How does the external context affect an implementation processes? A qualitative study investigating the impact of macro-level variables on the implementation of goal-oriented primary care

BACKGROUND

Although the importance of context in implementation science is not disputed, knowledge about the actual impact of external context variables on implementation processes remains rather fragmented. Current frameworks, models, and studies merely describe macro-level barriers and facilitators, without acknowledging their dynamic character and how they impact and steer implementation. Including organizational theories in implementation frameworks could be a way of tackling this problem. In this study, we therefore investigate how organizational theories can contribute to our understanding of the ways in which external context variables shape implementation processes. We use the implementation process of goal-oriented primary care in Belgium as a case.

METHODS

A qualitative study using in-depth semi-structured interviews was conducted with actors from a variety of primary care organizations. Data was collected and analyzed with an iterative approach. We assessed the potential of four organizational theories to enrich our understanding of the impact of external context variables on implementation processes. The organizational theories assessed are as follows: institutional theory, resource dependency theory, network theory, and contingency theory. Data analysis was based on a combination of inductive and deductive thematic analysis techniques using NVivo 12.

RESULTS

Institutional theory helps to understand mechanisms that steer and facilitate the implementation of goal-oriented care through regulatory and policy measures. For example, the Flemish government issued policy for facilitating more integrated, person-centered care by means of newly created institutions, incentives, expectations, and other regulatory factors. The three other organizational theories describe both counteracting or reinforcing mechanisms. The financial system hampers interprofessional collaboration, which is key for GOC. Networks between primary care providers and health and/or social care organizations on the one hand facilitate GOC, while on the other hand, technology to support interprofessional collaboration is lacking. Contingent variables such as the aging population and increasing workload and complexity within primary care create circumstances in which GOC is presented as a possible answer.

CONCLUSIONS

Insights and propositions that derive from organizational theories can be utilized to expand our knowledge on how external context variables affect implementation processes. These insights can be combined with or integrated into existing implementation frameworks and models to increase their explanatory power.

Social pressures and their impact on smartphone use stickiness and use habit among adolescents

Excessive smartphone use has become a growing issue among adolescents as they develop mentally and socially. While researchers have examined individual and technological predictors of smartphone addiction, few studies consider broader societal influences. This study explored how social pressures such as mimicry, coercion, and norms impact persistent conscious smartphone use (use stickiness) and unconscious smartphone use (use habit). A survey was administered in two phases to 309 college students at a university in Southern China to gather data on perceptions of social influences and their degree of smartphone overuse. The relationships were analysed using a structural equation model. The study confirms the impact of three social pressures - mimetic, coercive and normative - on adolescents' degree of smartphone overuse (use stickiness and use habit). The mimetic pressure positively impacted use stickiness but not use habit. The coercive pressure positively impacted both the use stickiness and the use habit. The normative pressure positively impacted use habit but not use stickiness. This study provides a novel perspective on overlooked social drivers of problematic smartphone tendencies among youth. Our study also provides insights for educators, parents, and policymakers to more effectively intervene in adolescent smartphone overuse.

Revolutionizing energy practices: Unleashing the power of artificial intelligence in corporate energy transition

Corporate energy transition is crucial for long-term sustainable development. The widely discussed Artificial Intelligence (AI), as a disruptive technological innovation, is highly potential for enhancing environment performance. However, the specific impact of AI on the process of corporate energy transition and its underlying mechanisms have not been fully explored. This study focuses on A-share listed corporates in Shanghai and Shenzhen stock markets in China spanning from 2011 to 2021. Based on corporate annual report information and information from over 200,000 patent application texts, we innovatively construct indicators for corporate energy transition and AI technology application. Furthermore, we empirically investigate the impact of AI technology on corporate energy transition and its potential mechanisms through combining information asymmetry theory and institutional theory. The empirical results indicate that: 1) AI can drive corporate energy transition and the promoting effect of AI collaborative innovation on corporate energy transition should not be ignored. 2) AI can help corporates achieve energy transition through pathways such as mitigating information asymmetry, reducing financing constraints, adjusting sustainable development concepts and practices. 3) The driving effect of AI on corporate energy transition varies depending on the characteristics of different types of corporates, industries, and regions. This study provides strategic guidance and decision support for business managers and policymakers, assisting both corporates and governments in better utilizing AI technology during the social energy transition process to achieve a dual optimization of environmental and economic goals.

The nonlinear impact of financial flexibility on corporate sustainability: Empirical evidence from the Chinese manufacturing industry

In the face of challenges ushered in by globalization and technological advancements, financial flexibility has emerged as a pivotal strategy for attaining sustainable development in China's manufacturing sector. Financial flexibility allows firms to manage internal cash flows, alleviate external financing constraints, and augment their capability to absorb risks. Using the framework of Financial Flexibility Theory and Institutional Theory, this study examines data from A-share listed manufacturing firms on the Shanghai and Shenzhen Stock Exchanges from 2011 to 2021. The research aims to investigate the nexus between financial flexibility and sustainable performance, while also probing the moderating roles of environmental uncertainty and governmental grants. The key findings of the study unveil an inverted U-shaped relationship between financial flexibility and sustainable performance. Moreover, environmental uncertainty exerts a significant negative influence on sustainable performance. When both environmental uncertainty and governmental grants are substantial, the inverted U-shaped correlation between financial flexibility and sustainable performance intensifies. The innovation of this study lies in revealing the optimal zone of financial flexibility for enterprises under the influence of environmental uncertainty and government grants. Amidst an increasingly intricate macro-environment, this research furnishes pragmatic insights for optimizing sustainable performance in manufacturing enterprises and offers a series of empirically grounded suggestions for enterprise managers, government departments, and investors, guiding them to enhance sustainable performance through judicious calibration of financial flexibility levels.

Do Islamic banks use institutional theory in the light of Shariah governance? Empirical evidence from a Muslim dominant country

The present paper examines the application of institutional theory (hereafter IT) mechanisms (isomorphism and legitimacy) in Shariah governance (henceforth SG) practices and in operations, as it best illuminates the operational guidelines and procedures for the Islamic banks to attain legitimacy. More specifically, the study aims to empirically explore the SG of Islamic banks in Bangladesh from the viewpoint of IT mechanisms. The study applied a qualitative case study method and a semi-structured face-to-face (individual) interview with various stakeholders connected with Bangladesh's Islamic banks and SG practices. The study finds that Islamic banks face pressure from the administration, regulators, and government in performing their activities and functions. More importantly, most Islamic banks replicate one leading Islamic bank, which indicates the presence of mimetic or cultural-cognitive isomorphism. Conversely, normative pressure covers the existing practicing environment, people's social awareness, knowledge, willingness, and accountability of the Board of Directors (BOD) towards the people concerning Shariah compliance with policymaking. Moreover, socio-political norms, regulations, and corruption influenced policymaking, preparation of SG guidelines, and their implementation. The study significantly contributed to national regulatory bodies by exploring the presence of significant pressures on diverse stakeholders. The study has several policy contributions for the Islamic banks and the Central Bank of Bangladesh. Notably, the study will help global regulatory bodies and policymakers minimize multifaceted pressures, improve SG practices, and enhance the quality of Shariah compliance.

