scholarly journals Centrality and compatibility of institutional logics when introducing value-based reimbursement

2021 ◽  
Vol 35 (9) ◽  
pp. 298-314
Author(s):  
Thérèse Eriksson ◽  
Lars-Åke Levin ◽  
Ann-Charlotte Nedlund
Keyword(s):  
Spine Surgery ◽  
Financial Incentives ◽  
Healthcare Providers ◽  
Institutional Logics ◽  
Professional Values ◽  
Structured Interviews ◽  
Content Type ◽  
A Value ◽  
Professional Pride ◽  
Interdisciplinary Healthcare

PurposeUsing financial incentives has been criticised for putting too much focus on things that can be measured. Value-based reimbursement may better align professional values with financial incentives. However, professional values may differ between actor groups. In this article, the authors identify institutional logics within healthcare-providing organisations. Further, the authors analyse how the centrality and compatibility of the identified logics affect the institutionalisation of external demands.Design/methodology/approach41 semi-structured interviews were conducted with representatives from healthcare providers within spine surgery in Sweden, where a value-based reimbursement programme was introduced. Data were analysed using thematic content analysis with an abductive approach, and a conceptual framework based on neo-institutional theory.FindingsAfter the introduction of the value-based reimbursement programme, the centrality and compatibility of the institutional logics within healthcare-providing organisations changed. The logic of spine surgeons was dominating whereas physiotherapists struggled to motivate a higher cost for high quality physiotherapy. The institutional logic of nurses was aligned with spine surgeons, however as a peripheral logic facilitating spine surgery. To attain holistic and interdisciplinary healthcare, dominating institutional logics within healthcare-providing organisations need to allow peripheral institutional logics to attain a higher centrality for higher compatibility. Thus, allowing other occupations to take responsibility for quality and attain the feeling of professional pride.Originality/valueInterviewing spine surgeons, physiotherapists, nurses, managers and administrators allows us to deepen the understanding of micro-level behaviour as a reaction (or lack thereof) to macro-level decisions.

scholarly journals Managerial strategies to make incentives meaningful and motivating

2017 ◽  
Vol 31 (2) ◽  
pp. 126-141 ◽  
Author(s):  
Sara Korlén ◽  
Anna Essén ◽  
Peter Lindgren ◽  
Isis Amer-Wahlin ◽  
Ulrica von Thiele Schwarz
Keyword(s):  
Financial Incentives ◽  
Practical Knowledge ◽  
Healthcare Providers ◽  
Patient Choice ◽  
Professional Values ◽  
Multiple Perspectives ◽  
Policy Makers ◽  
Content Type ◽  
Local Case ◽  
The Individual

Purpose Policy makers are applying market-inspired competition and financial incentives to drive efficiency in healthcare. However, a lack of knowledge exists about the process whereby incentives are filtered through organizations to influence staff motivation, and the key role of managers is often overlooked. The purpose of this paper is to explore the strategies managers use as intermediaries between financial incentives and the individual motivation of staff. The authors use empirical data from a local case in Swedish specialized care. Design/methodology/approach The authors conducted an exploratory qualitative case study of a patient-choice reform, including financial incentives, in specialized orthopedics in Sweden. In total, 17 interviews were conducted with professionals in managerial positions, representing six healthcare providers. A hypo-deductive, thematic approach was used to analyze the data. Findings The results show that managers applied alignment strategies to make the incentive model motivating for staff. The managers’ strategies are characterized by attempts to align external rewards with professional values based on their contextual and practical knowledge. Managers occasionally overruled the financial logic of the model to safeguard patient needs and expressed an interest in having a closer dialogue with policy makers about improvements. Originality/value Externally imposed incentives do not automatically motivate healthcare staff. Managers in healthcare play key roles as intermediaries by aligning external rewards with professional values. Managers’ multiple perspectives on healthcare practices and professional culture can also be utilized to improve policy and as a source of knowledge in partnership with policy makers.

