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Article
Publication date: 3 May 2016

Alexander Styhre, Adam Roth and Jonas Roth

Health care organizations are increasingly demanded to balance the institutional logic of “medical professionalism” and “business-like health care,” that is, to both…

Abstract

Purpose

Health care organizations are increasingly demanded to balance the institutional logic of “medical professionalism” and “business-like health care,” that is, to both recognize physicians’ professional expertise while locating it in a wider social, economic, and political organizational setting. The purpose of this paper is to examine the implications from this shift in terms of leadership work in health care organizations.

Design/methodology/approach

Case study methodology including interviews with 15 residents in Swedish health care organizations.

Findings

A study of the willingness of residents to take on leadership positions show that leadership roles are treated as what is potentially hindering the acquisition of the know-how, skills, and expertise demanded to excel in the clinical work. Consequently, taking on leadership positions in the future was relatively unattractive for the residents. In order to overcome such perceived conflict between professional skill development and leadership roles, top management of health care organizations must help residents overcome such beliefs, or other professional groups may increasingly populate leadership positions, a scenario not fully endorsed by the community of physicians.

Originality/value

The paper demonstrates how complementary or completing institutional logics are influencing debates and identities on the “shop floors” of organizations.

Details

Leadership & Organization Development Journal, vol. 37 no. 3
Type: Research Article
ISSN: 0143-7739

Keywords

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Book part
Publication date: 4 July 2016

Teresa L. Scheid

In this chapter, I develop an analysis of the institutional logics which have shaped the organizational field of public sector mental health and which provide a framework…

Abstract

Purpose

In this chapter, I develop an analysis of the institutional logics which have shaped the organizational field of public sector mental health and which provide a framework for understanding the complexities facing policy makers, providers, researchers, and community mental health advocates.

Approach

I first assess the current state of public sector mental health care. I then describe institutional theory, which focuses our attention on the wider social values and priorities (i.e., institutional logics) which shape mental health care. In the current post-deinstitutionalization era, there are three competing institutional logics: recovery and community integration, cost containment and commodification, and increased social control over those with severe mental disorders. Each of these logics, and the conflict between them, is explicated and analyzed. I then develop a theoretical framework for understanding how conflicting institutional logics are resolved. In the concluding section of this chapter, I offer some guidance to both researchers and advocates seeking meaningful system level reform.

Research implications

Researchers studying mental health policy need to understand how competing institutional logics work to shape the political climate, economic priorities, and types of services available.

Social implications

Advocacy is critical for meaningful reform, and a fourth institutional logic – that of social justice – needs to be developed by which to evaluate policy reforms and service offerings.

Details

50 Years After Deinstitutionalization: Mental Illness in Contemporary Communities
Type: Book
ISBN: 978-1-78560-403-4

Keywords

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Book part
Publication date: 7 October 2019

Maria Roth, Imola Antal, Ágnes Dávid-Kacsó and Éva László

Since the reforms started in the Romanian child protection, and in spite of adopting children’s rights, and investing in the professionalization of the child protection…

Abstract

Since the reforms started in the Romanian child protection, and in spite of adopting children’s rights, and investing in the professionalization of the child protection staff, research has indicated that children continue to suffer violence in care settings.

This chapter contributes to the literature that documents children’s rights violations in Romanian residential care, before and after the political shift in 1989, including the period after the accession to the EU, by presenting and discussing interview data of 48 adults who spent parts of their childhoods in child protection settings.

The conceptual framework of this analysis is based on the human rights perspective and the transitional justice. The main body of the article presents the testimonials of adults who grew up in institutional care in Romania, as collected in the framework of the SASCA project, funded by the European Union. 1

Details

Human Rights for Children and Youth
Type: Book
ISBN: 978-1-78973-047-0

Keywords

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Article
Publication date: 30 December 2020

James Aitken, Ann E. Esain and Sharon Williams

Managing complexity within care ecosystems is an increasing universal challenge. In health, this is emphasised by recent calls for greater care integration to achieve…

Abstract

Purpose

Managing complexity within care ecosystems is an increasing universal challenge. In health, this is emphasised by recent calls for greater care integration to achieve service improvement as levels of comorbidity and frailty grow within populations. This research takes a service-dominant logic (SDL) stance in examining the sources, types and nature of complexity within a care ecosystem in the UK.