Do institutional contingencies matter for green investment?-An institution based view of Chinese listed companies

Current research in the field of environmental management has placed significant emphasis on understanding the reasons behind varying organizational responses to environmental responsibilities. Governance scholars emphasize the central role of institutional factors in shaping environmental responsibilities, primarily due to the substantial influence exerted by regulatory institutions. Drawing on institutional theory, we investigate how sub-national institutional factors impact a firm's green investment intensity and explore their moderating influence on the relationship between green investment and a firm's financial performance. Using a database of Chinese listed companies from 2012 to 2019, this study employs fixed effect model as a baseline regression. Our analysis demonstrates that sub-national institutions, such as state-owned enterprises (SOEs), regional development, and cross-listing, have significant and positive impact on corporate green investment. Our study further provide an evidence that green investment significantly improve firms' financial performance. Moreover, the positive effect of green investment on financial performance is stronger in SOEs and in firms of developed regions as compared to their counterparts, and weaker in cross listed firms than those of non-cross listed peers. Our study suggest that subnational institutions play an imperative role in improving environmental quality and financial performance by promoting corporate green investment. To make sure that our findings remain robust to endogeneity, we applied generalized method of moments (GMM) and propensity score matching (PSM) method. Our findings further provide implications for emerging economies with similar shareholding patterns and unbalanced regional development.

[The presumed consent legislation - A success factor or a disruptive factor for tissue donation? A qualitative study based on multidisciplinary interviews with experts]

INTRODUCTION

Tissue transplantation can improve the quality of life of patients in a very wide range of applications. In 2021, around 900 people in Germany agreed to donate organs after death - the number of tissue donors was significantly higher. Nevertheless, there is a shortage of organs and tissues in Germany. In order to counteract this, the introduction of a presumed consent legislation has been discussed time and again. However, the debates focused on possible positive effects for organ donation, whereas potential consequences for tissue donation have so far not been considered in the political discourse or in research. Using an exploratory approach, this paper aims to contribute to closing this research gap: Multidisciplinary interviews with experts were conducted to investigate whether the presumed consent legislation is a key success factor for increasing the number of tissue donors in Germany and which other approaches might be promising.

METHODS

We conducted qualitative interviews with 14 experts who worked as employees in different positions in tissue banks/networks, ophthalmologists performing corneal transplantation, medical ethicists, lawyers or scientists. These interviews were evaluated using the structuring content analysis according to Mayring. In reporting, we followed the Standards for Reporting Qualitative Research (SQRQ).

RESULTS

The majority of experts did not consider presumed consent legislation to be a key factor in increasing the donation rate in Germany. Instead, an improvement of processes and structures in tissue donation was cited as the most important optimization potential. Furthermore, communication measures were postulated to create transparency about the characteristics of tissue donation as distinct from organ donation. These should address not only the general population, but also the professional groups involved in the tissue donation process.

CONCLUSION

The present study indicates that the presumed consent legislation is not a success factor for increasing the number of tissue donors in Germany. It would be far more effective to improve structures and processes in order to identify the large number of potential tissue donors and to be able to conduct informed conversations with their relatives. Information measures for the general public and professionals, which clearly differentiate between tissue donation and organ donation, are also more promising than fruitless debates about the introduction of the presumed consent legislation.

[Terra incognita of tissue donation: A systematic literature review analyzing institutional factors influencing the willingness to donate tissue]

INTRODUCTION

Partly because of a lack of governmental commitment in educational work, tissue donation is largely unknown in the German population, although it has an increasing relevance for patient care. Due to the progress in research, the shortage of donor tissues in Germany is constantly increasing and has to be compensated by imports. In contrast, nations such as the USA are self-sufficient in donor tissue and can even export it. Since not only individual but also institutional factors (e.g., legal framework, allocation principles and the organization of tissue donation) can lead to these national differences in donor rates, the present systematic literature review will investigate how these factors influence the willingness to donate tissue.

METHODS

Relevant publications were systematically searched in seven databases. The search command consisted of English and German terms for the two search components "tissue donation" and "health care system". Papers published in English or German between 2004 and May 2021 and focusing on the analysis of institutional factors influencing the willingness to donate tissue post-mortem for transplantation were included (inclusion criteria); studies on blood and organ and living donation as well as publications not dealing with institutional factors influencing the willingness to donate tissue were excluded (exclusion criteria). In reporting, we followed the PRISMA 2020 statement.

RESULTS

Of 1,398 hits, seven were finally included after screening. Many of the remaining studies focused on organ donation or non-institutional aspects of tissue donation. Only two studies considered the central population perspective. Furthermore, five publications originate from an Australian research group and focus on the international allocation of tissues. The results highlight the inadequate state of research and at the same time suggest that both tissue bank organization and allocation principles may influence the willingness to donate tissue. At the same time, the publications indicate that tissue donors are often not informed about a potential commercial use or an international allocation of tissues, which represents an ethical-legal conflict.

CONCLUSION

The results indicate that institutional factors may influence people's willingness to donate. In particular, the lack of societal awareness of the issue results in various areas of tension for which recommendations for action have been developed. In order to prevent a slump in tissue donations because of socially unacceptable practices, further population-based studies should explore the institutional framework conditions that society demands for tissue donation.

Institutional theory and circular economy business models: The case of the European Union and the role of consumption policies

The circular economy (CE) has been gaining traction in recent years as it promises a change for good, in terms of environmental, social, and economic benefits. The major changes required to implement circular economy business models (CEBMs), can prove to be especially difficult for organisations. This study provides a holistic analysis of the effect of CE institutional policies on the development of CEBMs in organisations, by exploring not only production-oriented policies, which have been the focus of previous research, but also consumption policies. Consumption policies, in the form of regulatory and information policies, are oriented towards consumers and have the potential to affect the demand for CE products, which in turn affects the development of CEBMs in organisations. The paper is framed within the institutional theory and the context of the European Union. Our results reveal that consumption policies have a positive, albeit diminishing, effect on the CEBMs. Our paper finds that regulation is the most impactful policy, having a larger impact than production policies. Our results highlight the important role of institutional policies in fostering consumers' demand for CE products and of consumption policies as tools to be employed by governments in fostering CEBMs and achieving sustainability.

