Divergent Organizational Change in Hospitals: Exploring how hospital leaders and employees can contribute to successful outcomes

Abstract

Over the past four decades, a large number of public health care reforms and policies internationally and nationally have been aimed at solving these challenges. At the outset of 2018, the Norwegian Minister of Health Services restated that reduction in waiting times and quality improvement are strategic goals for the Norwegian hospital sector. The policy vision is to create "The Patients' Health Service". He pointed to the development of new ways of planning and organizing services as means to reach those goals 1. Internationally, hospitals are introducing integrated, patient-centred organizational structures in order to achieve more patient-centred care, cost reductions and quality improvements. The new structures organize the delivery of services around the need of the patient instead of along the traditional lines of professional specialization (Vera & Kuntz, 2007). With regard to the planning of health service delivery work, the Minister announced that hospitals will be required to establish national planning indicators. These should describe the number of patients who do not turn up for their hospital appointments, the share of hospital consultations that are rescheduled, and the extent of time for which the hospitals are currently planning consultations ahead. The intent is to establish a national best practice for planning. These practices could ensure that patients more consistently receive the treatments they are entitled to within mandated guarantee deadlines, and enable hospitals to utilize their resources more efficiently as a result of a more coherent, long term matching of tasks and staff, instead of increasing efficiency by making health service professionals work faster and harder. Reforms, new policies and the continuous large-and/or small-scale changes aiming for service quality improvement that they manifest in within hospital organizations have been identified as a move away from 1

Developing Eldercare in Ageing Societies: A Qualitative Study on Misaligned Visions and Caged Change Agents

“…Challenges in terms of managing vertical alignment are frequently demonstrated in healthcare organisations, e.g., [21,22]. Key reasons for poor vertical alignment have been related to conficting institutional logics in development work in healthcare [23] and in public eldercare [24]. Specifcally, challenges regarding vertical alignment in public eldercare are seen in, for example, failed broader implementations of welfare technology due to a lack of resources, know-how, and follow-up in the implementation process [19,25].…”

Gender equality and managers' work in elderly and social care: A structural equation modelling approach

“…These logics are embedded in the organization and thus regulate managers' and employees' behavior and affect organizations' opportunities for improvement work (Thornton et al, 2012; Thornton & Ocasio, 2008). The notion of institutional logics has often been used to grasp and illustrate how different logics and values interact across macro‐ and micro levels in, for example, organizational improvement work (Øygarden, 2020; Reay & Hinings, 2005). One type of institutional logic is related to values of the state and focuses on common goods and public authorization (Thornton et al, 2012).…”

“…Earlier research on the relation between different institutional logics has demonstrated that conflicting logics can coexist, interact supportively or clash (Reay & Hinings, 2005). Research on institutional logics in health and social care has often focused on the conflicts between professional, state and managerial corporate logics (Andreasson, 2018) and suggests that such conflicts constitute important obstacles to successful improvement work (Andreasson et al, 2016; Dellve & Wikström, 2009; Øygarden, 2020). However, to our knowledge, no previous studies have focused on the alignments between, on the one hand, organizational gender equality and, on the other, institutional logics that relate to state and professional values.…”