Measuring social performance: reconciling the tension between commercial and social logics

2018 ◽  
Vol 45 (1) ◽  
pp. 205-222 ◽  
Author(s):  
A.K. Siti-Nabiha ◽  
Zubir Azhar ◽  
Salmi Mohd Isa ◽  
A.Z. Siti-Nazariah
Keyword(s):  
Performance Appraisal ◽  
Social Performance ◽  
Institutional Logics ◽  
Structured Interviews ◽  
Focus Group Interviews ◽  
Target Groups ◽  
Content Type ◽  
Competing Demands ◽  
Group Interviews ◽  
Social Logics

Purpose The purpose of this paper is to explore the implementation of microfinance programs in three Malaysian development finance institutions (DFIs). Its main concerns revolve around how these DFIs measure and manage their social performance and how they reconcile their competing social and commercial objectives which are driven by particular logics. Design/methodology/approach This paper analyzes the ways in which the DFIs selected for this study measure and manage their social performance. The data were acquired from two sessions of focus group interviews, a series of semi-structured interviews, and extensive reviews of documentaries. The institutional logics perspective is used to explore the interplay between social and commercial logics in shaping the view and use of social performance measures in the three studied DFIs. Findings Although these DFIs have consistently offered formal microfinance programs to designated target groups, their ultimate focus has been on measuring financial as opposed to social performance. Hence, performance appraisal is mainly aligned with the breadth of outreach, rather than its depth. Nevertheless, there appear to be conflicts between the need to accommodate both breadth and depth, due to the competing demands of the two objectives. The rivalry between these two competing demands, which represents the interplay between social and commercial logics, is resolved through reconciliation, that is, by making one objective compatible with the other. Originality/value This paper examines the ways in which the DFIs in the study measure and manage their social performance, a topic that is, currently, not widely explored. This study contributes to advancing the knowledge on the link between institutional logics and organizational practices, particularly in understanding the extent to which the Malaysian DFIs assign importance to social performance when designing and offering microfinance programs.

Engaging general practitioners in pay-for-performance scheme design

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Verna Smith
Keyword(s):  
General Practice ◽  
Performance Management ◽  
Case Studies ◽  
General Practitioners ◽  
Pay For Performance ◽  
National Level ◽  
Professional Values ◽  
Structured Interviews ◽  
Content Type ◽  
Scheme Design

PurposePolicymakers implementing pay-for-performance schemes within general practice should seek to design schemes which work with rather than against the professional values and goals of general practitioners. In this way, schemes are more likely to enhance the practitioners' engagement. The purpose of this paper is to show how this was done in two case studies of pay-for-performance design and present the lessons from this study for policymakers.Design/methodology/approachA Most Similar Systems collective case study of the design of two pay-for-performance schemes for general practitioners, the United Kingdom's Quality and Outcomes Framework (QOF) and the New Zealand’s Performance Management Programme (PMP) was undertaken, involving 26 semi-structured interviews with policymakers, documentary and literature analysis.FindingsInnovation in processes was found in both case studies which facilitated engagement by general practitioners in the formulation and implementation of these schemes. These were careful selection of highly skilled design teams, use of principle-based negotiation techniques and academic mediation of indicator selection. In addition, in England the majority of members in the combined QOF design team were general practitioners. The evidence from these two case studies reinforces approaches to scheme design which seek to harness rather than challenge medical professional values and which maximise the participation of general practitioners in the design process. Achieving funder/practitioner collaboration should be a key goal in the policymaking process.Practical implicationsPay-for-performance scheme designers can improve their ability to engage general practitioners in scheme design and scheme uptake by adopting approaches which actively engage general practitioners as designers and users of such schemes.Originality/valueThis study compares two contemporaneous processes of pay-for-performance scheme design and implementation in similar systems of general practice funding and delivery at the national level, offering a rare quasi-experimental opportunity for learning lessons from comparative analysis.

scholarly journals Institutional logics and practice variations in sustainability reporting: evidence from an emerging field

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Zeeshan Mahmood ◽  
Shahzad Uddin
Keyword(s):  
Sustainability Reporting ◽  
Institutional Logics ◽  
Practice Variation ◽  
Theoretical Explanation ◽  
Organizational Level ◽  
Structured Interviews ◽  
Content Type ◽  
Social Actors ◽  
Reporting Practices ◽  
Practice Variations