Do environmental management practices mediate institutional pressures-environmental performance relationship? Evidence from Vietnamese SMEs

Although SMEs contribute much to Vietnamese economic growth, they cause significant negative impacts on the environment. In environmental literature, the institutional theory is suggested to be used as a theoretical lens to examine the pressure driving an organization to improve environmental performance and indirectly through strategic response. Despite that, this theory needs more application to predict SMEs' environmentally friendly outcomes. Hence, this study draws upon institutional theory to examine that three institutional pressures, coercive, normative, and mimetic pressures have a direct impact on environmental performance as well as an indirect impact through the adoption of environmental management practices. Data were collected by surveying 253 manufacturing SMEs operating in Vietnam. Partial least-squared structural equation modeling was executed to assess data. The results suggest that three institutional pressures, coercive, mimetic, and normative pressure, indirectly improve environmental performance by adopting environmental management practices. At the same time, there is no direct effect of these pressures on environmental performance. These findings shed light on how institutional pressures affect environmental management practice adoption and environmental performance in the SME context. These findings also contribute the theoretical development of institutional theory by showing that adopting environmental management practices is a strategic response to institutional pressures to gain environmental performance. Lastly, due to mixed results on the relationship between institutional pressures and its outcomes (e.g., environmental management practice adoption, environmental performance), this study cast light on those relationships in Vietnam.

The finest diamond must be green: a closer look at the roles of institution in shipping firms' sustainable practices

Shipping companies' implementation of sustainable shipping management is an important means of protecting major water bodies in the marine environment. This research establishes a theoretical model based on institutional theory and incorporates a micro-consciousness level to explore the factors influencing companies' implementation of sustainable shipping practices. After surveying the management of Chinese shipping companies, a total of 282 datasets were obtained for analysis. This study demonstrated that rules and regulations, societal norms, environmental awareness, and legal awareness can improve shipping companies' sustainable shipping practices. Meanwhile, these practices have a positive impact on the environmental, financial, and competitive performance of shipping companies. Moreover, these findings are highly significant for maritime environmental protection and sustainability.

Exploring the effects of sudden institutional coercive pressure on digital transformation in colleges from teachers' perspective

While past technology acceptance studies focus on organization readiness, little is known about the acceptance behavior under sudden institutional coercive pressure. Against COVID-19 and distance teaching, this study explores the relationship between digital transformation readiness, adoption intention, digital transformation success, and sudden institutional coercive pressure based on the readiness research model and institutional theory. Surveying 233 college teachers who participated in distance teaching under COVID-19 in Taiwan for model and hypothesis validation using the partial least square structural equation modeling (PLS-SEM) approach. This result shows that (1) Teacher, social/public, and content readiness are crucial to distance teaching. Individuals, organizational resources, and external stakeholders influence distance teaching success and adoption; and (2) Sudden institutional coercive pressure has a negative moderated effect on teachers' readiness and adoption intention. When teachers are unprepared to implement distance teaching, this unanticipated epidemic and sudden institutional coercive pressure will accelerate and enhance their intention. The study provides government, educational policymakers, and teachers with a better understanding of distance teaching during the COVID-19 pandemic.

Re-setting special education for justice: An essay on the logics and infrastructure enabling deep change in the COVID-19-era

COVID-19 shocked the education system, disrupting the policies and practices of special education over multiple school years. This essay brings together the institutional logics perspective and racialized organization theory to first examine aspects of special education and then describe how leaders and teachers can improve special education to target inequities. We illustrate features of three logics of special education: compliance, intervention, and equity. We explain how these logics are racialized structures in the special education field. Applying an agentic stance, we portray how leaders and teachers draw on multiple, competing logics of special education. Next, we highlight how infrastructure enables leaders and teachers to enact the equity model of special education. In sum, this essay encourages improving infrastructural elements and confronting racism and ableism to re-envision special education in the face of COVID-disruptions.

Getting our hopes up: How actors perceive network effectiveness and why it matters

Health care's grand challenges, such as continuously increasing costs, challenge the sustainability of health systems. Purpose-oriented networks are considered a favorable mode of organization to address these grand challenges. Therefore, it is crucial that they are effective. While network effectiveness is a heavily theorized, multi-dimensional concept that is often measured as a perception of actors, little is known about how network actors perceive effectiveness in practice and how this influences their behavior. In this study, we explored how network actors perceive network effectiveness using 32 interviews with representatives from network member organizations and regulatory agencies actor, 28 h of network meeting observations, and 1.272 pages of documents such as meeting minutes and media outlets. Our results show that actors primarily see hard outcomes (e.g. changes in cost or quality of care) as effectiveness but given the temporal nature of these goals and difficulties quantifying them, they resort to the collaborative process as a proxy to assess effectiveness. Actors engage in networks to solve grand challenges. However, conforming to expectations and environmental pressures also play a substantial role for actors to (continue to) participate in networks. In the absence of hard outcomes, actors legitimize their continued participation in networks using the collaborative process of networks. Actors therefore take purpose-oriented networks for granted as a legitimate way of organizing. Besides attempting to solve grand challenges, networks thus also seem to be adopted because of powerful institutional rules that function as rationalized myths, to gain legitimacy. Future research should be aware of and further unravel the institutional pressures in networks.

Nexus amongst environmental regulations, carbon emission intensity and technological innovation in China's construction industry

China's construction industry confronts with the dilemma of carbon emissions in adjusting the environmental regulations. Many studies are neglected on discovering the potential nexus amongst environmental regulations (ERs), technological innovation (TI) and CEI (CEI) and ignores the relationships amongst TI for reducing CEI. To mitigate this gap, this study bridges institutional theory to integrate the practices in the construction industry. This study applies a panel dataset on the construction industry from 30 provinces during 2004-2018 and uses it with a two-step system-generalised method of moments for analysis. The proposed method enables the prevention of the interference of the heteroscedasticity problem and improves certain analytical efficiency. The results are as a guideline for policymakers in rechecking the policies and regulations adequacy. The findings indicate that (1) the forced emission reduction effect is proven by command-and-control and market-based ERs, which can inhibit CEI; (2) voluntary ERs have an inverted U-shaped nexus with CEI; in other words, the green paradox effect shifts to the forced emission reduction effect once the intensity of voluntary ERs increases; and (3) market-based and voluntary ERs reduce CEI effectively by using TI as the mediator in construction industry.

