The Influence of Institutional Logics and Emotions on the Uptake of Cervical Cancer Screening: A Case Study From Xai-Xai, Mozambique

This study investigates the role of emotional attachment to competing institutional logics on women's uptake of cervical cancer screening in Mozambique. Through a qualitative study conducted in Xai-Xai, Southern Mozambique, we identify 2 concurrent logics in the context of screening: preservation logic, influenced by social-cultural norms, and the prevention logic, centered around screening. Women, affected by emotions such as shame, fear, and marital subordination, often become attached to the preservation logic, which influences their values and contradicts acceptance of screening. However, some women with marital autonomy may reflect on both logics and gradually detach themselves from the preservation norms and show their intention to adopt life-saving behavior by accepting screening. It is through their emotions that women show their attachment to and detachment from competing logics, reinforcing traditional norms on the one hand, or giving them the means to adopt preventive measures on the other. The study indicates that cultural expectations, shame and the desire to preserve intimacy tie women to the logic of preservation and have a negative impact on participation in cervical cancer screening. Consequently, to improve screening uptake in Mozambique, the authorities need to adapt screening to socio-cultural and emotional factors, empower women, and effectively engage communities.

Multidisciplinary Collaboration in Hospitals via Patient- and Process-Oriented Units: A Longitudinal Study

Introduction

The complexity of healthcare is increasing, mainly due to the prevalence of multimorbidity in an ageing population. Complex care for patients with multimorbidity requires a multidisciplinary approach. Traditional physician-centered hospital structures do not facilitate the necessary multidisciplinary collaboration. European hospitals are implementing process-based hospital designs with patient- and process-oriented units to stimulate multidisciplinary collaboration. Patient-oriented units are formed based on shared patient groups and focus on care trajectories, while process-oriented units are formed based on having similar processes and focus on efficiency.

Purpose

This study has two aims. First, to study the effect of introduction of these units on multidisciplinary collaboration and perceived impact (efficiency, innovation, and effectiveness). Second, to study whether there are differences between patient- and process-oriented units.

Methods

A survey-based longitudinal evaluation study was conducted in 2020 and 2022 among physicians in a Dutch hospital to measure multidisciplinary collaboration (relational coordination) and perceived impact (efficiency, innovation, and effectiveness). In addition, open questions were used to enrich the data.

Results

Quantitative and qualitative data together suggest that physicians in patient-oriented units notice benefits from the redesign to multidisciplinary units, they perceive higher impact over time. Physicians in process-oriented units achieve a better relationship with the physicians in their unit over time, but they do not perceive impact as high as physicians in patient-oriented units.

Conclusion

A process-based design with patient- and process-oriented units is supportive of multidisciplinary collaboration and perceived impact, especially for physicians in patient-oriented units. Physicians in patient-oriented units are positive about the introduction of these units as they feel it contributes to better multidisciplinary patient care. As the results for physicians in process-oriented units may be less directly visible in terms of quality of care, they are less likely to see positive effects, even though their relationships are improving.

How Professional and Market Logics and the Conflict between Institutional Demands Affect Hospital Accreditation Compliance: A Multiple-Case Study in Brazil

Hospital accreditation has become ubiquitous in developing countries. While research acknowledges that accreditation can enhance healthcare quality, efficiency, and safety, concerns persist regarding hospitals' management of conflicts stemming from the diverse institutional logic inherent in this process. Therefore, this study aimed to investigate how professional and market logic, alongside conflicts arising from institutional demands, affect compliance with hospital accreditation. To this end, we conducted a multiple-case study in four Brazilian hospitals employing in-depth interviews and on-site observations. The triangulation of narrative analysis and the outcomes of multiple correspondence analysis revealed that when professional logic predominates, there is a greater propensity to tailor accredited activities by segmenting the tasks between physicians and nurses with the intention of mitigating existing conflicts. Conversely, when conflicts occur over established goals between professionals and orientated marked logic executives, the accreditation process is impeded, resulting in non-compliance. Ultimately, the findings underscore the alignment between the pursuit of legitimacy and efficiency within the accreditation process. We conclude by delineating the theoretical and practical implications of scrutinizing the internal dynamics of institutional logic.