PurposeThis paper aims to deepen the understanding of logics and practice variation in sustainability reporting in an emerging field.Design/methodology/approachThis paper adopts the institutional logics perspective and its conceptualization of society as an inter-institutional system as a theoretical lens to understand reasons for the presence of and variation in sustainability reporting. The empirical findings are based on analysis of 28 semi-structured interviews with significant social actors, and extensive documentary evidence focusing on eight companies pioneering sustainability reporting in Pakistan.FindingsThis paper confirms the presence of multiple co-existing logics in sustainability practices and lack of a dominant logic. Sustainability reporting practices are underpinned by a combination of market and corporate (business logics), state (regulatory logics), professional (transparency logics) and community (responsibility logics) institutional orders. It is argued that institutional heterogeneity (variations in logics) drives the diversity of motivations for and variations in sustainability reporting practices.Research limitations/implicationsThe paper offers a deeper theoretical explanation of how various logics dominate sustainability reporting in a field where the institutionalization of practice is in its infancy.Practical implicationsUnderstanding the conditions that influence the logics of corporate decision-makers will provide new insights into what motivates firms to engage in sustainability reporting. A broader understanding of sustainability reporting in emerging fields will foster its intended use to increase transparency, accountability and sustainability performance.Originality/valueThis paper contributes to relatively scarce but growing empirical research on emerging fields. Its major contribution lies in its focus on how multiple and conflicting institutional logics are instantiated at the organizational level, leading to wide practice variations, especially in an emerging field. In doing so, it advances the institutional logics debate on practice variations within the accounting literature.

scholarly journals Recruitment in Health Services Research - A Study on Facilitating and Inhibiting Factors Regarding The Recruitment of Community-Based Healthcare Providers

2021 ◽  
Author(s):  
Franziska Krebs ◽  
Laura Lorenz ◽  
Farah Nawabi ◽  
Isabel Lück ◽  
Anne-Madeleine Bau ◽  
...  
Keyword(s):  
Financial Incentives ◽  
Extrinsic Motivation ◽  
Healthcare Providers ◽  
Trial Participation ◽  
Healthcare Intervention ◽  
Structured Interviews ◽  
Services Research ◽  
Community Based ◽  
Social Burden ◽  
Inhibiting Factors

Abstract Background In healthcare intervention trials, the recruitment of patients is frequently conducted by community-based healthcare providers. The recruitment of healthcare providers is therefore a crucial prerequisite that can determine the success of a trial right from the start. However, the recruitment of healthcare providers often poses a major challenge, and little is known about its influencing factors. Methods The study was conducted alongside an intervention trial evaluating the effectiveness of a lifestyle intervention during pregnancy. Triangulation techniques were used to identify facilitators and barriers to the recruitment of healthcare providers. Qualitative text analysis of internal documents and semi-structured interviews with study coordinators were performed. These results were used to derive the facilitating and inhibiting factors for recruitment. Results Our findings identified intrinsic motivation and interest in the trial’s aims and goals as the most important factors in healthcare provider recruitment. Beyond that, extrinsic motivation generated through financial incentives or collegial obligation emerged as a conflicting strategy. While extrinsic motivation might aid in the initial enrollment of healthcare providers, it rarely results in active trial participation in the long run. The perceived availability of eligible patients emerged as another barrier. Some healthcare providers declined trial participation because they anticipated that they would not have any patients that would suit the intervention due to high social burden or low need on the part of the patients. Conclusions During the planning of a trial, more attention should be paid to the recruitment phase. Researchers should seek input from healthcare providers when planning their trial design and recruitment strategies, and conduct a thorough needs assessment to avoid barriers and create a sense of ownership. Financial compensation for the trial burden emerged as a basic requirement, but this is not sufficient for recruitment if used as the sole means of motivation. Adaptable recruiting and intervention strategies that suit different patient populations are important in helping healthcare providers feel adequately prepared for trial tasks. The recruitment skills of healthcare providers and the communication skills of trial staff should therefore be addressed explicitly before the start of the recruitment phase. Trial registration German Clinical Trials Register (DRKS00013173). Registered 3rd of January 2019

Inside the multi-tier supply firm: exploring responses to institutional pressures and challenges for sustainable supply management

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Shobod Deba Nath ◽  
Gabriel Eweje
Keyword(s):  
Supply Chain ◽  
Institutional Theory ◽  
Institutional Logics ◽  
Supply Management ◽  
Dark Side ◽  
Institutional Pressures ◽  
Structured Interviews ◽  
Content Type ◽  
Trade Offs ◽  
Research Stream

