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- Andersson, Thomas, 1970-, et al.
(author)
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Institutional Work Through Interaction in Healthcare
- 2017
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In: Academy of Management Proceedings. - : Academy of Management.
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Conference paper (peer-reviewed)abstract
- This study examines how interactions between individual actors can form institutional work in a highly institutionalized setting. Recent progress within the institutional logics perspective has directed focus to the roles of individual actors, their strategic actions, and how institutional logics may be interpreted and rebalanced. However, these contributions are founded on individual actors’ identity processes, but not on how institutional work can be performed through interactions among individual actors adhering to different institutional logics. We performed a qualitative case study, based on observations and interviews, with a focus on quality-improvement work performed in a hospital. The study affirmed that institutional work primarily maintains and upholds the rigidity of healthcare organizations, by interactions that either preserve the distance between different institutional logics or prevent their mutual influence on each other. However, when institutional work transcends maintaining – towards creating or disrupting – the interaction is characterized both by acts of claiming influence and acts of granting influence between actors adhering to different institutional logics. Nonetheless, these interactions are dependent upon the approaches of the physicians; such interactions start with the physicians either being granted influence or granting influence – influence that can later be claimed by the other actor. As such, although the coexistence of different institutional logics is currently an established phenomenon in healthcare, we illustrate how institutional work is contingent upon the dominating professional logic of physicians.
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- Eriksson, Erik, 1977, et al.
(author)
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Post-New Public Management in Public Healthcare: Recycled, Hybridized, Paradigmatic?
- 2019
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In: British Academy of Management (BAM) 2019 Conference. - : British Academy of Management.
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Conference paper (peer-reviewed)abstract
- New Public Management (NPM) is increasingly used pejoratively and claimed unfit for the complex challenges in contemporary societies, for example aging population structures and, as a result, increased number of cancer patients. Consequently, post-NPM gains increased attention. Drawing from a longitudinal case in Swedish cancer care, the present article seeks to pinpoint post-NPM in public healthcare practice. It is revealed that some post-NPM aspects are recycled by combining traditional public administration (pre-NPM) and NPM aspects: the former’s re-professionalisation is combined with the latter’s foci on performance measures, decentralisation, and accountability. Other post-NPM aspects are hybridizing typical NPM aspects with new (post-NPM) aspects: for instance, customer-focus is taken further to include the patient’s active participation in co-designing services, and standardization is reinterpreted to concern meeting-places rather than efficiency. Yet other aspects are replacing NPM shortcomings: for instance, trust is replacing control, and a systems approach is replacing the intra-organisational focus
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- Gadolin, Christian, 1987-, et al.
(author)
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Healthcare quality improvement work : a professional employee perspective
- 2017
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In: International Journal of Health Care Quality Assurance. - : Emerald Publishing Limited. - 0952-6862 .- 1758-6542. ; 30:5, s. 410-423
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Journal article (peer-reviewed)abstract
- PurposeThe purpose of this paper is to describe and analyze conditions that influence how employees engage in healthcare quality improvement (QI) work.Design/methodology/approachQualitative case study based on interviews (n=27) and observations (n=10).FindingsThe main conditions that influence how employees engage in healthcare QI work are professions, work structures and working relationships. These conditions can both prevent and facilitate healthcare QI. Professions and work structures may cement existing institutional logics and thus prevent employees from engaging in healthcare QI work. However, attempts to align QI with professional logics, together with work structures that empower employees, can make these conditions increase employee engagement, which can be accomplished through positive working relationships that foster institutional work, which bridge different competing institutional logics, making it possible to overcome barriers that professions and work structures may constitute.Practical implicationsUnderstanding the conditions that influence how employees engage in healthcare QI work will make initiatives more likely to succeed.Originality/valueHealthcare QI has mainly been studied from an implementer perspective, and employees have either been neglected or seen as passive resisters. Weak employee perspectives make healthcare QI research incomplete. In our research, healthcare QI work is studied closely at the actor level to understand healthcare QI from an employee perspective.
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