Hybridity enabled: A research synthesis of the enabling conditions for hybrid professionalism in healthcare

Hybrid professionals in healthcare organizations play a critical role, the characteristics, processes and implications of which have been thoroughly studied by scholars in the field. However, not as much attention has been paid to the conditions under which such roles might be taken by professionals entering the ground of management. This gap results into a lack of conceptual clarity and eventually ends being an obstacle in framing and ameliorating the tools needed to act such a role in its different phases. This is a research area worthy of a finer-grained understanding: the ability of organizations to effectively support role hybridization, in fact, is a requisite for professionals-managers' willingness to stay in the role and cope with the complexity that such a two-fold position entails, no matter what. Based on the results of a scoping literature review, this paper presents the enabling conditions for hybrid professionalism in healthcare, and proposes a classification of them into categories corresponding to different facets of hybrid role-taking: opportunities for interaction with management, tools supporting sense-making, and provision of delegation and autonomy. For each of these categories, organizational and management tools discussed in the literature are presented. The results of the study provide a road-map of the enabling conditions for hybrid professionalism that aims to be of practical convenience for managers and policy-makers in health care. Eventually, suggestions for organizational design and personnel management, as well as directions for further research, are highlighted.

Trust in interagency collaboration: The role of institutional logics and hybrid professionals

Interagency collaboration among social workers, teachers, and police is key to countering violent extremism in the Nordic countries by securing comprehensive assessment of cases of concern. Yet, previous research indicates that different institutional logics—perceptions of fundamental goals, strategies, and grounds for attention in efforts to counter violent extremists—exist across professions and challenge collaboration and trust building in practice. In this article, we empirically investigate these claims across social workers (n = 1,105), teachers (n = 1,387), and police (n = 1,053) in four Nordic countries: Denmark, Sweden, Norway, and Finland. Using results from online surveys with professionals, we investigate the distribution of a ‘societal security logic’ and a ‘social care logic’ across professions and the degree to which these institutional logics translate into mutual trust. Through a comparison of institutional logics among practitioners with and without practical experience of interagency collaboration, we investigate whether and how institutional logics tend to mix and merge in hybrid organizational spaces. We conclude that differences in institutional logics across professions are differences in degree rather than in kind, but that such differences are important in shaping mutual trust and that experiences of interagency collaboration are correlated with a convergence toward a ‘social care logic’ conception of countering violent extremism.

Working on connective professionalism: What cross-sector strategists in Swedish public organizations do to develop connectivity in addressing ‘wicked’ policy problems

In light of current debates on ‘protective’ and ‘connective’ professionalism, this article explores a new type of occupational position that is emerging within the Swedish public sector: the cross-sector strategist. The growing presence of this intermediary occupational position is seen as attempts to formalize and institutionalize the imprecise roles and governance of ‘wicked’ policy problems, and the job of these strategists is focused on supporting other jurisdictions to meet and act. By pursuing connective strategies in the form of triggering, selling, bridging, brokering, and forming accountabilities, cross-sector strategists seek to establish embedded workspaces where strategic action and decisions can be produced jointly and across jurisdictional boundaries. The study illustrates how calls for changes in professional action towards connectivity are now part of the formal organizational structure of public sector organizations, confirming the incapability of professional actors to connect in the absence of intermediary support functions. In the concluding discussion, we consider the relevance of ‘connective professionalism’ as a descriptive theoretical device applied to work settings understood as increasingly complex and interdependent, with calls for inter-professional collaboration and intensifying engagement in preventing problems rather than simply treating them.

Key issues of health and safety for workers in residential aged care: An expert study

Introduction

Residential aged care (RAC) represents a fast-growing sector within Australia's health care system and is characterized by high levels of workplace injury. To better understand this injury problem, this study investigated key informant perspectives concerning sector occupational health and safety (OHS) focused on key issues associated with the risk of worker injury.

Method

Semi-structured interviews were undertaken with nine key informants representing (OHS) specialists, healthcare employers, regulators, worker association representatives, and academic researchers in OHS or healthcare. Interviews were transcribed verbatim and analyzed using thematic analysis.

