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Despite many calls to strengthen connections between health systems and communities as a way to improve primary healthcare, little is known about how new collaborations can effectively alter service provision. The purpose of this paper is to explore how a health authority, municipal leaders and physicians worked together in the process of transforming primary healthcare.

A longitudinal qualitative case study was conducted to explore the processes of change at the regional level and within seven communities across Northern British Columbia (BC), Canada. Over three years, 239 interviews were conducted with physicians, municipal leaders, health authority clinicians and leaders and other health and social service providers. Interviews and contextual documents were analyzed and interpreted to articulate how ongoing transformation has occurred.

Four overall strategies with nine approaches were apparent. The strategies were partnering for innovation, keeping the focus on people in communities, taking advantage of opportunities for change and encouraging experimentation while managing risk. The strategies have bumped the existing system out of the status quo and are achieving transformation. Key components have been a commitment to a clear end-in-view, a focus on patients, families, and communities, and acting together over time.

This study illuminates how partnering for primary healthcare transformation is messy and complicated but can create a foundation for whole system change.

In this chapter, the authors consider the relationships between institutional settlements at the field level and the instantiation of logics at the organizational level. The authors present the case of Supervised Consumption Sites (also known as Safe Injection Sites) in Alberta, Canada where a settlement of logics supported by one government was disrupted with the election of a new provincial government in 2015, and then disrupted again after the election of yet another government four years later. The authors use this case to show how different institutional settlements can support or threaten particular types of organizations, and they also show how the instantiation of different settlements in organizations (organizational hybridity) can impact the ways in which organizations present themselves. By analyzing the public justifications provided by key members of Supervised Consumption Sites, they draw attention to connections between institutional settlements at the field level and organizational attempts to manage multiple logics.

We investigated how an institutional settlement concerning Native Indian gaming (the operation of gambling establishments such as casinos or bingo halls by Native Indian tribes) was preserved over time in spite of three significant challenges. Building on previous literature on settlements and institutional logics, we see settlements as institutional arrangements that manage power dynamics and competing institutional logics. Based on our analyses of the settlement and three challenges in the Native gaming field, we suggest that even seemingly volatile institutional settlements can be maintained when powerful actors balance each other’s ability to modify the settlement and different actors invoke alternative institutional logic(s). We also find that these processes can be facilitated by the embeddedness and formality of the settlement. We contribute to the settlement literature by showing how settlements can be maintained when actors draw on equally strong sources of power and different logics to counter the actions of other actors. Furthermore, we shed light on “how institutions matter” by demonstrating how institutional settlements can facilitate field stability.

We build on the concept of “constellations of logics” (Goodrick & Reay, 2011) to further our understanding of the relationship between institutional logics and action. We do so through a comparative case study of similar primary health care initiatives in Denmark and Canada. We draw on micro- and macro-level data to show how both the arrangement and relationship among logics impacted the design and accomplishment of the initiatives in each country. Based on our data, we theorize five different mechanisms through which logics can simultaneously constrain and enable action.

In this chapter the authors focus on the role of power associated with microfoundations of organizational hybridity. They develop a framework that illuminates how key sources of power based on Buchanan and Badham (2008) and French and Raven (1959) manifest at the level of everyday work practices. Using this framework, they draw on existing studies concerning hybridity in professional organizations to illustrate how different forms of power come into play when actors guided by different logics engage in day-to-day professional work. Overall, the authors suggest that more attention to how micro-level actors use different forms of power to support, hamper, or alter different mechanisms to manage tensions among competing logics in everyday work is critical to improving our understanding about the microfoundations of institutionalism.

This double volume presents a collection of 23 papers on how institutions matter to socio-economic life. The papers delve deeply into the practical impact an institutional approach enables, as well as how such research has the potential to influence policies relevant to critical institutional changes unfolding in the world today. In Volume 48A, the focus is on the micro foundations of institutional impacts. In Volume 48B, the focus is on the macro consequences of institutional arrangements. Our introduction provides an overview to the two volumes, identifies points of contact between the papers, and briefly summarizes each contribution. We close by noting avenues for future research on how institutions matter. Overall, the volumes provide a cross-section of cutting edge institutional thought and empirical research, highlighting a variety of fruitful directions for knowledge accumulation and development.

In this chapter, the authors explore the state of our field in terms of ways to present qualitative findings. The authors analyze all articles based on qualitative research methods published in the Academy of Management Journal from 2010 to 2017 and supplement this by informally surveying colleagues about their “favorite” qualitative authors. As a result, the authors identify five ways of presenting qualitative findings in research articles. The authors suggest that each approach has advantages as well as limitations, and that the type of data and theorizing is an important consideration in determining the most appropriate approach for the presentation of findings. The authors hope that by identifying these approaches, they enrich the way authors, reviewers, and editors approach the presentation of qualitative findings.

Research on institutional logics has missed the opportunity to understand how and why societies may fundamentally differ in their material and symbolic systems. In this chapter, the authors offer a qualitative examination of the implementation of infrastructure public–private partnership (PPP) projects in the Arab state of Qatar. The authors illustrate how the macrofoundations of Qatari society are rooted in the notion of tribe, an inter-institutional system under which the intertwined institutional orders of the state, the market, and the family have historically developed and operated. Their study sheds light on how these macrofoundations shape the processes and mechanisms that underpin the resistance to the introduction of innovative organizational forms. The chapter makes two contributions. First, it identifies how “foreign” organizational forms rooted in Western institutional orders trigger adverse reactions from societies characterized by different institutional orders. Second, it demonstrates the challenge of implementing PPPs in an institutional context that is unfavorable to them and where actors seek to preserve the supremacy of the extant inter-institutional system.