What drives patients' acceptance of Digital Therapeutics? Establishing a new framework to measure the interplay between rational and institutional factors

BACKGROUND

The rising incidence of chronic diseases among the population, further exacerbated by the phenomenon of aging, is a primary concern and a serious challenge for the healthcare systems worldwide. Among the wide realm of health digital technologies, the rise of Digital Therapeutics (DTx), which are medical devices able to deliver evidence-based treatments to manage and treat diseases, opens new opportunities. However, their diffusion and usage are still fragmented among countries. As the diffusion results from the adoption of technology from a social system and individual acceptance, this study aims to design and test a theoretical model that investigates the intention to use DTx, with a particular focus on the treatment of obesity, as a widespread and burdensome chronic condition.

METHODS

This research is built on 336 answers coming from a survey to test the proposed model, which consists of a combination of organizational mechanisms, derived from Institutional Theory, and rational factors, derived from the Technology Acceptance Model (TAM). The survey has been delivered to patients and former patients of Istituto Auxologico Italiano, a hospital with several locations in northern Italy, recognized as a center of excellence for the treatment of obesity.

RESULTS

The analyses of the answers, performed through the Structural Equation Modelling (SEM) technique, confirmed the influence of the Perceived Usefulness on Intention To Use, and of the Perceived Ease Of Use on the Perceived Usefulness, confirming the validity of the assumptions derived from the TAM. On the other hand, institutional factors were introduced as antecedents of the Perceived Usefulness, and the Perceived Ease Of Use. Results show that the Regulative Pillar influences both the TAM constructs, the Normative Pillar (peer influence) has a positive effect only on the Perceived Usefulness, and finally, the Cultural Pillar impacts the Perceived Ease Of Use.

CONCLUSION

This study allows filling the knowledge gap regarding the usage of the Institutional as a means to predict individuals' intentions. Moreover, managerial contributions are available as the results have been operationalized into practical advice to managers and healthcare professionals to foster the adoption, and thus the diffusion, of Digital Therapeutics.

Problematic use of social media: The influence of social environmental forces and the mediating role of copresence

People's dependence on technology in the digital environment has increasingly become the focus of academic and social attention. Social media, in particular, with the functions of connecting with others and maintaining interactions, has become an inseparable part of people's lives. Although the formation of problematic use of social media has been extensively discussed by scholars, it is mainly confined to the individual level and lacks a macro perspective from the external environment. This study draws on the perspective of institutional theory and introduces copresence as a mediating role, aiming to investigate the influence mechanism of social environmental forces on individuals' problematic use of social media. An online survey (N = 462) was conducted to collect data and test the research model. Our data were analyzed using the structural equation modeling (SEM) approach. Results show that social environmental forces exert an impact on problematic use of social media through the sense of copresence, and only mimetic force can directly affect behavior outcomes while the other two forces can not. Besides, social environmental forces have a relationship with people's sense of copresence while using social media. Among them, mimetic force and normative force positively correlate with copresence while coercive force is negatively related to copresence. Furthermore, copresence is found to influence problematic use of social media positively. Practical and theoretical implications are discussed.

Measuring entrepreneurial orientation and institutional theory for informal enterprises: scale validation

The importance of institutional factors and entrepreneurial orientation is widely recognized in the study of entrepreneurship development, leading to the development of different measurement scales. Using the sample of 45 informal enterprises, we examined the factor structure, reliability, convergent and discriminant validity of the selected constructs adapted to measure these constructs in the context of informal enterprises in Nigeria. We examined 45 items that measure institutional factors (political, cognitive, cultural, and corruption) and entrepreneurship orientation (innovativeness, proactiveness, and risk-taking). An assessment of Cronbach's alpha and composite reliability shows that the items measuring risk-taking, proactiveness, uncertainty avoidance, and masculinity are internally consistent. However, some of the items measuring other constructs have lower loading, highlighting their lack of internal consistency. The results also evidence convergent and discriminant validity of the measures used. We conclude that most of the items are reliable measurements of the corresponding constructs, and the constructs adapted to measure these constructs correlate positively with the alternative measure of the constructs. Thus, the measures evaluated in this study can be used to assess these constructs across informal enterprises. The paper contributes to validating the measurement scales and indices of institutional theory and theory of entrepreneurial orientation in the context of informal enterprises.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11135-022-01357-1.

The European university alliances-an examination of organizational potentials and perils

The European Union (EU) has repeatedly underlined the importance of higher education, research and innovation as drivers in the further development of Europe-economically, socially and culturally. One of the latest policy initiatives by the European Commission (EC) intended to promote this agenda is the European Universities Initiative (EUI) where alliances between universities across national borders are to identify new approaches for boosting European scientific cooperation. It might be argued that this development represents an attempt to find an organizational solution to the European policy ambitions in higher education, research and innovation. This article presents a framework for analysing European university alliances. Based on interviews with persons occupying key leadership and management roles in ten alliances, the article analyses the potential gains and perils alliances might face along four dimensions: their internal coordination, their ways of resolving conflicts, the commitment of member universities and the cultural characteristics of the alliances.

Stuck between medals and participation: an institutional theory perspective on why sport federations struggle to reach Sport-for-All goals

BACKGROUND

Sport-for-All emphasizes that every individual has the right to participate in sport. Despite all efforts to deliver Sport-for-All during the past decades, studies indicate that sport participation rates have been stagnating, whereas social inequalities in sport continue to exist. By applying an institutional theory lens, this study sheds light on how the dual mission of sport federations, i.e., providing Sport-for-All and high performance sport, affects the Sport-for-All projects of Flemish sport federations (e.g., amount of projects and target groups). In particular, Sport-for-All projects have to reduce barriers to engage in the sport system and be supported by a sport federation. Furthermore, this study seeks to better understand the impact of the underlying institutional logic on the institutional pressure and legitimacy of the sport federations.

METHOD

This study implemented a cross-sectional field study in sport federations. In particular, the sport federations selected for our study are the 47 Flemish sport federations. Both qualitative (i.e., document analysis) and quantitative research methods (i.e., a new questionnaire was developed based on institutional theory) were applied in the study.

RESULTS

Results indicated that sport federations are important partners in support of Sport-for-All projects, but also suggested that there is a discrepancy between the projects of the high performance-oriented and the Sport-for-All-oriented federations. Specifically, the high performance-oriented federations were targeting youth participants, whereas Sport-for-all-oriented federations aimed to reach disadvantaged groups. Furthermore, the results indicated that high performance-oriented federations endured more institutional pressure than Sport-for-All-oriented federations.