Design/methodology/approach

This illustrative case research focuses on a community care ecosystem. A multi-method approach is used combining semi-structured interviews, descriptive statistics and secondary data. The results were independently assessed and validated by participants through a second interview phase.

Findings

The findings from this research provide empirical support for the six complexities discussed in the supply chain literature. Identifying these complexities proffers the opportunity of applying manufacturing-derived complexity management strategies in care ecosystems. The conceptual model for institutional complexity, derived from the illustrative case study, showed that care professionals face additional complexity challenges in operating care ecosystems.

Practical implications

The management of complexity in care ecosystems requires professionals to be considerate of institutional arrangements when addressing the consequences of increasing levels of complexity. This necessitates the development of a balanced approach between reducing complexity while absorbing institutional arrangements which minimise risk.

Originality/value

Drawing on the supply chain complexity literature, the paper has developed a framework which guides care professionals facing increasing levels of complexity within the context of their institutional arrangements. As such, this research furthers our understanding of supply chain complexity effects in care ecosystems and provides a platform for future research.

Details

Supply Chain Management: An International Journal, vol. 26 no. 4
Type: Research Article
ISSN: 1359-8546

Keywords

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Article
Publication date: 5 October 2020

Nina Lunkka, Pirjo Lukkarila, Sanna Laulainen and Marjo Suhonen

The purpose of the paper is to investigate ambiguous language use in health-care project plans in a manner that accounts for the wider, institutional, public health-care context.

Abstract

Purpose

The purpose of the paper is to investigate ambiguous language use in health-care project plans in a manner that accounts for the wider, institutional, public health-care context.

Design/methodology/approach

The article deployed a case study approach and drew from Fairclough's critical discourse analysis (CDA) as well as a keyword analysis to investigate two time-sequenced versions of the same project planning document for a health-care project in Finland.

Findings

In the project plans investigated, the study identified patient as a keyword possessing various meanings within the public health-care context. By examining the discursive practices around the keyword patient, the study demonstrated their role in constituting the institutional context as well as the function of this context in constraining these practices.

Originality/value

By looking at the potential of the CDA to investigate discursive practices of the keyword in two sequential versions of a project plan within the broader context of public health care, the study adds to the scant existing literature on critically oriented health-care project communication studies.

Details

Qualitative Research in Organizations and Management: An International Journal, vol. 16 no. 1
Type: Research Article
ISSN: 1746-5648

Keywords

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Book part
Publication date: 24 September 2010

Maria DiTullio and Douglas MacDonald

A primary impetus of the modern hospice movement was the disparity, during the later 20th century, between the care provided to persons with illnesses considered “curable”…

Abstract

A primary impetus of the modern hospice movement was the disparity, during the later 20th century, between the care provided to persons with illnesses considered “curable” and the treatment – or lack of it – accorded the incurably or terminally ill. In its transformation from a reform-oriented, interdisciplinary response to the needs of the dying to an integrated component of the American healthcare system, hospice care's original mission, target population, and modality of service delivery were all significantly altered in ways that generated new disparities in access to “death with dignity.” This chapter attempts to trace the political, economic, and institutional dimensions of this transformation as reflected in the experiences of one Northeastern hospice during a 6-month period in 2001. Using an analytic approach known as institutional ethnography (IE), the authors focus on the work of the Hospice's Interdisciplinary Group (IDG) to uncover the linkages between local problems in the delivery of hospice care and extra-local sites of power and constraint at the mezzo- and macrolevels of the American healthcare system. The significance of these linkages for patients, frontline workers, and other stakeholders are interpreted from several perspectives. Implications for change are discussed.

