external stakeholders, professionalization of university management, and greater transparency in academic and administrative processes. Likewise, an increase in the availability of institutional information has facilitated comparisons between universities and stimulated strategic planning.

However, these changes have also sparked significant debate about their side effects: the growing bureaucratisation of academic practices, subordination of educational goals to technocratic criteria, tension between external control and institutional autonomy, and risk of homogenisation of university models, among others. These dilemmas call into question the extent to which quality systems, conceived as tools for improvement, can become mechanisms of pressure that limit innovation, diversity, and the critical role of universities.

In this context, this article aims to explore a key question: what transformations are taking place in the institutional culture of universities as a result of agency processes, both within organizations and in their environment of agents and networks? This question allows us to analyze how the proliferation of evaluation agencies, regulatory frameworks, and intermediary actors is reconfiguring the logic of university operations, generating new forms of governance, management, and control. To address this issue, a neo-institutionalist approach (Peters, 2003) was adopted, enabling the examination of the effects of these dynamics on organizational legitimacy and institutional standardization processes, organizational structures, and networks of actors in highly institutionalized contexts such as higher education.

Although the concept of isomorphism has been widely explored in the social science literature, there is still no comprehensive systematization that specifically relates it to quality models in higher education. This paper aims to fill that gap by synthesizing the findings of 113 documents and analyzing how isomorphic pressures manifest, what factors drive them, their consequences, and how the tension between global standardization and local adaptation is articulated. In this regard, we offer a systematic review that not only identifies patterns of institutional convergence promoted by quality models, but also analyses how these models are translated, adapted, or resisted in different contexts. Our aim is also to contribute to the debate on quality in higher education with a situated, critical perspective oriented toward future research agendas.

The review offers two main contributions: (a) a systematic organization of the literature around the three isomorphic mechanisms, and (b) the inclusion of gray and regulatory sources that broaden the evidence base beyond academic publications.

2 Methods

To develop this scoping review, the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) methodological approach was adopted. This strategy provides a structured guide for identifying, evaluating, synthesizing, and analyzing relevant literature in a rigorous and transparent manner. The objective of this review was to compile and examine academic, regulatory, and professional sources that address key issues related to quality management and institutional isomorphism in higher education. Through this approach, we sought to ensure broad and systematic coverage of available knowledge, facilitating understanding of the current landscape and identifying gaps or thematic convergences in the field under study.

2.1 Eligibility criteria

We included peer-reviewed articles, book chapters, doctoral theses and gray literature addressing institutional isomorphism in relation to quality assurance in higher education. We excluded studies without explicit relevance to these concepts, purely technical models, non-scholarly pieces and works published before 1990.

2.2 Information sources and search strategy

Searches were conducted (Nov 2024–Mar 2025) in Scopus, Web of Science and Google Scholar, complemented by gray literature from quality agencies and international organizations. Search strings combined terms related to quality assurance, higher education and isomorphism. Only full-text documents were included. English-language keywords were used.

2.3 Selection of sources of evidence

After removing duplicates, titles and abstracts were screened, followed by full-text assessment based on eligibility criteria. Of 417 records identified, 113 met all criteria and were retained.

2.4 Data charting process

Data were charted using an iterative matrix capturing publication type, region, method, theoretical framework and isomorphic mechanism. Categories were refined after pilot coding.

2.5 Synthesis of results

Results were synthesized through descriptive mapping and qualitative content analysis to identify recurrent isomorphic patterns, contextual differences and research gaps.

The bibliographic search was carried out between November 2024 and March 2025 in scientific databases including Scopus, Web of Science, and Google Scholar, using Boolean operators with combinations of the following terms: “quality assurance” “quality management,” “higher education” and “institutional isomorphism.” This search returned 186 documents in Scopus, 202 from Web of Science, 21 from Google Scholar, and 8 additional documents with a regulatory or legislative focus. Duplicates were eliminated and inclusion criteria were applied, based on thematic relevance, availability of the full text, and explicit relationship to the key concepts of the study, were applied. As a result, the final corpus consisted of 113 documents that addressed the topic from theoretical, empirical, normative, and comparative perspectives.

This review followed the methodological recommendations of Arksey and O’Malley (2005) and the updates proposed by Levac et al. (2010) to ensure a systematic and transparent process. Document selection was carried out in three phases: identification, screening, and eligibility. In the identification phase, records were retrieved from Scopus, Web of Science, and Google Scholar using combinations of keywords related to institutional isomorphism, quality assurance, higher education, governance, accreditation, and organizational change. After removing duplicates, an initial screening based on title and abstract was applied to discard works clearly not aligned with the object of study.

The exclusion criteria included:

- Articles focused on non-university levels of education.

- Theoretical studies with no explicit connection to quality, governance, or organizational change in higher education.

- Papers whose focus was exclusively technical (e.g., statistical metrics, algorithmic models) without institutional analysis.

- Documents that were not available in full access.

Subsequently, in the eligibility phase, the texts were reviewed in their entirety to confirm their conceptual and methodological relevance. Publications whose content did not address any of the isomorphic mechanisms (coercive, mimetic, or normative) were discarded.

Given the exploratory nature of this study, the following criteria were applied to assess the quality of secondary sources:

- Clarity of study objectives.

- Consistency between theoretical framework and results.

- Methodological transparency.

- Relevance to institutional analysis, and

- Adequacy of the evidence presented.

In addition, priority was given to articles published in peer-reviewed journals, studies with explicit theoretical foundations, and works that provided comparative or transnational perspectives. This process yielded a final sample of 113 articles, which constitutes a solid basis for mapping the relationships between institutional isomorphism and quality systems in higher education.