Results

This study identified six themes on OHS within RAC including (i) the physical and emotional nature of the work, (ii) casualization of employment, (iii) prioritization, (iv) workforce profile, (v) OHS role construction, and (vi) clinical standards. The study highlighted differences in OHS roles between RAC and other safety-critical sectors regarding governance and management of OHS. The key informants identified a propensity within RAC to downplay or disregard worker OHS issues justified through prioritizing resident safety. Further, neither OHS professional nor institutional logics are prominent in RAC leadership and decision-making where the emphasis is placed on mandatory standards to maintain funding purposes. Several recommendations are made to address identified issues.

The development of the concept of return-on-investment from large-scale quality improvement programmes in healthcare: an integrative systematic literature review

BACKGROUND

Return on Investment (ROI) is increasingly being used to evaluate financial benefits from healthcare Quality Improvement (QI). ROI is traditionally used to evaluate investment performance in the commercial field. Little is known about ROI in healthcare. The aim of this systematic review was to analyse and develop ROI as a concept and develop a ROI conceptual framework for large-scale healthcare QI programmes.

METHODS

We searched Medline, Embase, Global health, PsycInfo, EconLit, NHS EED, Web of Science, Google Scholar using ROI or returns-on-investment concepts (e.g., cost-benefit, cost-effectiveness, value). We combined this terms with healthcare and QI. Included articles discussed at least three organisational QI benefits, including financial or patient benefits. We synthesised the different ways in which ROI or return-on-investment concepts were used and discussed by the QI literature; first the economically focused, then the non-economically focused QI literature. We then integrated these literatures to summarise their combined views.

RESULTS

We retrieved 10 428 articles. One hundred and two (102) articles were selected for full text screening. Of these 34 were excluded and 68 included. The included articles were QI economic, effectiveness, process, and impact evaluations as well as reports and conceptual literature. Fifteen of 68 articles were directly focused on QI programme economic outcomes. Of these, only four focused on ROI. ROI related concepts in this group included cost-effectiveness, cost-benefit, ROI, cost-saving, cost-reduction, and cost-avoidance. The remaining articles mainly mentioned efficiency, productivity, value, or benefits. Financial outcomes were not the main goal of QI programmes. We found that the ROI concept in healthcare QI aligned with the concepts of value and benefit, both monetary and non-monetary.

CONCLUSION

Our analysis of the reviewed literature indicates that ROI in QI is conceptualised as value or benefit as demonstrated through a combination of significant outcomes for one or more stakeholders in healthcare organisations. As such, organisations at different developmental stages can deduce benefits that are relevant and legitimate as per their contextual needs.

TRIAL REGISTRATION

Review registration: PROSPERO; CRD42021236948.

If It Is Complex, Let It Be Complex - Dealing With Institutional Complexity in Hospitals Comment on "Dual Agency in Hospitals: What Strategies Do Managers and Physicians Apply to Reconcile Dilemmas Between Clinical and Economic Considerations?"

Waitzberg and colleagues identified strategies that managers and physicians in hospitals apply to reconcile dilemmas between clinical and economic considerations. Contributions that actually acknowledge the institutional complexity of hospitals and describe how to deal with it are rare. This comment explains the reason behind the institutional complexity in healthcare organizations and argues that institutional complexity is a good foundation for a well-functioning and sustainable healthcare, as long as we are able to deal with this complexity. This point underscores the importance of their contribution. However, even if the identified strategies on how to reconcile and balance different, competing demands are important, they are not easy to apply in practice. First, the strategies require frequent and high-quality interaction between different actors adhering to different institutional logics. Second, even when the strategies are applied successfully, it is difficult to make them sustainable since they rest on a fragile balance between competing logics. However, these are important avenues for future research for researchers who want to follow the route of Waitzberg and colleagues.

Clinicians' psychological empowerment to engage in management as part of their daily work

PURPOSE

The purpose of the article is to analyze how physicians and nurses, as the two major health care professions, experience psychological empowerment for managerial work.

DESIGN/METHODOLOGY/APPROACH

The study was designed as a qualitative interview study at four primary care centers (PCCs) in Sweden. In total, 47 interviews were conducted, mainly with physicians and nurses. The first inductive analysis led us to the concept of psychological empowerment, which was used in the next deductive step of the analysis.