Details

The Impact of Demographics on Health and Health Care: Race, Ethnicity and Other Social Factors
Type: Book
ISBN: 978-1-84950-715-8

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Book part
Publication date: 10 November 2005

Petri Parvinen and Grant T. Savage

A common observation is that both single- and multi-payer health care systems will achieve lower overall costs if they use primary care gatekeeping. Questioning this…

Abstract

A common observation is that both single- and multi-payer health care systems will achieve lower overall costs if they use primary care gatekeeping. Questioning this common wisdom, we focus on the health care access system, that is, the way in which patients gain access to health care. Gatekeeping, the use of primary care providers to control access to more specialized physician and hospital services, has come under intense scrutiny in the United States and in Europe. The few international comparative studies that have focused on the issues of quality of care, cost containment, and patient satisfaction find weak or no support for common assumptions about gatekeeping. Hence, we examine the institutional environments in seven countries in order to: (a) define and categorize health care access systems; (b) identify the components of a health care access system; (c) explore the notion of a strategic fit between health care financing systems and access system configurations; and (d) propose that the health care access system is a key determinant of process-level cost efficiency. Drawing upon institutional and governance theories, we posit that the structure and organization of an access system is determined by how it addresses six essential questions: Who is covered? Which services are included? What are the points of access? How much time elapses before access? What are the ways of selecting among points of access? and Are services and their quality the same for everyone? This analytical framework reveals that national health care access systems vary the most in their points of access, access times, and selection mechanisms. These findings and our explanations imply that access systems are one of the only tools for demand management, that any lasting change to an access system typically is implemented over an extended time period, and that managers of health care organizations often have limited freedom to define governance structures and shape health care service production systems.

Details

International Health Care Management
Type: Book
ISBN: 978-0-76231-228-3

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Article
Publication date: 8 December 2014

Paula Hyde, Diane Burns, Anne Killett, Andrea Kenkmann, Fiona Poland and Richard Gray

The purpose of this paper is to propose five organisational factors associated with abuse, neglect and/or loss of dignity of older people resident in care homes. It…

Abstract

Purpose

The purpose of this paper is to propose five organisational factors associated with abuse, neglect and/or loss of dignity of older people resident in care homes. It derives from one set of findings from the ResPECT Study of Organisational Dynamics of Elder Care commissioned by Comic Relief and Department of Health through the Prevention of Abuse and Neglect In the Care of Older Adults programme.

Design/methodology/approach

A knowledge synthesis method was selected to identify organisational aspects of elder mistreatment in residential care settings. The method was selected for its suitability in examining ill-defined and contested concepts such as; elder mistreatment – where the available evidence is dispersed and produced in varied forms. A rapid review comprising a search of three academic databases and a detailed examination of selected investigation reports into institutional mistreatment was followed by panel meetings with subject matter experts to complete the knowledge synthesis.

Findings

This paper identifies and elaborates five organisational factors associated with elder mistreatment; infrastructure, management and procedures, staffing, resident population characteristics and culture. It also indicates macro-structural factors affecting care quality.

Research limitations/implications

Further research is needed to elaborate the influence of these organisational factors on mistreatment and to understand any interactions.

Practical implications

As an adjunct to personal factors, the knowledge synthesis indicates common organisational factors contributing to institutional abuse. This suggests that care quality is produced systemically and that it can collapse as a result of seemingly minor and unrelated organisational changes.

Social implications

Care home safety and quality is an ongoing concern, with popular analysis frequently stopping at the point of describing individual errant behaviour. However, as “problem” organisations are closed down, “problem” organisational factors continue to recur elsewhere.

Originality/value

The paper identifies and elaborates organisational aspects of elder mistreatment in residential care settings. The findings are original, valuable and grounded in relevant experience by the method of analysis and synthesis of the findings from inquiry reports as well as research and the contribution to the development of findings by those central to the issue, residents, relatives and care providers.

Details

Quality in Ageing and Older Adults, vol. 15 no. 4
Type: Research Article
ISSN: 1471-7794

Keywords

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Article
Publication date: 13 April 2009

Felicity Elvidge and Geraldine MacPhail

This paper profiles the Maidstone ‘Quality in Care’ project and makes suggestions for how it could be developed and implemented across residential and nursing care for…

Abstract

This paper profiles the Maidstone ‘Quality in Care’ project and makes suggestions for how it could be developed and implemented across residential and nursing care for older people and for social care more widely. ‘Quality in Care’ is a quality assurance model of support provided to residential care homes for older people where there are serious concerns about the risks of abuse and/or neglect and the quality of services and care provided. The aim of the intervention is to ensure that vulnerable adults are safeguarded and protected and that service standards are improved in key areas. The model has the potential to be transferred to all client groups and most service types although resource constraints currently limit the project to older people only.

Details

The Journal of Adult Protection, vol. 11 no. 1
Type: Research Article
ISSN: 1466-8203

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