Untangling the perception of value in value-based healthcare - an interview study

PURPOSE

Value-based health care (VBHC) argues that health-care needs to re-focus to maximise value creation, defining value as the quota when dividing the outcomes important for the patient, by the cost for health care to deliver such outcomes. This study aims to explore the perception of value among different stakeholders involved in the process of implementing VBHC at a Swedish hospital to support leaders to be more efficient and effective when developing health care.

DESIGN/METHODOLOGY/APPROACH

Participants comprised 19 clinicians and non-clinicians involved in the implementation of VBHC. Semi-structured interviews were conducted and content analysis was performed.

FINDINGS

The clinicians described value as a dynamic concept, dependent on the patient and the clinical setting, stating that improving outcomes was more important than containing costs. The value for non-clinicians appeared more driven by the interplay between the outcome and the cost. Non-clinicians related VBHC to a strategic framework for governance or for monitoring different continuous improvement processes, while clinicians appreciated VBHC, as they perceived its introduction as an opportunity to focus more on outcomes for patients and less on cost containment.

ORIGINALITY/VALUE

There is variation in how clinicians and non-clinicians perceive the key concept of value when implementing VBHC. Clinicians focus on increasing treatment efficacy and improving medical outcomes but have a limited focus on cost and what patients consider most valuable. If the concept of value is defined primarily by clinicians' own assumptions, there is a clear risk that the foundational premise of VBHC, to understand what outcomes patients value in their specific situation in relation to the cost to produce such outcome, will fail. Health-care leaders need to ensure that patients and the non-clinicians' perception of value, is integrated with the clinical perception, if VBHC is to deliver on its promise.

Institutional Logics in the UK Construction Industry's Response to Modern Slavery Risk: Complementarity and Conflict

There is a growing understanding that modern slavery is a phenomenon 'hidden in plain sight' in the home countries of multinational firms. Yet, business scholarship on modern slavery has so far focussed on product supply chains. To address this, we direct attention to the various institutional pressures on the UK construction industry, and managers of firms within it, around modern slavery risk for on-site labour. Based on a unique data set of 30 in-depth interviews with construction firm managers and directors, we identify two institutional logics as being integral to explaining how these companies have responded to the Modern Slavery Act: a market logic and a state logic. While the institutional logics literature largely assumes that institutional complexity will lead to a conciliation of multiple logics, we find both complementarity and continued conflict in the logics in our study. Though we identify conciliation between aspects of the market logic and the state logic, conflict remains as engagement with actions which could potentially address modern slavery is limited by the trade-offs between the two logics.

The Interplay of Conflicting and Complementing Institutional Logics in Sustainability Practices

The impact of institutional environments on sustainability is well documented in the international business literature. However, how multiple and occasionally conflicting institutional logics shape sustainability as it is practiced by individuals across countries remains undertheorized. Our study contributes to this line of research by examining how multiple institutional logics inform the comprehension of sustainability practices in two high-hazard organizations in the Republic of Serbia and Canada. In doing so, our findings explicate three multi-level mechanisms - pulling down (1st level), relating (2nd level), and aligning (2nd level) - through which individuals in these organizations across two countries construct a localized understanding of sustainability. In both countries, individuals pull down elements of the state and organizational logics to construct meso-level logics they use to comprehend sustainability practices, albeit differently. In Serbia, due to the conflict between the current state logic and dominant high-hazard organizational logic, individuals pull down elements of the high-hazard organizational logic and the enduring legacy state logic to construct a community logic and align sustainability practices with it. In Canada, the state logic complements the high-hazard organizational logic, resulting in individuals pulling down elements of both logics to construct the professional logic and aligning their practice with it. In both countries, due to the dominance of the high-hazard organizational logic, individuals relate their practices to the well-being of others. Based on our comparative case analysis, we create a general model and a country-specific model depicting how individuals embed multiple institutional logics into their sustainability practices.

Online health communities and the patient-doctor relationship: An institutional logics perspective

Taking an institutional logics perspective, this study investigates how "internet-informed" patients manage tensions between the logic of personal choice and the logic of medical professionalism as they navigate treatment decisions and the patient-doctor relationship. Based on 44 semi-structured interviews with members of an online health community for people with diabetes, this study finds that patients exercise a great deal of agency in evaluating healthcare options not only by activating the logic of personal choice but also by appropriating the logic of medical professionalism. Furthermore, patients are strategic in deciding what community advice to share with their doctor or nurse depending on the healthcare professionals' reaction to the logic of personal choice. In contrast to many previous studies that emphasise patient consumerism fuelled by information on the Internet, this study provides a more nuanced picture of patient-doctor relationship engendered by patients' participation in online health communities.