Furthermore to academic literature, sources available on institutional portals, the European Association for Quality Assurance in Higher Education (ENQA) et al. (2015) and other European entities specializing in quality assurance were also incorporated. Furthermore, national regulations, conference proceedings, technical reports, and gray literature prepared by state and regional agencies were reviewed (Fundación para el Conocimiento Madrid, 2018). Figure 1 illustrates the document search and selection process.

FIGURE 1

Figure 1. Document search and selection process. Source: elaborated by the authors, adapted from the PRISMA-ScR.

Each document was examined based on its title, abstract, and keywords, and subsequently classified according to four thematic axes defined through a preliminary theoretical review of the links between institutional isomorphism and organizational change processes in higher education:

1. Theoretical approaches to institutional isomorphism: conceptual studies focusing on the framework of neo-institutionalism, with emphasis on the typologies of coercive, mimetic, and normative isomorphism (DiMaggio and Powell, 1983; Meyer and Rowan, 1977).

2. Quality management and assurance processes: studies analyzing quality models and continuous improvement cultures, based on the taxonomies proposed by Harvey and Williams (2020) and Brennan and Shah (2000).

3. Educational policies and reforms with isomorphic effects: research examining university reforms and the influences of global governance on national systems, following frameworks such as those of Martens and Jakobi (2010) or Zgaga (2013).

4. Rankings and accreditation: studies analyzing how rankings, accreditation systems, and other reputation mechanisms influence university organizational dynamics (Hazelkorn, 2015; Pusser, 2016).

Thematic classification was carried out using a deductive-inductive process aligned with the PRISMA-ScR guidelines (Tricco et al., 2018). The four axes were defined based on a preliminary theoretical review of the neo-institutional literature and were subsequently refined through an iterative process of coding the full texts. Each document was classified according to its dominant analytical approach.

This scheme of thematic axes has been used in previous reviews (Stensaker et al., 2011; de Boer et al., 2007), allowing the integration of theoretical, empirical, and normative studies into a coherent analytical architecture. On the other hand, documents addressing higher education without explicit reference to institutional isomorphism or quality systems were excluded. This filter allowed us to define a representative and relevant corpus, capable of offering a broad and interdisciplinary overview of the object of study.

In addition to thematic classification, it is important to identify the academic publications most active in producing work on institutional isomorphism and quality management in higher education. This information provides insight into the most active dissemination channels and academic communities leading the international debate on the subject. Table 1 presents the distribution of the thematic axes identified in the scoping review. Of note, a strong presence of European and Anglo-Saxon journals was observed, reflecting both the origin of the reforms analyzed and the predominance of theoretical and methodological approaches consolidated in those contexts.

TABLE 1

Table 1. Distribution of thematic axes.

The information presented in Table 2 was prepared from the analysis of the final corpus of 113 documents considered in this review. For each article, the journal of publication and its country of origin were identified using data indexed in Scopus, Web of Science, and Google Scholar. This systematization made it possible to identify the most frequently published journals and establish geographic patterns in academic production on the topic.

TABLE 2

Table 2. Main journals with published articles included in this review.

In addition to the thematic analysis, a geographical classification of the 113 studies included in the review was carried out in order to identify regional patterns of academic production on institutional isomorphism and quality management in higher education. As shown in Table 3, most of the studies come from Europe (52.21%), followed by North America (15.04%) and Latin America (12.39%). Asia accounts for 9.73% of the total, while a small number of studies take a global approach (6.19%) or originate in Oceania (2.65%). This distribution highlights the historical consolidation of the methodological and regulatory debate in the European context, as well as the growing international interest in the comparative study of isomorphic dynamics in higher education.

TABLE 3

Table 3. Geographic distribution of the studies included in the review (N = 113).

3 Thematic axes

To provide a clearer view of the distribution of the studies analyzed in this review, the bar chart below summarizes the number of documents grouped into each of the four thematic axes. As Figure 2 shows, the largest volume of publications concerns quality management and assurance processes, which confirms the centrality of this line in current debates on higher education. This is followed by studies on educational policies and reforms with isomorphic effects, which also reflect a high degree of academic attention. In contrast, the sections devoted to rankings, accreditation, and theoretical approaches to institutional isomorphism show lower coverage, suggesting open spaces for future research, especially from conceptual and critical perspectives.

FIGURE 2

Figure 2. Distribution of documents by thematic axis. Source: elaborated by the authors.

3.1 Theoretical approaches to institutional isomorphism in higher education

The first thematic axis brings together studies that explore the conceptual bases of institutional isomorphism, particularly from the perspective of neo-institutionalism. This approach originates in the seminal work of DiMaggio and Powell (1983), who identify three mechanisms by which organizations tend to converge structurally: coercive, mimetic, and normative isomorphism. The documents grouped under this heading focus on theoretical development and the elaboration of analytical frameworks for interpreting institutional homogenisation processes.

Unlike the empirical axes, this block offers fundamental interpretive tools for understanding how and why universities adopt similar practices, respond to external pressures, and seek organizational legitimacy. Although numerically less represented, the theoretical studies reviewed are essential for supporting a rigorous analysis of the phenomenon of isomorphism in university settings.

The key concepts developed include:

• Coercive isomorphism: the adoption of structures or practices imposed by legal regulations or public policies. Some studies analyze the role of organizations such as the Organization for Economic Co-operation and Development (OECD) or the European Union in promoting common models, even outside their direct jurisdiction.