FINDINGS

The study showed that both professions experienced self-determination for managerial work, but that nurses were more dependent on structural empowerment. Nurses experienced that they had competence for managerial work, whereas physicians were more ignorant of such competence. Nurses used managerial work to create impact on the conditions for their clinical work, whereas physicians experienced impact independently. Both nurses and physicians experienced managerial work as meaningful, but less meaningful than nurses and physicians' clinical work.

PRACTICAL IMPLICATIONS

For an effective health care system, structural changes in terms of positions, roles, and responsibilities can be an important route for especially nurses' psychological empowerment.

ORIGINALITY/VALUE

The qualitative method provided a complementary understanding of psychological empowerment on how psychological empowerment interacted with other factors. One such aspect was nurses' higher dependence on structural empowerment, but the most important aspect was that both physicians and nurses experienced that managerial work was less meaningful than clinical work. This implies that psychological empowerment for managerial work may only make a difference if psychological empowerment does not compete with physicians' and nurses' clinical work.

Dual Agency in Hospitals: What Strategies Do Managers and Physicians Apply to Reconcile Dilemmas Between Clinical and Economic Considerations?

BACKGROUND

Hospital professionals are "dual agents" who may face dilemmas between their commitment to patients' clinical needs and hospitals' financial sustainability. This study examines whether and how hospital professionals balance or reconcile clinical and economic considerations in their decision-making in two countries with activity-based payment systems.

METHODS

We conducted 46 semi-structured interviews with hospital managers, chief physicians and practicing physicians in five German and five Israeli hospitals in 2018/2019. We used thematic analysis to identify common topics and patterns of meaning.

RESULTS

Hospital professionals report many situations in which activity-based payment incentivizes proper treatment, and clinical and economic considerations are aligned. This is the case when efficiency can be improved, eg, by curbing unnecessary expenditures or specializing in certain procedures. When considerations are misaligned, hospital professionals have developed a range of strategies that may contribute to balancing competing considerations. These include 'reshaping management,' such as better planning of the entire course of treatment and improvement of the coding; and 'reframing decision-making,' which involves working with averages and developing tool-kits for decision-making.

CONCLUSION

Misalignment of economic and clinical considerations does not necessarily have negative implications, if professionals manage to balance and reconcile them. Context is important in determining if considerations can be reconciled or not. Reconciling strategies are fragile and can be easily disrupted depending on context. Creating tool-kits for better decision-making, planning the treatment course in advance, working with averages, and having interdisciplinary teams to think together about ways to improve efficiency can help mitigate dilemmas of hospital professionals.

When multiple logics initiate a butterfly effect: the case of locum tenens physicians in Germany

Modern work structures and organizations are often characterized by the simultaneous existence of multiple logics. Research has made profound efforts in describing a wide range of possible responses to different constellations of multiple logics in recent decades. But less is known about the subsequent effects of those responses. Since responses to multiple logics aim to change the initial constellation, they are likely to provoke counter-responses that alter the new constellation. Thus, as butterfly effect, certain strategies in dealing with multiple logics can initiate a series of responses that can lead to a fundamental change in the constellations of logics. The rise and fall of locum tenens physicians in Germany illustrate how series of responses can evolve, increase, and fundamentally alter the given constellation of logics. Thereby, our multi-method study also sheds light on the role of omnipresent actors and raises the question of how the actors can be theorized in a setting of multiple logics.

Family members as hybrid owner-managers in family-owned newspaper companies: handling multiple institutional logics

Purpose

This article aims to increase the understanding of the role of individual actors and arenas in dealing with multiple institutional logics in family firms.

Design/methodology/approach

This study follows a case-study approach of two family-owned newspaper companies. Based on interviews and secondary sources, the empirical material was analysed focussing on three institutional logics, that is, family logic, management logic and journalistic logic.

Findings

First, the authors show how and in which arenas competing logics are balanced in family-owned newspaper companies. Second, the authors highlight that family owners are central actors in the process of balancing different institutional logics. Further, they analyse how family members can become hybrid owner-managers, meaning that they have access to all institutional logics and become central actors in the balancing process.

Originality/value

The authors reveal how multiple institutional logics are balanced in family firms by including formal actors and arenas as additional lenses. Therefore, owning family members, especially hybrid owner-managers, are the best-suited individual actors to balance competing logics. Hybrid owner-managers are members of the owner families who are also skilled in one or several professions.