Narrative curation and stewardship in contested marketspaces

We identify value narratives as stories that promote certain product or service attributes as benefits within the marketplace. We show how value narratives reflect benefit attributes that align with alternative versus mainstream market settings. Our empirical focus is local food value narratives within a common local food system with alternative settings being farmers' markets and mainstream settings being supermarkets. Farmers' market and supermarket purveyors choose which benefit characteristics to emphasize throughout narrative curation, enabling us to witness strategic narrative use, or what we term narrative stewardship. We find that multiple value narratives express an array of 'local food' benefits in ways that create a contested marketplace. Narrative deployment at farmers' markets is guided by an amalgam of institutional perspectives, while narrative use at supermarkets is dominated by a market institutional perspective. We identify a continuum of value narrative stewardship (promotion-neglect) within farmers' markets that leaves the meaning and value of 'local food' vulnerable to mainstream market appropriation via narrative voidance, dilution, and replacement. We propose strategies for better value narrative stewardship.

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).

How collective interactions and institutional logics influence permanency planning in child protection in Quebec

BACKGROUND

In the Canadian province of Quebec, placing children in foster care is an exceptional measure whose ultimate goal is family reunification. When child-protection workers decide that reunification is unlikely, they must design permanency plans that ensure continuity of care and stable relationships for the child. Most studies of this important decision-making process have focused on individual practitioners as if they acted alone. This process is collective, interactive, and influenced by various contextual elements.

OBJECTIVE

The objective of this exploratory study was to examine the collective, interactive aspects of the decision-making process involved in permanency planning.

PARTICIPANTS AND SETTING

The participants were key players involved in child-protection decisions at an Integrated University Health and Social Services Centre (CIUSSS).

METHODS

The theoretical approach of this study combines Giddens's structuration theory with ethnomethodology. Data were collected through interviews with 16 key players and nine months of observing advisory-committee meetings.

RESULTS

In making permanent placement decisions, the participants must engage in extensive interactions with one another. They must also apply various institutional (clinical, legal, and managerial) logics with differing goals and differing operational frameworks, the tensions among which make the process more complex and challenging.

CONCLUSIONS

Our findings highlight the complexity of making permanent placement decisions and the importance of interaction and collaboration in this process. These findings suggest that management of this process should focus not on holding practitioners accountable and penalizing them for mistakes, but rather on providing adequate conditions for practice to facilitate thoughtful collective deliberation and learning and ethical decision-making.

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

Purpose

Using 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/approach

41 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.

Findings

After 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/value

Interviewing 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.

Communication officers in local authorities meeting social media: On the production of social media photos of older adults

European local authorities increasingly use social media to present services and activities organized for citizens living in the particular area. Previous studies found that authority-managed social media visually depicted older adults as being active, sociable, happy, and physically capable, reflecting the normative "third age" representation. Yet few studies to date have examined how local authorities produce the photos of older adults for social media posting. Drawing on semi-structured interviews with communication officers in a Swedish municipality, the purpose of this study is to investigate the production process for social media photos of older adults within local authorities from an institutional logics perspective. The analysis illustrates that communication officers strive to create a good image of the municipality and its services, follow municipal policy and EU law on data protection, seek photos through particular sources, adjust to and develop photographic standards of good photos, and endeavor to promote social media engagement in the photos. These motives and work practices of communication officers contribute to the visual representations of older adults as engaging in municipal services, being socially active, and staying physically capable. The analysis also indicates that both social media and bureaucratic logics encourage officers to produce photos of older adults that highlight the bright side of later life. The findings contribute to previous studies on online representations of older adults generated by local authorities, by showing how the third age representation may come about in practice, and which logics may influence officers to generate such representation. Furthermore, the knowledge provided could be used as a basis for assessment and improvement on authorities' production for social media photos of older adults, which in turn contributes to more diverse and thoughtful representations of older adults and later life in authority-managed social media.