CONCLUSION

The results of our study indicated that the Sport-for-All projects of performance-oriented federations are often more superficial compared to Sport-for-All oriented federations, and that the latter federations play an important role in attaining public health targets. Moreover, policymakers should consider how they can optimize the role of the performance-oriented federations in the Sport-for-All delivery (e.g., they could function as a bridge to guide participants who prefer a less competitive setting towards Sport-for-All oriented federations).

Exploring the technical and behavioral dimensions of green supply chain management: a roadmap toward environmental sustainability

Environmental sustainability issues have become an increasing concern for enterprises and organizations due to new tendencies in climate change. Green supply chain management (GSCM) practices are growing worldwide in this context. Based on socio-technical systems and institutional theory, the present study develops a conceptual model highlighting a mediating effect between two distinct categories of GSCM dimensions, i.e., technical practices and behavioral practices, along with the moderating effect of institutional pressure on organizational performance. Data were collected from 260 Pakistani manufacturers, and the structural equation modeling (SEM) approach was employed to analyze the hypotheses. The classification of technical and behavioral GSCM practices and findings of this research contributes to the literature on GSCM. Empirical results reveal that behavioral practices of GSCM (top management support, supplier, and customer involvement) mediate the relationship between technical GSCM practices (eco-design, green manufacturing, and reverse logistics) and organizational performance (economic, environmental, and social). The results also demonstrate that institutional pressure positively moderates the relationship between technical practices and organizational performance. These findings suggest that organizations in developing countries must focus on the behavioral dimensions of GSCM first for the successful implementation of technical dimensions of GSCM to gain effective environmental, economic, and social performance.

Cloud accounting adoption in Thai SMEs amid the COVID-19 pandemic: an explanatory case study

The COVID-19 pandemic has altered the way small and medium-sized businesses (SMEs) function. To maintain business efficiency and reduce operating costs in the context of the constraints imposed by the pandemic, SMEs have been forced to embrace new digital technologies. Cloud accounting is becoming an increasingly important business operating tool for SMEs. By adopting cloud-based accounting, SMEs can become more efficient, financially organized, and flexible. This study aims to investigate the factors that have a pervasive influence on cloud accounting adoption among SMEs in Thailand, following the pandemic's effects. This study integrates three technology adoption theories-the Technology-Organization-Environment framework, Diffusion of Innovation theory, and Institutional Theory-and studies them alongside SMEs' unique characteristics. The research employs a qualitative case study method and triangulated sources of evidence. The findings provide important implications for the research community, policymakers, cloud accounting vendors, and SME owners aiming to formulate better approaches to cloud accounting adoption after the pandemic. The results suggest that vendors should focus on SMEs' particular characteristics and needs. By contrast, SMEs should determine the organizational fit of the cloud accounting platform and integrate cloud accounting with other aspects of their operations.

Overcoming institutionalised barriers to digital health systems: an autoethnographic case study of the judicialization of a digital health tool

BACKGROUND

The deployment of digital health systems may be impeded by barriers that are, or are linked to underlying enduring institutions. Attempting to challenge the barriers without addressing the underpinning institution may be ineffective. This study reflects on ways actors may surmount institutionalised barriers to the uptake of digital tools in health systems.

METHODS

I applied Institutional theory concepts to an autoethnographic case study of efforts to introduce a digital tool to provide citizens with medicines information.

RESULTS

The tool's uptake was impeded because of state regulators' institutionalised interpretation of pharmaceutical advertising laws, which rendered the tool illegal. I, along with allies beyond the health sector, successfully challenged the regulators' institutionalised interpretation of pharmaceutical advertising laws through various actions. These actions included: framing the tool as legal and constitutional, litigation, and redefining these concepts: 'advertising', 'health institution', and the role of regulatory bodies vis a vis innovation.

CONCLUSION

After identifying a barrier as being institutionalised or linked to an institution, actors might challenge such barriers by engaging in institutional work; i.e. deliberate efforts to challenge the relevant institution (e.g. a law, norm or shared belief). Institutional work may require the actions of multiple actors within and beyond the health sector, including judicial actors. Such cross-sectoral alliances are efficacious because they provide institutional workers with a broader range of strategies, framings, concepts and forums with which to challenge institutionalised barriers. However, actors beyond the health system (e.g. the judiciary) must be inquisitive about the potential implications of the digital health interventions they champion. This case justifies recent calls for more deliberate explorations within global health scholarships and practice, of synergies between law and health.

COVID-19, government interventions and emerging capital markets performance

In this study, we explore the impact of government intervention to contain the spread of COVID-19 in emerging countries on the performance of their leading stock indices. We retrieved data on the performance of 25 international capital market indices included in the MSCI Emerging Markets Index and data about the closures, economic, and health measures imposed in each country examined. Overall, our findings show that government restrictions are associated with negative market returns, possibly due to the anticipated adverse effect to the economy. The adverse effect is more evident when closures are imposed. The market response to economic stimulus is mild but varies depending on the type of intervention imposed, much as with the health measures. Public campaigns may raise public awareness about COVID-19, but they can also increase the public's fear of the pandemic, reflected in the negative response in capital markets. The results are essential for understanding the trends and fluctuations in emerging markets during this current crisis and for preparing for crises in the future.

Disturbance shapes the US forest governance frontier: A review and conceptual framework for understanding governance change

Conflict in US forest management for decades centered around balancing demands from forested ecosystems, with a rise in place-based collaborative governance at the end of the twentieth century. By the early 2000s, it was becoming apparent that not only had the mix of players involved in forest management changed, but so had the playing field, as climate-driven disturbances such as wildfire and insect and disease outbreaks were becoming more extensive and severe. In this conceptual review paper, we argue that disturbance has become the most prominent driver of governance change on US national forests, but we also recognize that the governance responses to disturbance are shaped by variables such as discourses, institutional history and path dependence, and institutional innovation operating at different system levels. We review the governance changes in response to disturbance that constitute a new frontier in US federal forest governance and offer a conceptual framework to examine how these governance responses are shaped by multi-level factors.

Unpacking the red packets: institution and informal payments in healthcare in China

Informal cash payments from patient to healthcare providers for services provided by the healthcare system have attracted increasing scholarly interest. However, the root and mechanism of informal payments are not well understood. This paper contributes to the literature by positing informal payments as informal institutions. We use a nationally representative longitudinal survey in 28 provinces in China to explore the root of informal payments. Our empirical findings suggest that patients' informal payments for healthcare services may originate from information acquisition and processing, failure of government and market in allocating healthcare resources, and disparities in utilization. Further, this informal institution could be changed by the self-reinforcement of individual patients. These findings suggest that policies to facilitate transparency and to remove institutional barriers, such as the introduction of market competition, may reduce the incidence of informal payments.