• Mimetic isomorphism: arises in contexts of uncertainty, where universities tend to imitate those considered successful. This dynamic relates to the influence of international rankings, the spread of Anglo-Saxon models, and the adoption of discourses of excellence or internationalization.

• Normative isomorphism: associated with the professionalization of academic and management staff, this concept highlights how specialized training and participation in international networks generate common organizational patterns.

• Institutional decoupling: based on Meyer and Rowan (1977), this concept explains how universities can formally adopt legitimized structures without implying substantive transformations. In such cases, symbolic responses to external demands rather than profound operational changes are evident.

• Organizational fields: These fields situate universities in complex institutional environments in which governments, evaluation agencies, non-profit organizations, businesses, and the media all interact. These environments set the rules of the game for legitimation and competition.

Notable authors include Meyer and Rowan (1977), Greenwood and Hinings (1996), Powell and Colyvas (2008), Marginson (2006) 2016, and Ferlie et al. (2008), who provide diverse approaches to understanding organizational changes in higher education. The reviewed studies also reflect current academic debates on coloniality in academia, global governance, and the ways in which universities respond to, resist, or negotiate quality models driven by the dominant regulatory frameworks. Research such as that of Shahjahan and Kezar (2013) provides a critical view of how global educational policies often replicate unequal power logics, in which certain discourses on quality and internationalization are imposed without considering local particularities.

Along these same lines, works such as those by Gornitzka and Maassen (2014) analyze how international agencies and organizations configure governance environments that exert pressure on university institutions to adapt to standardized models that are not always compatible with their traditions or missions. In response, other more recent research, such as that of Vostal (2016) or Rhoads and Torres (2006), introduce critical and poststructuralist approaches that help to make visible the capacity of universities and their actors to act with agency: to reinterpret, adapt, or even question the imposed reforms.

From these perspectives, the analysis of institutional isomorphism is enriched by considering not only external structures, but also the internal dynamics, tensions, and decisions that shape, in practice, what we understand by quality in higher education. Finally, neo-institutionalism emphasizes that higher education should be understood not only as a space for the transmission of knowledge, but also as a complex institutional system conditioned by historical, normative, and cultural structures that influence its evolution, resistance to change, and adaptation to new demands.

3.2 Quality management and assurance processes

The second thematic axis brings together studies that address the models, mechanisms, and dynamics linked to quality assurance in higher education institutions. This line of research has gained increasing relevance since the 1990s, in parallel with the global expansion of institutional evaluation systems, academic auditing, and external accreditation.

Unlike the previous axis, which focuses on conceptual frameworks, the documents in this section present a more applied and normative approach, aimed at understanding how universities seek to ensure, evaluate, and improve their organizational, teaching, and research performance. Many of these works explore the tensions between external demands for quality and the internal organizational culture of universities (Lu and Wang, 2023).

One of the most influential theoretical contributions in this field is that of Harvey and Green (1993), who propose a typology that defines quality as excellence, perfection, suitability for purpose, transformation, and consistency. This classification has been widely used as a starting point for analyzing the plurality of institutional interpretations of quality.

Harvey and Williams (2020), for their part, conducted a systematic review of 15 years of research in this area, providing a panoramic view of the evolution of evaluation systems and the associated methodological challenges. Other authors, such as Stensaker (2008), have problematised the real effects of quality assurance, questioning whether these tools generate effective improvements or, on the contrary, promote symbolic responses. Brennan and Shah (2000) explore the perceptions of academic and administrative staff, highlighting the degrees of acceptance, appropriation, and resistance to these processes.

Likewise, Van Vught and Westerheijden (1994) developed external evaluation models, distinguishing between systems oriented toward regulatory control and those focused on continuous improvement. These approaches allow quality systems to be classified according to their degree of formalization, participation, and market orientation.

The documents analyzed explore different assurance models:

• European models: focused on regulatory convergence driven by the EHEA, with special attention to ENQA guidelines and their application to national frameworks.

• Anglo-Saxon models: such as the Quality Assurance Agency for Higher Education (QAA) in the United Kingdom or the Tertiary Education Quality and Standards Agency (TEQSA) in Australia, noted for their emphasis on accountability, transparency, and continuous improvement.

• Total Quality Management (TQM) models: some studies analyze the incorporation of business practices, such as ISO standards or the EFQM model, into the university environment.

In general, the documents agree that quality is a polysemic, multidimensional, and deeply contextual concept. Its interpretation varies depending on the regulatory framework, institutional mission, and expectations of the actors (students, teachers, authorities, agencies, and employers) involved. In this regard, the need to build a participatory culture of quality is emphasized, combining external evaluation and internal self-evaluation, fostering institutional learning and avoiding excessive bureaucratisation.

Among the main organizational effects identified are:

• Positive results: including process standardization, strengthened accountability, improved strategic planning, and increased institutional transparency.

• Adverse effects: including administrative overload, formalization of practices without substantive changes, resistance from academic staff, and a disconnect between institutional objectives and externally-imposed indicators.

In contexts where governance structures are fragile or poorly institutionalized, several studies warn of a superficial incorporation of quality discourses and models. Rather than transformative processes, these adoptions often function as strategic responses aimed at meeting external demands, securing funding, or achieving accreditation, without necessarily leading to a substantive improvement in academic or management practices.

This phenomenon has been analyzed, for example, by González-Pereira et al. (1998), who show how certain rankings and quality assurance mechanisms can induce formal, but not structural, behaviors. Along the same lines, Bernasconi (2011) warns that, in universities in Latin America and Southern Europe, the language of quality is adopted as a source of legitimation, without any real commitment to continuous improvement.

