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- Andersson, Thomas, 1970-, et al.
(författare)
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Co-optation as a response to competing institutional logics : Professionals and managers in healthcare
- 2018
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Ingår i: Journal of Professions and Organization. - : Oxford University Press. - 2051-8803 .- 2051-8811. ; 5:2, s. 71-87
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Tidskriftsartikel (refereegranskat)abstract
- Researchers working under the institutional logics perspective find the struggle between managerial logic and various professional logics one of the most intriguing issues in healthcare organizations. Previous research provided several explanations at both the organizational level (mediation, hybridization, and selective coupling) and the individual actor level (hierarchization, sense making, reinterpretation, and hijacking) for the coexistence of professional and managerial logics in healthcare. However, all of these explanations are based on the underlying institutional logics not changing. In this article, we show that co-optation can explain the coexistence of institutional logics, but that it also causes the underlying institutional logics to change. Co-optation means that an actor adopts a strategic element from another logic that retains the most important elements of its own logic. Empirically, this article illustrates co-optation processes through a qualitative study of outpatient units in child and adolescent psychiatric care in Sweden. Using an institutional logics framework, we describe and explain how managers co-opted elements of professional logics and professionals co-opted elements of managerial logic in their attempts to support their own interests. Even if co-optation is performed to protect the home logic, the co-opted elements ultimately change it. This study contributes to the institutional logics framework by describing and explaining how co-optation can be a dynamic response to competing logics at the individual actor level.
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| 2. |
- Andersson, Thomas, et al.
(författare)
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Does patient-centred care mean risk aversion and risk ignoring? : Unintended consequences of NPM reforms
- 2012
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Ingår i: International Journal of Public Sector Management. - : Emerald Group Publishing Limited. - 0951-3558 .- 1758-6666. ; 25:4, s. 260-271
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Tidskriftsartikel (refereegranskat)abstract
- Purpose – This article aims to describe and analyze the results of efforts to improve patient-centered care (PCC) in psychiatric healthcare.Design/methodology/approach – Using the methodology of a qualitative case study, the authors studied three Swedish child and adolescent psychiatric care (CAP) units in order to describe how patient-centered actions are performed. They conducted 62 interviews, made 11 half-day observations, and shadowed employees for two days.Findings – The article shows that the increased focus on accountability for unit performance and medical risks results in unintended consequences. The patient’s medical risk is transformed to a personal risk for the psychiatrist and the resource risk is transformed to a personal risk for the unit manager. Patients become risk objects for both psychiatrists and unit managers, which creates an alignment between them to try to send patients elsewhere. New public management (NPM) reforms may consequently lead to the institutionalization of unintended healthcare practices.Practical implications – The article shows that accountability pressure to reduce patient risk may create new risks for patients.Originality/value – The study uses theoretical concepts of risk tradeoffs (risk substitution and risk transformation), which were developed for the macro level, to explain the unintended consequences of NPM reforms at the micro level.
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| 4. |
- Andersson, Thomas, et al.
(författare)
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Medarbetarskap, professioner och samarbeten internt och externt
- 2012
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Ingår i: Studiematerial: Hållbart chefskap i hälso- och sjukvården med vinjetter om engagemang, stress, tidsanvändning, medarbetarskap och vårdpraktik. - : Västra Götalandsregionen. - 9789163704864 ; , s. 30-43
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Bokkapitel (refereegranskat)
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| 5. |
- Andersson, Thomas, et al.
(författare)
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Multiprofessional cooperation and accountability pressures. Consequences of a post-new public management concept in a new public management context
- 2012
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Ingår i: Public Management Review. - : Informa UK Limited. - 1471-9037 .- 1471-9045. ; 14:6, s. 835-855
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Tidskriftsartikel (refereegranskat)abstract
- This article examines how multiprofessional healthcare teams, working as a post-New Public Management (post-NPM) reform, respond to accountability pressure resulting from the implementation of NPM reforms. The team members use three strategies to respond to this pressure: responsibility avoiding that results in conflict; responsibility ignoring that results in parallel work and responsibility sharing that results in cooperation. Depending on how the professionals respond to different contextual factors, the choice of strategies can either foster or inhibit cooperation in multiprofessional teams. Achieving holistic patient care is threatened when accountability pressure increases for teams that have not yet developed their internal routines of cooperation.
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| 8. |
- Liff, Roy, 1951, et al.
(författare)
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Experts' contribution to strategy when strategy is absent. A case study of quality experts in hospitals
- 2021
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Ingår i: Public Management Review. - : Informa UK Limited. - 1471-9037 .- 1471-9045. ; 23:9
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Tidskriftsartikel (refereegranskat)abstract
- This study investigates how new categories of experts can contribute to strategy development in public organizations. Interplay between managers and experts was analysed using principal-agent theory, stewardship theory, and partnership theory, each assigning the experts different kinds of strategic contribution. Results show that experts may contribute to an iterative and emergent strategy process as stewards through a consultative process method that lets the means guide the goals. Experts' knowledge of what other actors in the organization perceive as important guides the experts' application of the technical methods and processing.
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| 9. |
- Liff, Roy, et al.
(författare)
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The multi-professional team as a post-NPM control regime : Can it integrate competing control regimes in healthcare?
- 2013
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Ingår i: Offentlig Förvaltning. Scandinavian Journal of Public Administration. - Göteborg : Göteborgs universitet. - 2000-8058 .- 2001-3310. ; 16:2, s. 45-67
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Tidskriftsartikel (refereegranskat)abstract
- This paper focuses on multi-professional teams (MPT) as a potential post New Public Management (NPM) control regime in order to develop individualistic and holistic care in healthcare in the context of two competing logics: managerialism and professionalism. In a qualitative case study, three outpatient Child and Adolescent Psychiatric (CAP) care units are investigated using interviews, observations and shadowing. The study shows that the MPT has an integrative effect on the two logics when informal alliances are formed between psychologists/psychiatrists and unit managers. We conclude that the MPT may achieve patient care in a resource-effective and professional way but not individualistic and holistic care. An explanation may be that individualistic and holistic care is neither measurable/quantifiable as required by the resource-effectiveness goal nor in focus as a consequence of the logic of professionalism. A theoretical implication is that the negative effect of NPM on the professionals’ autonomy is mitigated by the MPT. Earlier studies may have underestimated the importance of “hard facts” introduced by a strong control regime, in this case, the NPM context. The control regime may take over and create collaboration; nonetheless, the outcome is not entirely the desired one.
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