Environment Practices Mediating the Environmental Compliance and firm Performance: An Institutional Theory Perspective from Emerging Economies

Coercive pressure has forced firms to take up environmental measures in the last two decades in emerging economies. Under normative pressure, large firms with farsightedness take up the environmental practices as industry leaders. In a little mature emerging economy, such as India, where triple bottom line awareness is growing, the government facilitates the firms to operate in an environment-friendly ecosystem. We investigate how do environmental compliance and environmental practices influence the overall firm performance? The performance was measured in terms of financial, customer, internal business process, and learning and growth performance. A survey instrument was designed using well-established scales and administered to the middle to top-level corporate management executives to gather 240 data from the Indian firms. A rigorous statistical validity, diagnostics, and SEM were used to test the hypotheses. The environmental practices showed a full mediation effect on the effect of environmental compliance on performance. The examination of mediation relationships in an environmental context is limited in the reported literature. This paper is among the initial works that deal with complicated mediation relationships drawn from institutional theory propositions. The study established and argued that environmental practices' ecosystem would turn firms towards voluntary environmental compliance and eventually enjoy the long-term performance.

Mergers may enhance the legitimacy of community health organisations in neoliberal environments

PURPOSE

Comprehensive primary health care (PHC) models are seldom implemented in high income countries, in part due to their contested legitimacy in neoliberal policy environments. This article explores how merging affected the perceived legitimacy of independent community health organisations in Victoria, Australia, in providing comprehensive PHC services.

DESIGN/METHODOLOGY/APPROACH

A longitudinal follow-up study (2-3 years post-merger) of two amalgamations among independent community health organisations from the state of Victoria, Australia, was conducted. This article explores the perceived effects of merging on (1) the pragmatic, normative and cognitive legitimacy of studied organisations and (2) the collective legitimacy of these organisations in Victoria's health care system. Data were collected through 19 semi-structured interviews with key informants and subjected to template and thematic analyses.

FINDINGS

Merging enabled individual organisations to gain greater overall legitimacy as regional providers of comprehensive PHC services and thus retain some capacity to operationalise a social model of health. Normative legitimacy was most enhanced by merging, through acquisition of a large organisational size and adoption of business practices favoured by neoliberal norms. However, mergers may have destabilised the already contested cognitive legitimacy of community health services as a group of organisations and as a comprehensible state-wide platform of service delivery.

PRACTICAL IMPLICATIONS

Over-reliance on individual organisational behaviour to maintain the legitimacy of comprehensive PHC as a model of organising health and social care could lead to inequities in access to such models across communities.

ORIGINALITY/VALUE

This study shows that organisations can manage their perceived legitimacy in order to ensure the survival of their preferred model of service delivery.

Environmental concerns and switching toward electric vehicles: geographic and institutional perspectives

Smog pollution deteriorates environmental quality and has severe health risks. This affects the daily lives of people in China, particularly in urban areas. Along with other factors, a large portion for smog comes from transportations, making it dense and more hazardous in urban areas. The Chinese government aims to reduce air pollution by promoting electric vehicles and green modes for mobility along with other environmental protection measures. The study explores the switching intentions of people from motorized vehicles to electric vehicles by integrating push-pull-mooring model and institutional theory. The study incorporates environmental quality, regulative environment, alternative attractiveness, normative environment, self-(decision)efficacy, and willingness to pay into an integrated framework. The study further analyzes the green behavior of consumers by extending switching intentions for electric vehicles. The integrated framework explains mooring as the most influential factor followed by normative environment from pull factors and environmental quality from push factors. The effect of regulative environment remains weak and significant, but the effect of alternative attractiveness remains weak and insignificant. The switching intentions strongly and significantly explain green behavior. Furthermore, mooring moderates the relationship between push factors, some of the pull factors, and switching intentions.

Role of institutions in shaping corporate governance system: evidence from emerging economy

Corporate governance (CG) is often split among rule and principle-based approaches to control in idiosyncratic institutional contexts. This split is often primed by the types of institutional conformations, their potencies, and the complementarities within them. Drawing on the theoretical foundation of institutional theory, this study theorizes CG practices and structures as institutionally resoluted and directed and explores the key institutional determinants of good CG practices in an emerging economy. Based on qualitative method, this study presents eight specific antecedents of good corporate governance practices in weak institutional settings (Pakistan). In particular, the study explores the extent to which certain underlying formal and informal institutional determinants, such as the auditing, political, legal, board, shareholders awareness, voting, culture and values play a determining role in corporate governance. This study advocates how each of these precursors must be implied, enunciated and hitched, on the basis of pertinent institutional peculiarities, in order to address contextual corporate governance challenges. This study contributes to the institutional theorizing of good corporate governance, by paying attention to the context, efficacy (instrumentality) and legitimacy (symbolic) in expounding the good corporate governance practices in an international business environment.

What can organisational theory offer knowledge translation in healthcare? A thematic and lexical analysis

BACKGROUND

Despite the relative abundance of frameworks and models to guide implementation science, the explicit use of theory is limited. Bringing together two seemingly disparate fields of research, this article asks, what can organisational theory offer implementation science? This is examined by applying a theoretical lens that incorporates agency, institutional, and situated change theories to understand the implementation of healthcare knowledge into practice.

METHODS

Interviews were conducted with 20 general practitioners (GPs) before and after using a resource to facilitate evidence-based sexual healthcare. Research material was analysed using two approaches - researcher-driven thematic coding and lexical analysis, which was relatively less researcher-driven.

RESULTS

The theoretical lens elucidated the complex pathways of knowledge translation. More specifically, agency theory revealed tensions between the GP as agent and their organisations and patients as principals. Institutional theory highlighted the importance of GP-embeddedness within their chosen specialty of general practice; their medical profession; and the practice in which they worked. Situated change theory exposed the role of localised adaptations over time - a metamorphosis.

CONCLUSIONS

This study has theoretical, methodological, and practical implications. Theoretically, it is the first to examine knowledge translation using a lens premised on agency, institutional, and situated change theories. Methodologically, the study highlights the complementary value of researcher-driven and researcher-guided analysis of qualitative research material. Practically, this study signposts opportunities to facilitate knowledge translation - more specifically, it suggests that efforts to shape clinician practices should accommodate the interrelated influence of the agent and the institution, and recognise that change can be ever so subtle.

How institutional forces, ideas and actors shaped population health planning in Australian regional primary health care organisations

Background

Worldwide, there are competing norms driving health system changes and reorganisation. One such norm is that of health systems’ responsibilities for population health as distinct from a focus on clinical services. In this paper we report on a case study of population health planning in Australian primary health care (PHC) organisations (Medicare Locals, 2011–2015). Drawing on institutional theory, we describe how institutional forces, ideas and actors shaped such planning.