These dynamics relate to what Meyer and Rowan (1977) conceptualized as institutional decoupling: the distance between what institutions claim to do and what they actually transform. Thus, symbolic isomorphism becomes a strategy for navigating highly normative environments, but not necessarily for innovating or strengthening organizational culture. In the European context, the implementation of quality assurance systems has been decisively promoted by the EHEA, through standardized frameworks that seek to guarantee academic, organizational, and training quality. Factors such as internationalization, accountability, and institutional competition have accelerated this process in recent decades.

From the literature reviewed, five key findings stand out:

1. Institutional isomorphism is a widespread trend in the adoption of quality models, although it does not always translate into contextualized or innovative responses.

2. Academic leadership and teacher evaluation are essential components in consolidating a quality-oriented institutional culture.

3. External agencies play a central role in shaping quality systems, although they face criticism for promoting overly standardized models.

4. Internationalization acts as a driver of institutional improvement but requires specific adaptation strategies.

5. Cultural and organizational barriers persist, hindering the effective implementation of quality systems, especially with regard to bureaucratisation and resistance to change.

In summary, this axis shows how quality systems act as vectors of isomorphism: coercive (due to regulatory requirements), mimetic (due to imitation of leading institutions), or normative (due to the professionalization of management teams). These dynamics are particularly visible in young or peripheral universities, which tend to replicate dominant models to gain institutional legitimacy.

This is, in short, the most consolidated axis of research on quality and institutionality in higher education. The contributions compiled here show how quality has become a common language, a management tool, and a form of regulation, capable of both promoting improvements and of generating internal tensions and institutional contradictions.

3.3 Educational policies and reforms with isomorphic effects

This thematic axis focuses on the analysis of public policies and educational reforms that have contributed to institutional convergence in higher education systems. It examines how certain initiatives promoted by national governments and international organizations generate isomorphic pressures–mainly coercive and normative–that influence the organization and governance of universities.

An emblematic example of this process is the Bologna Process, launched in 1999, which promoted the creation of the EHEA. This initiative not only promoted the harmonization of academic structures and qualifications frameworks, but also consolidated an institutional culture focused on quality, transparency, and continuous improvement. Since then, European universities have undergone substantial structural changes aligned with supranational recommendations and standards.

Numerous studies included in this axis analyze the effects of so-called new public management (NPM) in the university environment. These reforms, driven in many cases by organizations such as the OECD, World Bank, and multilateral agencies, have promoted the introduction of a market logic oriented toward efficiency, competition, performance measurement, and accountability. Under the guise of modernisation and continuous improvement, instruments such as academic productivity indicators, programme contracts, standardized evaluation systems, and hierarchical structuring of educational offerings have been implemented. However, various publications–such as those by Ferlie et al. (2008) or Paradeise et al. (2009)–warn that these policies, rather than stimulating innovation or adapting to the specific missions of each institution, tend to homogenize organizational models and reduce institutional diversity across the university ecosystem.

This loss of diversity is not a minor phenomenon, since institutional diversity is an essential value for the balanced development of higher education systems. Universities perform different functions depending on their history, territorial context, student population, and areas of specialization. Preserving this heterogeneity allows systems to respond more appropriately to the social, cultural, and economic challenges of their environments. Furthermore, diversity can result from deliberate processes of institutional innovation, well-executed academic autonomy, and a strategic vision adapted to local realities. Uniformising structures and practices in the name of efficiency can, on the contrary, erode the ability of institutions to develop their own solutions, experiment with new forms of teaching, or cultivate missions that transcend conventional indicators of quality.

Authors such as Martens and Jakobi (2010), Witte (2006), and Gornitzka (2006) have described these dynamics as forms of soft governance, defined as processes in which indirect pressure is exerted on States and institutions to adopt international standards without the use of formal coercive mechanisms. This type of governance operates through instruments such as rankings, recommendations, comparative indicators, or international reference frameworks, which do not impose legal obligations but do influence institutional decisions. Although appearing flexible, the literature warns that these reforms generate profound and lasting structural effects, especially at the symbolic and cultural levels.

In this sense, it is essential to differentiate between institutional culture and organizational cultures. The former refers to a broader and more persistent set of norms, shared values, and symbolic orientations that shape how universities conceive their mission, relationship with their environment, and collective action. Organizational cultures, on the other hand, are more specific, diverse, and adaptable, linked to particular units, faculties, or departments within a single institution. Soft governance affects not only the formal structure of universities, but also their institutional culture, as it introduces new ways of thinking about what is legitimate, efficient, or desirable. By internalizing the languages of quality, excellence, and global competitiveness, universities not only adjust their management practices but also redefine their values, priorities, and decision-making criteria. Thus, following the logic of symbolic adaptation, institutions transform their institutional cultures to align with international frameworks, which can generate tensions with preexisting organizational cultures and traditional academic missions.

From a critical perspective, some articles address the way in which these policies are translated at the institutional level. Authors such as Shahjahan and Kezar (2013) argue that global models are not adopted uniformly, but are reformulated, negotiated, and adapted based on local cultural, political, and organizational frameworks. This perspective allows us to understand the variations, mediations, and resistance that emerge when confronted with standardized reforms, challenging the idea of uniform implementation. Accordingly, case studies constitute a valuable methodological strategy for future research, as they allow in-depth analysis of how domestic institutional arrangements are configured, adapted, or redefined in relation to specific contexts and local power relations.

Other studies, including those by Dobbins et al. (2011), explore how these dynamics manifest in practice in countries with different institutional trajectories, observing common patterns such as the separation between academic and administrative management, the strengthening of accountability, and the professionalization of management positions. These transformations, while responding to rationales of efficiency and quality, also imply a reconfiguration of traditional university power structures.