Remote Working in a Public Bureaucracy: Redeveloping Practices of Managerial Control When Out of Sight

This article examines managerial control practices in a public bureaucracy at the moment of introducing remote work as part with a new ways of working (NWW) project. The qualitative study builds on 38 interviews with supervisors and subordinates conducted before the advent of COVID-19. By interpreting interviewees' conversations about current and anticipated future work practices in the changing work setting, we reveal tacit and hidden practices of managerial control that are currently prevalent in many organizations introducing remote working. Three constitutive moments of the organization's transformation to NWW are analytically distinguished: (i) how implicit becomes explicit, (ii) how collective becomes self, and (iii) how personal becomes impersonal. Our findings emphasize that the transition to NWW must take into account prevailing institutional logics and must reconnect to a fundamental and often neglected question: What does doing work mean within the particular organization? Negotiating this fundamental question might help to overcome supervisors' uncertainties about managerial control and provide clarity to subordinates about what is expected from them while working remotely. Finally, we discuss how the transition to NWW may serve as both an opportunity and a potential threat to established organizational practices while highlighting the challenge supervisors face when the institutional logics conflict with remote working.

Hijacking institutional logics in the implementation of a cancer trial

Practice-based studies have demonstrated how institutional logics function as repertoires of cultural resources that actors may use strategically for professional (re-)positioning. This article focuses on the concept of hijacking based on a qualitative study of the implementation of a randomized controlled trial (RCT) in specialized cancer palliation. Using the logics-as-resources perspective as theoretical framing, we describe the negotiations and hijacking of logics that followed the introduction of the RCT and the temporary reversal of home logics between professional subgroups in cancer treatment and care. The analysis shows how hijacking unfolds in a highly institutionalized and complex professional healthcare setting characterized by intra-institutional heterogeneity. We contribute to the literature by highlighting how hijacking is related to power differentials and identity work and may contribute to obscuring underlying conflicts, in this case between science and care logics. The article develops our understanding of hijacking as a theoretical concept and an empirical phenomenon.

The relational road to voice: how members of a low-status occupational group can develop voice behavior that transcends hierarchical levels

Members of frontline low-status occupational groups often have access to a vast pool of knowledge, expertise, and experience that may be valuable for organizations. However, previous research has shown that members of these occupational groups are often reluctant to exhibit voice behavior due to their low position in the organizational hierarchy and perceived status differences. Drawing on in-depth interviews with auxiliary nurses (ANs) who participated in a development trajectory, as well as with their colleagues and supervisors, we demonstrate how members of this low-status occupational group develop voice behavior. Our findings show how acquiring three different types of knowledge and acting on this knowledge can lead to forming new and different types of relationships with members of higher status occupational groups in the organization. Subsequently, these relational changes enhanced voice behavior, as the ANs under study became more skillful in navigating the organization and felt better equipped to share their ideas, concerns, and perspective. We contribute to the literature on voice behavior by members of low-status occupational groups by moving beyond the findings of previous studies that have shown that low-status employees are unlikely to exhibit voice behavior. We detail how the development of knowledge, as well as relationships between different occupational groups, is crucial for the enhancement of voice behavior that transcends hierarchical levels. Moreover, we add to the literature on upward influence of subordinates by showing how such voice allows subordinates to exert upward influence in their organizations and initiate change that benefits their own occupational group.

Practicing Integrated Care Pathways in Norwegian Hospitals: Coordination through Industrialized Standardization, Value Chains, and Quality Management or an Organizational Equivalent to Improvised Jazz Standards

The goal of coordinating pathways for cancer patients through their diagnostic and treatment journey is often approached by borrowing strategies from traditional industries, including standardization, process redesign, and variation reduction. However, the usefulness of these strategies is sometimes limited in the face of the complexity and uncertainty that characterize these processes over time and the situation at both patient and institutional levels. We found this to be the case when we did an in-depth qualitative study of coordination processes in patient pathways for three diagnoses in four Norwegian hospitals. What allows these hospitals to accomplish coordination is supplementing standardization with improvisation. This improvisation is embedded in four types of emerging semi-formal structures: collegial communities, networks, boundary spanners, and physical proximity. The hierarchical higher administrative levels appear to have a limited ability to manage and support coordination of these emerging structures when needed. We claim that this can be explained by viewing line management as representative of an economic-administrative institutional logic while these emerging structures represent a medical-professional logic that privileges proximity to the variation and complexity in the situations. The challenge is then to find a way for emergent and formal structures to coexist.