Methods

We reviewed the planning documents of the 61 Medicare Locals and rated population health activities in each Medicare Local. We also conducted an online survey and 50 interviews with Medicare Local senior staff, and an interview and focus group with Federal Department of Health staff.

Results

Despite policy emphasis on population health, Medicare Locals reported higher levels of effort and capacity in providing clinical services. Health promotion and social determinants of health activities were undertaken on an ad hoc basis. Regulatory conditions imposed by the federal government including funding priorities and time schedules, were the predominant forces constraining population health planning. In some Medicare Locals, this was in conflict with the normative values and what Medicare Locals felt ought to be done. The alignment between the governmental and the cultural-cognitive forces of a narrow biomedical approach privileged clinical practice and ascribed less legitimacy to action on social determinants of health. Our study also shed light on the range of PHC actors and how their agency influenced Medicare Locals’ performance in population health. The presence of senior staff or community boards with a strong commitment to population health were important in directing action towards population health and equity.

Conclusions

There are numerous institutional, normative and cultural factors influencing population health planning. The experience of Australian Medicare Locals highlights the difficulties of planning in such a way that the impact of the social determinants on health and health equity are taken into account. The policy environment favours a focus on clinical services to the detriment of health promotion informed by a social determinants focus.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5273-4) contains supplementary material, which is available to authorized users.

Ideas, actors and institutions: lessons from South Australian Health in All Policies on what encourages other sectors' involvement

BACKGROUND

This paper examines the extent to which actors from sectors other than health engaged with the South Australian Health in All Policies (HiAP) initiative, determines why they were prepared to do so and explains the mechanisms by which successful engagement happened. This examination applies theories of policy development and implementation.

METHODS

The paper draws on a five year study of the implementation of HiAP comprising document analysis, a log of key events, detailed interviews with 64 policy actors and two surveys of public servants.

RESULTS

The findings are analysed within an institutional policy analysis framework and examine the extent to which ideas, institutional factors and actor agency influenced the willingness of actors from other sectors to work with Health sector staff under the HiAP initiative. In terms of ideas, there was wide acceptance of the role of social determinants in shaping health and the importance of action to promote health in all government agencies. The institutional environment was initially supportive, but support waned over the course of the study when the economy in South Australia became less buoyant and a health minister less supportive of health promotion took office. The existence of a HiAP Unit was very helpful for gaining support from other sectors. A new Public Health Act offered some promise of institutionalising the HiAP approach and ideas. The analysis concludes that a key factor was the operation of a supportive network of public servants who promoted HiAP, including some who were senior and influential.

CONCLUSIONS

The South Australian case study demonstrates that despite institutional constraints and shifting political support within the health sector, HiAP gained traction in other sectors. The key factors that encouraged the commitment of others sectors to HiAP were the existence of a supportive, knowledgeable policy network, political support, institutionalisation of the ideas and approach, and balancing of the economic and social goals of government.

Rethinking informal payments by patients in Europe: An institutional approach

The aim of this paper is to explain informal payments by patients to healthcare professionals for the first time through the lens of institutional theory as arising when there are formal institutional imperfections and asymmetry between norms, values and practices and the codified formal laws and regulations. Reporting a 2013 Eurobarometer survey of the prevalence of informal payments by patients in 28 European countries, a strong association is revealed between the degree to which formal and informal institutions are unaligned and the propensity to make informal payments. The association between informal payments and formal institutional imperfections is then explored to evaluate which structural conditions might reduce this institutional asymmetry, and thus the propensity to make informal payments. The paper concludes by exploring the implications for tackling such informal practices.

Understanding human resource management practices in Botswana's public health sector

Purpose The purpose of this paper is to assess the management of the public sector health workforce in Botswana. Using institutional frameworks it aims to document and analyse human resource management (HRM) practices, and make recommendations to improve employee and health system outcomes. Design/methodology/approach The paper draws from a large study that used a mixed methods approach to assess performance of Botswana's Ministry of Health (MOH). It uses data collected through document analysis and in-depth interviews of 54 key informants comprising policy makers, senior staff of the MOH and its stakeholder organizations. Findings Public health sector HRM in Botswana has experienced inadequate planning, poor deployment and underutilization of staff. Lack of comprehensive retention strategies and poor working conditions contributed to the failure to attract and retain skilled personnel. Relationships with both formal and informal environments affected HRM performance. Research limitations/implications While document review was a major source of data for this paper, the weaknesses in the human resource information system limited availability of data. Practical implications This paper presents an argument for the need for consideration of formal and informal environments in developing effective HRM strategies. Originality/value This research provides a rare system-wide approach to health HRM in a Sub-Saharan African country. It contributes to the literature and evidence needed to guide HRM policy decisions and practices.

Exploring the link between institutional pressures and environmental management systems effectiveness: An empirical study

Institutional theory has been widely debated by scholars. A part of literature examines how institutional pressures act on company choices regarding proactive environmental strategies. However, the institutional perspective has still not completely clarified the influence of these pressures on the effectiveness of environmental management systems (EMSs) in achieving goals in terms of eco-innovation, competitiveness and corporate reputation. This paper analyses the role played by coercive, mimetic and normative forces in stimulating innovative and competitive responses by firms with an environmental certification. Using the results of a survey on 242 European EMAS-registered organisations, the paper highlights the more positive influence of mimetic and normative pressures than coercive ones. The paper contributes to the literature debate on EMSs analysed through the lens of institutional theory.

Systematic impact of institutional pressures on safety climate in the construction industry

This paper explores how three types of institutional pressure (i.e., coercive, mimetic and normative pressures) systematically impact on the safety climate of construction projects. These impacts are empirically tested by survey data collected from 186 questionnaires of construction companies operating in Shanghai, China. The results, obtained by partial least squares analysis, show that organizational management commitment to safety and employee involvement is positively related to all three institutional pressures, while the perception of responsibility for safety and health is significantly influenced by coercive and mimetic pressure. However, coercive and normative pressures have no significant effect on the applicability of safety rules and work practices, revealing the importance of external organizational pressures in improving project safety climate from a systematic view. The findings also provide insights into the use of institutional forces to facilitate the improvement of safety climate in the construction industry.