In recent literature (2021–2025), various studies have shown that the accelerated digitization of higher education, especially in the post-pandemic context, is shaping a new institutional field in which isomorphic pressures are intensifying. Lu and Wang (2023) analyses how national digital transformation policies, often designed under the discourse of modernization and global competitiveness, operate as coercive mechanisms that force universities to align themselves with common technological agendas. His work shows how conditional funding, regulatory frameworks, and national digitization strategies limit institutional maneuverability, pushing universities to adopt very similar infrastructures, management protocols, and performance monitoring devices, regardless of their historical mission or resources.

Marsicano et al. (2020) focus on the mimetic isomorphism generated during the most critical phases of the pandemic and its prolongation in the subsequent period. Their research shows that, in highly uncertain scenarios, universities tend to observe the decisions of institutions considered leaders or benchmarks–in terms of prestige, visibility, or capacity for innovation–and replicate their digital responses: from the configuration of hybrid campuses and the normalization of online teaching to the adoption of certain platforms and technological solutions. What is relevant in their analysis is not only the specific imitation, but also the crystallization of “convergence trajectories” that consolidate certain digital models as the sector standard, reinforcing dynamics of organizational homogenization.

Likewise, Núñez Valdés et al. (2021) focus on the normative dimension of isomorphism, showing how digitization is institutionalized through professional communities, techno-pedagogical networks, and international organizations that produce and disseminate standards on what is considered “good practice” in digital higher education. Their study shows that digital teaching competency frameworks, quality guidelines for e-learning, certification schemes, and seals of excellence function as shared references that guide teacher training, the organization of support services, and strategic decision-making. In this way, universities are not only pressured to meet formal requirements, but also to align themselves with a set of professional and cultural expectations about what a modern and digitally competent institution should be like.

Finally, Sangwa et al. (2025) provide a more structural reading of post-pandemic digitization by describing the consolidation of a university technology ecosystem based on learning analytics, artificial intelligence, administrative automation, and integrated academic management platforms. According to these authors, the growing dependence on global providers and standardized technical architectures creates new forms of structural isomorphism, as organizational decisions are increasingly mediated by algorithmic logic, interoperability requirements, and shared data frameworks. Their analysis suggests that university governance is being reconfigured around indicators, control panels, and digital metrics which, even though they are presented as neutral management tools, introduce criteria for comparison and competitive pressure that encourage convergence between institutions.

These studies show that digitization and post-pandemic reforms do not represent merely a technological update, but rather a process of institutional reorganization that intensifies the coercive, mimetic, and normative mechanisms already described by neo-institutionalism. Digital transformation is thus configured as a central vector of homogenization in contemporary higher education, with direct effects on quality policies, governance structures, and university organizational cultures.

Taken together, this axis shows that the educational policies implemented in higher education over the past two decades tend to operate neutral but rather, operate as mechanisms of institutional isomorphism. Through legal frameworks, international standards, and conditional funding, these policies promote the adoption of convergent models that redefine the mission, operations, and priorities of universities. In many cases, these orientations respond to a technocratic rationale that seeks to align higher education systems with global criteria of efficiency, quality, and competitiveness. While these processes have led to progress in inter-institutional coordination and transparency, they have also generated tensions regarding institutional autonomy, academic identity, and the diversity of missions, thereby affecting the balance between external accountability and the core values of university institutions.

This axis therefore invites reflection on the limits and possibilities of educational reforms, and on the need to design more context-sensitive policies that recognize the historical, cultural, and organizational specificities of each higher education system.

3.4 Rankings and accreditation

This thematic axis analyses the role of international rankings, accreditation systems, and other external evaluation instruments as mechanisms that generate isomorphism in higher education. These mechanisms not only influence the public image of universities, but also shape their strategic decisions, organizational structures, and institutional priorities.

Global rankings, such as QS, Times Higher Education (THE), and the Academic Ranking of World Universities (ARWU), have established themselves as benchmarks of academic prestige. Although they vary in methodology, they all share the ability to influence the behavior of institutions, promoting competitive standardization aimed at improving their relative position in these tables. This pressure generates mimetic dynamics, in which universities tend to emulate the models of those at the top of the rankings, regardless of their own local context or institutional mission.

Authors such as Hazelkorn (2015) and Espeland and Sauder (2007) highlight that this logic produces organizational reactivity effects, meaning that universities tend to modify their policies and practices not necessarily to improve their intrinsic quality, but to align themselves with the indicators that define success according to international rankings. This phenomenon has been described as a case of performativity, in which metrics not only measure reality, but actively contribute to constructing it.

In this context, Jerry Z. Muller’s book The Tyranny of Metrics (Muller, 2018) offers an incisive critique of the excessive and uncritical use of quantitative indicators in sectors such as education, research, and public administration. The author warns that an obsession with measurement can lead to a loss of institutional purpose, distort priorities, and generate perverse incentives. Applied to the university setting, this approach suggests that blind reliance on numbers can blur the academic mission, reduce educational complexity to simplified parameters, and promote decisions guided more by visibility than by relevance or substantive quality.

Accreditation systems, both national and international, also operate as vectors of normative isomorphism. By establishing common standards and criteria for evaluating programmes or institutions, they create a framework that promotes organizational homogenisation. Through self-assessment, external auditing, and certification processes, accreditation agencies promote specific forms of governance, institutional culture, and academic management.

Research by authors such as Westerheijden et al. (2007) addresses the effects of these systems on the institutional autonomy and diversity of the university system. While accreditations help ensure minimum quality standards, they can also limit pedagogical innovation and promote rigid organizational models, especially when applied in a standardized manner and without considering the specific characteristics of each institution.