PurposeThe purpose of this study is to examine how multi-tier suppliers respond to the institutional pressures for the implementation of sustainable supply management (SSM) practices in supply chains, and what institutional logics allow them to do so.Design/methodology/approachThis study employs a qualitative research design, drawing on data from semi-structured interviews with 46 owners and managers of multi-tier suppliers and 18 key informants of diverse stakeholders. Following an abductive approach, institutional theory conceptually guides the analytical iteration processes between theory and interview data.FindingsThe findings demonstrate two kinds of thematic responses to institutional pressures – coupling (good side) and decoupling (dark side) of the supply chain – used by the factory management of multi-tier suppliers. This paper also identifies multiple institutional logics – market-led logic, values-led logic and holistic sustainability logic – that are perceived to conflict (trade-offs) and complement (synergies) the SSM implementation.Research limitations/implicationsBy investigating the perspectives of the factory management of upstream apparel suppliers, this study enhances the understanding of the connection between (de)coupling responses and institutional logics inside the multi-tier supplier firms. Further research would be required to include more downstream tiers including the ultimate users.Practical implicationsThe findings may be of particular attention to brand-owning apparel retailers, industry leaders and policymakers who are seeking to understand multi-tier suppliers' challenges, conflicts and (de)coupling responses, and become aware of how they can be dealt with.Originality/valueThis study contributes to and expands the embryonic research stream of sustainable multi-tier supply chain management by connecting it to the wider application of institutional theory.

Achieving better quality care in general practice: are incentives the answer?

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711461
Author(s):  
Kanwal Ahmed ◽  
Salma Hashim ◽  
Mariyam Khankhara ◽  
Ilhan Said ◽  
Amrita Shandakumar ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Intrinsic Motivation ◽  
Financial Incentives ◽  
Quality Care ◽  
Healthcare Providers ◽  
Structured Interviews ◽  
Multiple Indicators ◽  
Improved Outcomes ◽  
Quality And Outcomes

BackgroundThe introduction of financial incentives, such as the quality and outcomes framework (QOF), historically lead to improvements in standardising practice. However, with shifting demands on healthcare providers, are these schemes still enough to drive high-quality care?AimTo explore current incentives, intrinsic and extrinsic, their role and effectiveness in improving quality of care and how they are perceived by GPs.MethodMixed methods study using two systematic literature reviews including 44 papers and 18 semi-structured interviews with GPs.ResultsIn the literature, QOF was associated with reduced socioeconomic inequalities, decreased mortality and improved outcomes. However, the absence of control groups and the simultaneous analysis of multiple indicators complicates the findings. GPs agreed with the literature and viewed financial incentives as beneficial, however, they felt the key driver in providing good-quality care was their intrinsic motivation. Financial incentives were found to contribute to depersonalised care, diluted provision of non-incentivised activities and hindered overall practice. The results from the second literature review were in keeping with the views of the participants. They illustrated the importance of managing factors contributing to physician burnout, reduced performance, and low job satisfaction, which can result in the provision of low-quality care.ConclusionFinancial incentives have the potential to induce behaviour change, however, their use in quality improvement is limited when used alone. If used in an environment that nurtures intrinsic motivation, healthcare providers will be more driven to achieve a higher quality of care and will be better able to cope with shifting demands.

Changing institutional logics and implications for supply chains: Ethiopian rural water supply

2019 ◽  
Vol 24 (3) ◽  
pp. 355-376 ◽  
Author(s):  
Linda Annala ◽  
Pia Eva Polsa ◽  
Gyöngyi Kovács
Keyword(s):  
Water Supply ◽  
Supply Chains ◽  
Large Scale ◽  
Institutional Logics ◽  
Structured Interviews ◽  
Rural Water Supply ◽  
Content Type ◽  
Rural Water ◽  
Field Notes ◽  
Practical Implications