Bridging institutional logics: Implementing naloxone distribution for people exiting jail in three California counties

Drug overdose is the leading cause of death among formerly incarcerated people. Distribution of the opioid overdose medication naloxone to people who use drugs reduces overdose mortality, and officials in many jurisdictions are now considering or implementing programs to offer naloxone to people exiting jails and prisons. The principles and practices of harm reduction programs such as naloxone distribution conflict with those of penal institutions, raising the question of how organizations based on opposing institutional logics can collaborate on lifesaving programs. Using in-depth interviews and observations conducted over four years with 34 penal, medical, public health, and harm reduction practitioners, we introduce and conceptualize two organizational features to explain why this therapeutic intervention was implemented in local jails in two of three California counties. First, interorganizational bridges between harm reduction, medical, and penal organizations facilitated mutual understanding and ongoing collaboration among administrators and frontline workers in different agencies. Second, respected and influential champions within public health and penal organizations put jail-based naloxone distribution on the local agenda and cultivated support among key officials. Our findings offer guidance for future studies of institutional logics and policy responses to the overdose crisis.

Diffusion of the Airport Health Accreditation Program in the COVID-19 period: An Assessment with Institutional Logic And Legitimacy Approach

The purpose of this study is to reveal the reason for the diffusion of Airports Health Accreditation among airports. Institutional logic and legitimacy literature are used in the research. The research area consists of 56 airports from different parts of the world. In the research, a qualitative research method was used. Document analysis was used as a data collection method, and descriptive content analysis was used as a data analysis method. According to the results of the research, there are two basic logic and legitimacy seeking that lead airport to this certificate. The first of these is moral legitimacy and professional logic. Accordingly, airports want to be seen as legitimate by professional actors in their institutional environment by certifying that they have taken the necessary measures against COVID-19 threats. The second is pragmatic legitimacy and market logic. According to this remarkable result of the research, one of the important reasons for the airports to turn to this accreditation is to meet the expectations of the customers and gain legitimacy in their eyes. Airports use this accreditation to rebuild trust in the eyes of customers and passengers, to create an airport reputation that took the necessary measures during the pandemic period, to be preferred again, and to revitalize airports.

Organizing as negotiation: the construction of a pathway in Norwegian mental health services

BACKGROUND

In 2015, a decision was made to implement clinical pathways in Norwegian mental health services. The idea was to construct pathways similar to those used in cancer treatment. These pathways are based on diagnosis and evidence-based medicine and have strict timeframes for the different procedures. The purpose of this article is to provide a thorough examination of the formulation of the pathway "mental illness, adults" in Norwegian mental health services. In recent decades, much research has examined the implementations and outcomes of different mental health sector reforms and services in Western societies. However, there has been a lack of research on the process and creation of these reforms and/or services, particularly how they emerge as constructs in the contexts of policy, profession and practice.

METHODS

A qualitative single case study design was employed. A text and document analysis was performed in which 52 articles and opinion pieces, 30 public hearing responses and 8 political documents and texts were analysed to identify the main actors in the discourse of mental health services and to enable a replication of their affiliated institutional logics and their views concerning the clinical pathway. Additionally, ten qualitative interviews were performed with members of the work group responsible for designating the pathway "mental illness, adults".

RESULTS

This article shows how the two main actor groups, "Mental health professionals" and "Politicians", are guided by values associated with a specific logic when understanding the concept of a clinical pathway (CP). The findings show that actors within the political field believe in control and efficiency, in contrast to actors in mental health services, who are guided by values of discretion and autonomy. This leads to a debate on the concept of CPs and mental health services. The discussion becomes polarized between concern for patients and concern for efficiency. The making of the pathway is led by the Directorate of Health, with health professionals operating in the political domain and who have knowledge of the values of both logics, which were taken into consideration when formulating the pathways, and explains how the pathway became a complex negotiation process between the two logics and where actors on both sides were able to retain their core values. Ultimately, the number of pathways was reduced from 22 to 9. The final "Pathway for mental illness, adults" was a general pathway involving several groups of patients. The pathway explains the process from diagnosis through treatment and finalizing treatment. The different steps involve time frames that need to be coded, requiring more rigid administrative work for compliance, but without stating specific diagnostic tools or preferred treatment strategies.

CONCLUSIONS

This article shows that there is also a downside of having sense making guided by strong values associated with a specific institutional logic when constructing new, and hopefully better, mental health care services. This article demonstrates how retaining values sometimes becomes more crucial than engaging in constructive debates about how to solve issues of importance within the field of mental health care.