In this regard, some studies highlight the value of initiatives such as U-Multirank, which seek to offer a more multidimensional and contextualized view of university quality. However, the literature indicates that, even in these cases, there is a persistent tendency to reinforce logics of global competition and to prioritize easily quantifiable metrics.

This axis allows us to understand how benchmarking and external certification mechanisms generate isomorphic pressures that affect both established and emerging universities. The former tends to strengthen their positions through strategies of controlled differentiation, while the latter are forced to adopt the practices and structures of leading institutions to gain visibility and legitimacy.

Taken together, the documents reviewed warn of the risks of over-reliance on rankings and accreditations as instruments of institutional guidance. While they can contribute to improving transparency and accountability, their indiscriminate use can sometimes lead to a reductionist view of quality, based exclusively on external indicators and disconnected from the substantive missions of individual universities.

This axis underscores the need to build more diverse, participatory, and context-sensitive assessment systems that recognize the distinct trajectories, strengths, and challenges of higher education institutions.

3.5 Gray literature

The analysis of gray literature allows us to broaden our understanding of the regulatory and institutional framework surrounding quality processes in higher education. This category includes key technical, legislative, and strategic documents produced by international organizations, quality assurance agencies, and public administrations. Although not always indexed in scientific databases, these materials exert a direct influence on university policies and institutional practices.

Among the most relevant documents are the Bologna Declaration (Bologna, 1999), Standards and Guidelines for Quality Assurance in the European Higher Education Area (ESGs) formulated by the ENQA, ISO 21001:2018 (International Organization for Standardization (ISO), 2018) standard, the Fundación Europea para la Gestión de la Calidad [EFQM], 2020 model, and operational guidelines developed by agencies such as the National Agency for Quality Assessment and Accreditation (Agencia Nacional de Evaluación de la Calidad y Acreditación [ANECA], 2025) or the Madri+d Knowledge Foundation.

At the international level, the ESG guidelines have established themselves as a benchmark in the EHEA, promoting principles such as student orientation, continuous improvement, transparency, and stakeholder engagement. These standards provide a common framework that has been adapted by various national agencies such as ANECA in Spain, thus strengthening coherence between European assessment systems.

At the national regulatory level, Royal Decree 822/2021, establishing the organization of university education in Spain and integrating the principles of the EHEA into the local legal and educational context, stands out (Gobierno de España, 2021). This decree represents an effort to harmonize formal requirements with the global dynamics of quality assurance.

The ISO 21001:2018 (International Organization for Standardization (ISO), 2018) standard, promoted in Spain by Asociación Española de Normalización (AENOR) (2019) establishes a management system for educational organizations based on principles such as continuous improvement, stakeholder satisfaction, and process effectiveness. Its growing adoption in the university sector reflects a trend toward the technification and standardization of institutional management.

For its part, the EFQM model offers a comprehensive approach that integrates leadership, strategy, people, partnerships, resources, and results. In its 2020 version, it incorporates values such as sustainability, innovation, and long-term value creation, positioning itself as an advanced tool for universities seeking to go beyond regulatory compliance and embrace transformative management.

Overall, this review of gray literature indicates a progressive convergence between international, national, and regional quality frameworks. This alignment has facilitated the standardization of procedures, but it also poses significant challenges, such as the risk of homogenisation, bureaucratic rigidity, and a potential disconnect between standards and institutional realities.

The documents analyzed agree on the importance of moving toward more open, participatory, and contextualized systems, capable of recognizing institutional diversity and responding to the changing needs of contemporary educational environments.

4 Results

The consolidation of quality assurance systems in higher education has generated significant transformations in university structures. At the same time, it has given rise to a series of tensions, criticisms, and unforeseen effects that various studies have begun to analyze and problematise. This section brings together the main findings derived from the thematic analysis carried out on the 113 selected documents (see Table 1).

One of the most notable phenomena is policy-driven isomorphism, understood as the adoption of similar educational models in different countries in response to external pressures. The literature reviewed shows how globalization has encouraged regulatory convergence regarding educational quality, where the pursuit of international legitimacy tends to prevail over adaptation to local needs and characteristics.

We refine the concept of policy-driven isomorphism by clarifying that it complements, rather than duplicates, coercive isomorphism. While coercive pressures derive from binding legal mandates, policy-driven isomorphism refers to alignment generated through supranational coordination instruments, international standards and soft-governance mechanisms that encourage convergence without formal legal compulsion. This distinction helps explain forms of institutional homogenisation characteristic of the EHEA (European Higher Education Area), where persuasion, benchmarking and regulatory harmonization shape organizational behavior.

From this perspective, regulatory frameworks and international standards act as instruments of institutional alignment, promoting the homogenisation of structures, processes, and evaluation criteria. However, this trend can restrict the innovative capacity, hinder contextual adaptation, and weaken institutional diversity, which is a key value in higher education systems.

Based on the analysis of these documents, five main challenges currently facing quality systems were identified:

1. Regulatory homogenisation: The application of common standards reduces institutional diversity, with the risk of imposing uniform solutions in very different contexts.

2. Preponderance of quantitative indicators: The emphasis on objective metrics can generate a technocratic view of quality, neglecting paedagogical, social, or cultural dimensions.

3. Bureaucratisation of processes: The increasing formalization of evaluation mechanisms can result in an excessive administrative burden, diverting the focus from substantive improvement.

4. Institutional resistance: Changes driven from outside the university often encounter internal resistance stemming from established organizational cultures.