Medical hybridity and beyond: professional transitions in Italian outpatient settings

The marketization of public healthcare has brought about organizational transformations, affecting health professionals' ways of working in hospitals and outpatient organizations. As a result of the reforms in the 1990s, the principle of business-like healthcare has been introduced in the Italian health system. This paper presents the main findings of a study of specialist doctors working in two local health organizations in the Tuscany region. Drawing on semi-structured interviews with specialist doctors working in an outpatient setting, the article examines the manifold reactions to changes of the medical profession within outpatient settings. In particular, the combination of professional and organizational dimensions has been taken into consideration. The results show that a change is involving outpatient specialist doctors' identity: organizational change affects several dimensions of the medical professional ethos. The change has been understood by categorizing three major types of approaches to medical professionalism, which are aimed to understand the complexity of the domain and to summarize professionals' reactions: the first is linked to a traditional model of professionalism; the second accepts partially business-like organizational issues, while trying to create individual spaces of autonomy in daily tasks; the third co-opts new organizational issues, which become part of the medical professional ethos.

The balancing act of organizing professionals and managers: An ethnographic account of nursing role development and unfolding nurse-manager relationships

Scholars describe organizing professionalism as ‘the intertwinement of professional and organizational logics in one professional role’. Organizing professionalism bridges the gap between the often-described conflicting relationship between professionals and managers. However, the ways in which professionals shape this organizing role in daily practice, and how it impacts on their relationship with managers has gained little attention. This ethnographic study reveals how nurses shape and differentiate themselves in organizing roles. We show that developing a new nurse organizing role is a balancing act as it involves resolving various tensions concerning professional authority, task prioritization, alignment of both intra- and interprofessional interests, and internal versus external requirements. Managers play an important yet ambiguous role in this development process as they both cooperate with nurses in aligning organizational and nursing professional aims, and sometimes hamper the development of an independent organizing nursing role due to conflicting organizational concerns.

Logic fluidity: How frontline professionals use institutional logics in their day-to-day work

This article aims to gain a better understanding on micro processes of how frontline professionals use institutional logics in their day-to-day work. It contributes to the growing literature on the dynamics between institutions and the professional frontline. To further develop this field of study, a conceptual framework is presented that integrates institutional logics, vocabularies of practice, and narratives as central concepts. By adopting a composite narrative approach and identifying vocabularies of practice, the article interprets how frontline professionals make use of different logics to make sense of a new principle introduced in their professional field. Findings are based on a case study of professional patient collaboration in healthcare. The article composes five narratives that act as vehicles through which healthcare professionals use five logics: a medical professional logic, managerial logic, commercial logic, consultation logic, and patient-centeredness logic. It argues that frontline professionals use vocabularies of practice to assemble narratives that help them to navigate between a plurality of logics. It further shows that professionals move fluently from one narrative to another, critiquing the ideas of adherence to a dominant logic and conflict solving. The article finalizes with a discussion that advocates for a process studies perspective and a stronger focus on micro processes in research on professional performance in the context of institutional plurality.

Providing healthcare through “value shops”: impact on professional fulfilment for physicians and nurses

Purpose

The purpose of this paper is to empirically explore and demonstrate the ability of healthcare professionals to attain professional fulfilment when providing healthcare inspired by “value shops”.

Design/methodology/approach

A qualitative case study incorporating interviews and observations was conducted.

Findings

The empirical data suggest that the professional fulfilment of both physicians and nurses is facilitated when care is organized through “value shops”. Both groups of professionals state that they are able to return to their “professional core”.

Originality/value

The beneficial outcomes of organizing healthcare inspired by the “value shop” have previously been explored in terms of efficiency and quality. However, the professional fulfilment of healthcare professionals when providing such care has not been explicitly addressed. Professional fulfilment is vital in order to safeguard high-quality care, as well as healthcare professionals' involvement and engagement in implementing quality improvements. This paper highlights the fact that care provision inspired by the “value shop” may facilitate professional fulfilment, which further strengthens the potential positive outcomes of the “value shop” when utilized in a healthcare setting.