The comprehensiveness of environmental management systems: The influence of institutional pressures and the impact on environmental performance

This study contributes to the EMS literature by providing a more detailed insight into the comprehensiveness of environmental management systems (EMSs) by focusing on the intensity of use of environmental management practices. In addition, the study examines the influence of institutional pressures (coercive, mimetic and normative) on the comprehensiveness of environmental management systems (EMSs), and the impact of EMS comprehensiveness on environmental performance. A mail survey questionnaire was used to collect data from a random sample of Australian senior managers across various industries. Both coercive and normative pressures were found to influence the comprehensiveness of EMSs. Specifically, the pressure exerted by the government, through the creation of appropriate regulatory pressures and public incentives, and by employees, customers, professional groups, the media, and community, influenced the comprehensiveness of the EMS. In addition, organisations with more comprehensive EMSs were found to experience higher levels of environmental performance. With more than 300,000 organisations worldwide adopting EMSs (ISO, 2013), the findings provide an important insight into the relevance of EMSs. In particular, it is suggested that organisations should endeavour to implement a more comprehensive EMS and be conscious of the role that coercive and normative pressures play in influencing the comprehensiveness of their EMSs.

The influence of institutional pressures on hospital electronic health record presence

Electronic health records (EHR) are a promising form of health information technology that could help US hospitals improve on their quality of care and costs. During the study period explored (2005-2009), high expectations for EHR diffused across institutional stakeholders in the healthcare environment, which may have pressured hospitals to have EHR capabilities even in the presence of weak technical rationale for the technology. Using an extensive set of organizational theory-specific predictors, this study explored whether five factors - cause, constituents, content, context, and control - that reflect the nature of institutional pressures for EHR capabilities motivated hospitals to comply with these pressures. Using information from several national data bases, an ordered probit regression model was estimated. The resulting predicted probabilities of EHR capabilities from the empirical model's estimates were used to test the study's five hypotheses, of which three were supported. When the underlying cause, dependence on constituents, or influence of control were high and potential countervailing forces were low, hospitals were more likely to employ strategic responses that were compliant with the institutional pressures for EHR capabilities. In light of these pressures, hospitals may have acquiesced, by having comprehensive EHR capabilities, or compromised, by having intermediate EHR capabilities, in order to maintain legitimacy in their environment. The study underscores the importance of our assessment for theory and policy development, and provides suggestions for future research.

Institutionalization of deinstitutionalization: a cross-national analysis of mental health system reform

Background

Policies generate accountability in that they offer a standard against which government performance can be assessed. A central question of this study is whether ideological imprint left by policy is realized in the time following its adoption. National mental health policy expressly promotes the notion of deinstitutionalization, which mandates that individuals be cared for in the community rather than in institutional environments.

Methods

We investigate whether mental health policy adoption induced a transformation in the structure of mental health systems, namely psychiatric beds, using panel data on 193 countries between 2001 and 2011.

Results

Our striking regression results demonstrate that late-adopters of mental health policy are more likely to reduce psychiatric beds in mental hospitals and other biomedical settings than innovators, whereas they are less likely than non-adopters to reduce psychiatric beds in general hospitals.

Conclusions

It can be inferred late adopters are motivated to implement deinstitutionalization for technical efficiency rather than social legitimacy reasons.

Electronic supplementary material

The online version of this article (doi:10.1186/1752-4458-8-47) contains supplementary material, which is available to authorized users.

Do institutional logics predict interpretation of contract rules at the dental chair-side?

In quasi-markets, contracts find purchasers influencing health care providers, although problems exist where providers use personal bias and heuristics to respond to written agreements, tending towards the moral hazard of opportunism. Previous research on quasi-market contracts typically understands opportunism as fully rational, individual responses selecting maximally efficient outcomes from a set of possibilities. We take a more emotive and collective view of contracting, exploring the influence of institutional logics in relation to the opportunistic behaviour of dentists. Following earlier qualitative work where we identified four institutional logics in English general dental practice, and six dental contract areas where there was scope for opportunism; in 2013 we surveyed 924 dentists to investigate these logics and whether they had predictive purchase over dentists' chair-side behaviour. Factor analysis involving 300 responses identified four logics entwined in (often technical) behaviour: entrepreneurial commercialism, duty to staff and patients, managerialism, public good.

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We provide quantitative evidence of four English dental practice institutional logics.

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Dental professionalism appears shaped around the needs of the dental practice community (patients and staff).

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We give evidence linking institutional logics to dental chair-side opportunism.

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We show an interaction between dentists' chair-side opportunism and higher level dealings with commissioners.

Interacting institutional logics in general dental practice

We investigate the organisational field of general dental practice and how agents change or maintain the institution of values associated with the everyday work of health care provision. Our dataset comprise archival literature and policy documents, interview data from field level actors, as well as service delivery level interview data and secondary data gathered (2011–12) from 16 English dental practices. Our analysis provides a typology of institutional logics (prevailing systems of value) experienced in the field of dental practice. Confirming current literature, we find two logics dominate how care is assessed: business-like health care and medical professionalism. We advance the literature by finding the business-like health care logic further distinguished by values of commercialism on the one hand and those of accountability and procedural diligence on the other. The logic of professionalism we also find is further distinguished into a commitment to clinical expertise and independence in delivering patient care on the one hand, and concerns for the autonomy and sustainability of a business enterprise on the other.

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A case study of English dental practice explores how multiple competing logics are managed.

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Practice ownership responsibility is identified as a distinct logic.

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Dental practitioners were found to readily move between four different logics sometimes invoking several at the same time.

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Commercialism logic was less in conflict with professionalism logic than with population health managerialism.

Competing and coexisting logics in the changing field of English general medical practice

Recent reforms, which change incentive and accountability structures in the English National Health Service, can be conceptualised as trying to shift the dominant institutional logic in the field of primary medical care (general medical practice) away from medical professionalism towards a logic of "population based medicine". This paper draws on interviews with primary care doctors, conducted during 2007-2009 and 2011-2012. It contrasts the approach of active management of populations, in line with recent reforms with responses to patients with medically unexplained symptoms. Our data suggest that rather than one logic becoming dominant, different dimensions of organisational activity reflect different logics. Although some aspects of organisational life are relatively untouched by the reforms, this is not due to 'resistance' on the part of staff within these organisations to attempts to 'control' them. We suggest that a more helpful way of understanding the data is to see these different aspects of work as governed by different institutional logics.

Exploring the utility of institutional theory in analysing international health agency stasis and change

Of recent interest is the capacity of international health agencies to adapt to changes in the global health environment and country needs. Yet, little is known about the potential benefits of using social science institutional theory, such as path dependency and institutional change theory, to explain why some international agencies, such as the WHO and the Global Fund to Fight AIDS, Tuberculosis and Malaria, fail to adapt, whereas others, such as the World Bank and UNAIDS, have. This article suggests that these institutional theories can help to better understand these differences in international agency adaptive capacity, while highlighting new areas of policy research and analysis.