5. Functionalist approach to employability: The orientation of systems toward job placement as a central criterion can strain the critical and formative function of the university.

These challenges not only represent operational obstacles but also have structural implications for the way universities organize, evaluate, and project themselves. Table 4 summarizes, through a matrix, the relationship between these challenges and the most frequent consequences derived from them. This representation makes it possible to clearly visualize how certain logics of standardization, quantification, or bureaucratisation can compromise fundamental dimensions such as institutional diversity, academic autonomy, or the critical function of universities.

TABLE 4

Table 4. Relationship between challenges and resulting consequences.

Thematic analysis also allows us to observe which approaches are most represented in the current literature. The dominant axis is that of quality management, which confirms the central position acquired by evaluation and accountability processes in contemporary discourse on higher education. In contrast, the presence of fewer studies on the theoretical axis highlights the need for greater conceptual depth, especially from critical, comparative, and contextually-sensitive perspectives.

This classification exercise not only maps the state of the art, but also guides future research agendas. In particular, it suggests paying attention to under-explored topics such as:

• The impact of regulatory reforms on universities with less adaptive capacity.

• The role of agencies in peripheral contexts or those with low institutional autonomy.

• The competitive logic behind the development of quality instruments.

While some studies included in this review already incorporate case analysis as a methodology to explore these phenomena in depth, especially in national contexts, these remain limited in number. Their potential is considerable, as they allow us to link theoretical approaches to institutional isomorphism with the concrete ways in which universities adopt, resist, or adapt to reforms. In line with what has been previously proposed, case analyses are likely to become essential in future research to demonstrate how processes of translation, negotiation, or institutional decoupling are configured, offering a situated perspective that complements more general or normative approaches.

Ultimately, the results of this review point to a dual need: on the one hand, to advance a critical understanding of the isomorphic mechanisms at work in higher education; and on the other, to promote quality approaches that integrate participation, autonomy, and contextual relevance as necessary conditions for more inclusive, innovative, and socially engaged universities.

5 Discussion

This exploratory review mapped and analyzed recent academic production on the links between institutional isomorphism and quality management in higher education. The study reveals a clear trend toward organizational homogenisation, driven by political reforms, international standards, accreditation processes, and global competition dynamics.

Based on the analysis of 113 documents, it is clear that quality systems have become key instruments for ensuring institutional legitimacy and responding to demands for accountability, transparency, and continuous improvement. However, this evolution is not without tensions. Various studies warn of the risk of bureaucratisation, over-reliance on quantitative indicators, and the loss of diversity in university missions.

A key finding from the literature, and which needs to be addressed in greater depth, is the adverse effects associated with the expansion of metrics, rankings, and comparative performance systems. Although these instruments are presented as mechanisms for improving transparency, accountability, and international competitiveness, numerous studies warn that they can generate dynamics that negatively affect academic freedom, innovation, and epistemological diversity. Institutional pressure to improve quantitative indicators, such as graduation rates, research productivity, or impact measured by citations, can lead to forms of strategic behavior that prioritize what is measurable and comparable, to the detriment of other essential dimensions of the university mission.

This emphasis on numbers tends to displace academic activities that are less visible or valued by rankings, such as pedagogical innovation, interdisciplinary research, community work, or the production of local knowledge.

Likewise, the literature points out that international rankings contribute to reinforcing global hierarchies that privilege Anglo-Saxon models of excellence, pressuring universities, especially those in peripheral contexts, to orient their activity toward standards that do not always align with their social needs or national priorities. This dynamic can limit academic freedom by inducing departments and researchers to reorient their agenda to conform to external metrics, reducing the space for intellectual creativity and experimentation.

Furthermore, the standardization imposed by these systems encourages competitive isomorphism that discourages institutional and curricular diversity, generating a trend toward homogeneous programs, similar organizational structures, and academic cultures increasingly oriented toward market logic. In short, while metrics and rankings can provide useful information, their uncritical adoption can have significant costs for university autonomy, educational quality, and the ability of institutions to respond innovatively and contextually to emerging social challenges.

The literature agrees that institutional isomorphism does not manifest itself in a homogeneous or automatic manner. Universities, far from being passive agents, negotiate, adapt, or even resist external pressures depending on their history, structure, and context. In this sense, it is necessary to overcome deterministic visions and move toward more nuanced approaches, capable of recognizing complexity and institutional agency.

The reforms promoted by the European Higher Education Area and other international bodies have had an undeniable structural impact, but they must also be analyzed in terms of their unintended effects and their adaptation to local realities. The review of gray and regulatory literature shows a growing convergence between global models and national practices but also raises questions about the sustainability and relevance of certain standardized approaches.

Although much of the literature reviewed is based on European and North American contexts, incorporating the perspective of the Global South is essential to avoid reproducing a homogeneous and linear narrative of institutional change. In Latin America, Africa, and various regions of Asia, quality assurance dynamics and isomorphic pressures emerge in markedly different political, economic, and historical conditions. Higher education systems in these regions have often undergone rapid expansion, frequently in contexts of insufficient funding, uneven state capacities, and persistent tensions between public missions and market logic.

This contrast between European systems and contexts in the Global South allows us to understand that quality assurance processes and patterns of isomorphism do not advance in a linear or uniform manner. While a more institutionalized, stable model based on sophisticated external evaluation mechanisms predominates in Europe, in the Global South the dynamics are shaped by greater structural inequality, regulatory dependence, and capacity constraints. Consequently, although both spaces converge in the adoption of international standards and the search for legitimacy, the trajectories followed by universities differ profoundly: in Europe, strategic adaptation within consolidated systems can be observed, while in the Global South, hybrid configurations, adaptive responses, and forms of symbolic compliance linked to the need to balance global demands with local realities are emerging. Recognizing these differences is essential to avoid homogeneous interpretations of institutional change and to move toward quality frameworks that are truly contextualized, inclusive, and sensitive to global diversity.