Professional employees and professional managers: conflicting logics, hybridity, and restratification

A plethora of studies have documented the changing nature of professional work and the organizations in which it takes place. Among the most documented trends are the emergence of managerial–professional hybrid workers and professional (re)stratification. Although the links between these two trends have been noted, their interconnections have not been fully explored. This article analyzes data from a mixed-methods study of professional engineers in Ontario, Canada, to explore the extent to which they experience conflicting logics, hybridity, resistance, and restratification. Findings indicate that many engineers could be classified as hybrid, as they see managerial roles as an extension of engineering. At the same time, many others see managers as oppositional to engineers, with different priorities. On the whole, there is evidence of restratification as the work experiences, professional attitudes, and responses to conflicting logics (hybridity or resistance) vary between managers and employees. This restratification has the potential to undermine professional unity.

Changing Logics in Healthcare and Their Effects on the Identity Motives and Identity Work of Doctors

Recent literature on hybridity has provided useful insights into how professionals have responded to changing institutional logics. Our focus is on how shifting logics have shaped senior medical professionals’ identity motives and identity work in a qualitative study of hospital consultants in the United Kingdom’s National Health Service. We found a binary divide between a large category of traditionalist doctors who reject shifting logics, and a much smaller category of incorporated consultants who broadly accept shifting logics and advocate change, with little evidence of significant ambivalence or temporary identity ‘fixes’ associated with liminality. By developing a new inductively generated framework, we show how the identity motives and identity work of these two categories of doctors differ significantly. We explore the underlying causes of these differences, and the implications they hold for theory and practice in medical professionalism, medical professional leadership and healthcare reform.

An interprofessional perspective on healthcare work: physicians and nurses co-constructing identities and spaces of action

In this article we develop a theoretical perspective of how professional identities in multi-professional organisational settings are co-constructed in daily interactions. The research reported here is located in a healthcare context where overlapping knowledge bases, unclear divisions of responsibilities, and an increased managerialist emphasis on teamwork make interprofessional boundaries in healthcare operations more complex and blurred than ever. We thereby build on a research tradition that recognises the healthcare sector as a negotiated order, specifically studying how professional identities are invoked, constructed, and re-constructed in everyday work interactions. The perspective is employed in an analysis of qualitative data from interviews and participant observation at a large Swedish hospital, in which we find three main processes in the construction of space of action: hierarchical, inclusive, and pseudo-inclusive. In most of the interactions, existing inter-professional divides and power relations are sustained, preventing developments towards integrated interprofessional teamwork.

Counter-rhetoric and sources of enduring conflict in contested organizational fields: A case study of mental health professionals

As a means by which actors justify beliefs and practices, rhetoric has a key institutional role. In contested settings, where multiple groups and the logics associated with them interact, research has highlighted rhetorical strategies that exploit rival systems. The account we develop expands on these ideas and suggests they embrace forms of counter-rhetoric, or arguments that delegitimize a rival’s logic and refine and reframe others’ values. We use these categories to explore the case of a local mental health service, an area of health policy known for problematic diagnosis and treatment. Here groups of medical and social-care providers were required to work together in a system of intensive inter-professional relations and clashing logics. Our analysis focuses on this interaction, exploring the language-based nature of logics and sources of conflict between logics that are asserted in counter-rhetorical forms.

Complementary work in the hospital: How infection preventionists perceive opportunities for cooperation with higher status physicians

Social scientists and management scholars have tended to see workplace interaction through the lens of hierarchy. However, modern workplaces include many people who do not fit neatly into such hierarchies because their work is designed to assess, support, sanction, or monitor other workers who already have well-established positions. Motivated by this observation, we conducted interviews with 193 infection preventionists—healthcare workers whose job it is to work with higher status physicians to monitor and suppress healthcare-acquired infections—to assess how workers outside of existing hierarchies can integrate their work. Inductive analyses of these interviews suggest three strategies: deference; relying on bureaucracy’s routines and practices; and recruiting higher status confederates, which we call side-channeling. From these analyses, we introduce the concept of complementary work to describe labor that seeks to supplement existing workplace hierarchies.