Purpose The institutional logic in developing countries is changing from aid toward trade, having implications for institutionally embedded supply chains (SCs) and their members. The purpose of this study is to investigate the transition from aid toward trade through a theoretical lens of institutional logics and the implications of changing logics for SC members and designs. Design/methodology/approach This is a large-scale qualitative study of the SCs of maintenance and repair operations (MRO) of water points. Empirical data were collected via 53 semi-structured interviews, observations, including photographs, and field notes from several echelons of MRO SCs in ten different Ethiopian districts. Findings In spite of the same underlying tenet of a unidirectional trajectory toward a business logic, the study shows that the co-existence or constellation of different institutional logics resulted in diverse practices that impacted SC design. Research limitations/implications The research was carried out in the MRO SC at a time of changing institutional logics, thereby being able to study their transition or constellation of logics. Practical implications The research has implications for policymakers and development practitioners: when designing and implementing rural water supply programs, the presence of co-existing logics and the lack of uniform SC designs should not be viewed as a hindrance. In fact, the study showed how constellations of logics can provide ways through which water points continue functioning and providing clean drinking water to the communities. Originality/value Few studies so far have focused on institutional logics and their implications for SC design.

Interpersonal practice in project marketing: how institutional logics condition and change them

2019 ◽  
Vol 34 (4) ◽  
pp. 723-734
Author(s):  
Bernard Cova ◽  
Per Skålén ◽  
Stefano Pace
Keyword(s):  
Business Ethics ◽  
Gender Equality ◽  
Specific Activity ◽  
Institutional Logics ◽  
Customer Relationships ◽  
Current Debate ◽  
Relative Role ◽  
Institutional Logic ◽  
Structured Interviews ◽  
Content Type

Purpose Project marketing is the specific activity of companies selling projects-to-order. Interpersonal practice is known to be important in this type of marketing. While this interpersonal practice has been little studied, some previous research suggests that changes in the institutional macro environment have affected it. Therefore, the purpose of this paper is to study today’s interpersonal practice in project business and how the institutional environment conditions it. Design/methodology/approach Semi-structured interviews were conducted with marketing managers at project-based firms in different business sectors in France and Sweden. Data collection and analysis was informed by grounded theory. Findings The paper identifies three types of interpersonal practice in project marketing, referred to as the transactional, the work-based and the socializing. Changes in these are explained in relation to the three institutional logics identified in the data: the market institutional logic of business ethics, the corporate institutional logic of rationalization and the family institutional logic of gender equality. Research limitations/implications Future studies can continue and broaden this work as it regards how the institutional conditioning of interpersonal practice varies with context. Practical implications By clearly categorizing the three types of interpersonal practice and their relative role today, companies can orient the activities of salespeople, business developers and other project marketers. Social implications The paper highlights how business ethics and gender equality have changed interpersonal practices in project marketing. Originality/value The paper contributes to the current debate on project marketing by identifying three types of interpersonal practice and by illustrating how institutional logics condition and change these. The paper shows that extra-business activities are needed less than previous research has argued with regard to maintaining customer relationships in-between projects.

Progress towards institutionalising field-wide water efficiency change

2014 ◽  
Vol 27 (5) ◽  
pp. 809-833 ◽  
Author(s):  
Matthew Egan
Keyword(s):  
Competitive Advantage ◽  
Design Methodology ◽  
Institutional Logics ◽  
Water Efficiency ◽  
Efficiency Change ◽  
Structured Interviews ◽  
Content Type ◽  
Drought Conditions ◽  
Practical Implications ◽  
Global Water

Purpose – The purpose of this paper is to explore how a heterogeneous range of water efficiency responses were driven across a field of seven water consuming organisations in Australia at a time of acute drought conditions into the late 2000s. Design/methodology/approach – Semi-structured interviews were conducted with a range of individuals from 2008 to 2010. Findings – A loosely coordinated range of drivers motivated pervasive water efficiency responses in two of the seven case organisations. Would-be leaders sought to invoke a water efficiency field, and champion nascent logics and theorisation in order to gain some competitive advantage. There was little sense among others of any normative, mimetic or coercive pressure to adopt homogeneous practices. While the field lacked effective champions for change, an institutionalisation of novel water efficiency practices continued across the field into 2010. Research limitations/implications – Further research could investigate how water efficiency responses continued to develop or decline into the 2010s, and how such practices integrate with the management of other sustainability issues (including carbon). Practical implications – Global water resources are subject to increasing supply constraints. This paper responds by exploring how the institutionalisation of water efficiency change can be driven across a field of organisations. Originality/value – Relatively little is understood about “institutionalization” as an unfinished process. This paper responds by contributing an understanding of how institutional logics developed, and how theorisation for water efficiency progressed in the context of water scarcity in Australia in the late 2000s.

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