From a practical perspective, the findings of this review provide relevant guidance for policymakers, quality assurance agencies, and university governance teams.

First, recognizing the differentiated nature of isomorphic pressures allows for progress toward less uniform and more context-sensitive regulatory frameworks that combine accountability with respect for institutional autonomy. Public officials should prioritize instruments that strengthen academic missions, avoiding bureaucratic burdens that shift attention to formal compliance.

Second, accreditation agencies can benefit from evaluative approaches that go beyond verifying procedures to promote substantive improvements and real organizational learning processes, thereby reducing the risk of superficial convergence.

Finally, university managers can use these results to understand how global pressures interact with internal capacities and institutional culture, guiding strategies that harmonize external demands with institutional identity, local priorities, and long-term development goals.

Beyond these practical implications, future research would benefit from greater methodological specificity.

To make these recommendations more concrete, future research should prioritize case studies examining how universities translate and negotiate quality assurance requirements in practice. Such studies–whether ethnographic, process-tracing or comparative–can reveal how isomorphic pressures are mediated by governance structures, professional cultures and resource conditions, particularly in low-capacity or peripheral systems. Comparative cases between Europe and the Global South would help explain why similar standards lead to divergent institutional trajectories.

Considering the findings of this review, several specific future lines of research are identified that may contribute to advancing the study of institutional isomorphism and quality systems in higher education:

Empirically analyze processes of institutional resistance through longitudinal case studies that examine how certain universities negotiate, reinterpret, or neutralize coercive and normative pressures, especially in contexts with low autonomy or unstable regulatory frameworks.

Investigate the impact of quality systems on teaching and curriculum innovation, incorporating mixed methodologies that allow for the identification of both inhibitory and facilitating effects, and comparing institutions with different levels of dependence on external indicators.

Examine the role of intermediate actors (agencies, consultancies, professional networks) in the production, translation, and circulation of quality standards, paying attention to how these actors contribute to the consolidation of isomorphic organizational fields.

Explore how isomorphism dynamics articulate with agendas of equity, inclusion, and social justice, through research that analyses whether evaluation frameworks reproduce inequalities or, conversely, can be adapted to promote differentiated social missions.

Develop comparative studies between Europe and the Global South to understand how institutional capacity, funding patterns, and historical legacies condition the adoption of international quality assurance models.

Delve into the unintended consequences of the expansion of metrics, rankings, and standardized evaluations, investigating how they affect academic creativity, epistemological diversity, and university governance.

From a critical and proactive perspective, this review suggests the need to rethink quality assurance systems from more flexible, participatory, and contextualized perspectives. In contrast to technocratic and uniformist logic, we advocate for models that recognize institutional diversity, promote responsible autonomy, and foster a culture of genuine quality, oriented toward learning, continuous improvement, and commitment to the environment.

In summary, this review provides an understanding of how neo-institutionalist approaches offer powerful analytical tools for interpreting the changes that universities are undergoing in the context of quality assurance. Beyond identifying patterns of isomorphism, there is a clear need to move toward studies that consider internal dynamics, cultural mediations, and local institutional frameworks. In this sense, the notion of institutional culture emerges as a key concept for analyzing not only the structures adopted, but also the values, practices, and decisions that shape the identity of university organizations. Looking ahead, it will be essential to strengthen research based on a case-analysis approach, allowing for a more in-depth look at how institutions reinterpret and negotiate reforms, particularly in peripheral contexts or those with limited autonomy. Only in this way will it be possible to balance the demands of accountability with the diversity, autonomy, and transformative mission of universities.

5.1 Limitations

This review has several limitations. First, it relies mainly on Scopus, Web of Science and Google Scholar, whose coverage favors European and Anglophone scholarship. Second, the use of English-language search terms limited the inclusion of studies published in other languages or in regional journals. Third, non-indexed national or institutional literature may have been omitted. As a result, the corpus displays a predominantly European and EHEA-centered orientation. These limitations should be considered when interpreting the findings, and highlight the need for future research drawing on more linguistically and geographically diverse sources.

Data availability statement

Publicly available datasets were analyzed in this study. This data can be found here: the study is based on published academic literature and publicly accessible institutional reports available in Scopus, Web of Science, and Google Scholar. There is no specific dataset or repository associated with this review.

Author contributions

SG: Formal analysis, Resources, Writing – original draft, Project administration, Data curation, Visualization, Conceptualization, Investigation, Writing – review & editing, Validation, Supervision, Funding acquisition, Software, Methodology. JR-A: Visualization, Funding acquisition, Resources, Validation, Formal analysis, Writing – original draft, Supervision, Investigation, Writing – review & editing, Methodology, Conceptualization.

Funding

The author(s) declared that financial support was received for this work and/or its publication. The publication of this article was funded by Antonio de Nebrija University.

Acknowledgments

We would like to thank the editors of Frontiers in Education – Higher Education for their guidance during the submission process. They also express their gratitude to colleagues and researchers whose ideas and discussions helped shape the conceptual framework of this study. Finally, they sincerely thank Nebrija University for its institutional support.

Conflict of interest

The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Generative AI statement

The author(s) declared that generative AI was used in the creation of this manuscript. This article involved the use of AI tools such as ChatGPT and Copilot to support writing and language improvement.

Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.

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