The Regulatory Dynamics of Sustainable Finance: Paradoxical Success and Limitations of EU Reforms

The financial sector has seen a transformation towards 'sustainable' finance particularly in Europe, driven also by unprecedented regulatory reforms. At the same time, many are sceptical about the real impact of these reforms, fearing that they are triggering a paradoxical financialisation of sustainability. Building on recent research on institutional logics and institutional fields formation, we examine changes in the EU regulatory dynamics as characterised by shifts in framing the relationship between sustainability and finance. Deploying a longitudinal approach (2009-2019), consisting of archival data and semi-structured interviews, we explore the development of EU sustainable finance regulation as an extended, interactive and contested process. Specifically, we suggest that regulatory dynamics depend on the hybrid configuration of the social constituencies supporting sustainable finance reforms and on shifts in the overall prevalence of the financial logic in society. Our paper sheds light on the inherent contradictions and limitations of sustainable finance as a means for transformative sustainability reforms.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10551-021-04763-x.

'What matters to you?' Normative integration of an intervention to promote participation of older patients with multi-morbidity - a qualitative case study

Background

Interventions in which individual older patients with multi-morbidity participate in formulating goals for their own care are being implemented in several countries. Successful service delivery requires normative integration by which values and goals for the intervention are shared between actors at macro-, meso- and micro-levels of health services. However, health services are influenced by multiple and different institutional logics, which are belief systems guiding actors’ cognitions and practices. This paper examines how distinct institutional logics materialize in justifications for patient participation within an intervention for patients with multi-morbidity, focusing on how variations in the institutional logics that prevail at different levels of health services affect vertical normative integration.

Methods

This qualitative case study of normative integration spans three levels of Norwegian health services. The macro-level includes a white paper and a guideline which initiated the intervention. The meso-level includes strategy plans and intervention tools developed locally in four municipalities. Finally, the micro-level includes four focus group discussions among 24 health professionals and direct observations of ten care-planning meetings between health professionals and patients. The content analysis draws on seven institutional logics: professional, market, family, community, religious, state and corporate.

Results

The particular institutional logics that justified patient participation varied between healthcare levels. Within the macro-level documents, seven logics justified patients’ freedom of choice and individualization of service delivery. At meso-level, the operationalization of the intervention into tools for clinical practice was dominated by a state logic valuing equal services for all patients and a medical professional logic in which patient participation meant deciding how to maintain patients’ physical abilities. At micro-level, these two logics were mixed with a corporate logic prioritizing cost-efficient service delivery.

Conclusion

Normative integration is challenging to achieve. The number of institutional logics in play was reduced downwards through the three levels, and the goals behind the intervention shifted from individualization to standardization. The study broadens our understanding of the dynamic between institutional logics and of how multiple sets of norms co-exist and guide action. Knowledge of mechanisms by which normative justifications are put into practice is important to achieve normative integration of patient participation interventions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06106-y.

Bridging the rural-urban divide in social innovation transfer: the role of values

This study examines the process of knowledge transfer between a pair of social enterprises, organizations that are embedded in competing social and economic logics. Drawing on a longitudinal case study of the interaction between social enterprises operating in emerging economy settings, it uncovers factors which influence the transfer of a social innovation from a dense, population-rich setting to one where beneficiaries are geographically dispersed and the costs of service delivery are correspondingly elevated. Evidence from the case study suggests that institutional bricolage-the crafting of improvised solutions in resource-constrained settings-can serve as potent driving force in driving innovation transfer, and that this process of re-combining available resources may be facilitated by the extent to which the values between partner social enterprises are aligned. With such alignment, social enterprise partners may be able to increase trust, develop a smoother knowledge-transfer process, and find practical solutions which facilitate the transfer of life-enhancing social innovations to neglected rural settings.

Benefactor or burden: Exploring the professional identity of safety professionals

INTRODUCTION

The professional identity of safety professionals is rife with unresolved contradictions and tensions. Are they advisor or instructor, native or independent, enforcer of rules or facilitator of front-line agency, and ultimately, a benefactor for safety or an organizational burden? Perhaps they believe that they are all of these. This study investigated professional identity through understanding what safety professionals believe about safety, their role within organizations, and their professional selves. Understanding the professional identity of safety professionals provides an important foundation for exploring their professional practice, and by extension, understanding organizational safety more broadly.

METHOD

An embedded researcher interviewed 13 senior safety professionals within a single large organization. Data were analyzed using grounded theory methodology. The findings were related to a five-element professional identity model consisting of experiences, attributes, motives, beliefs, and values, and revealed deep tensions and contradictions. This research has implications for safety professionals, safety professional associations, safety educators, and organizations.

Healthcare quality improvement work: a professional employee perspective

Purpose The purpose of this paper is to describe and analyze conditions that influence how employees engage in healthcare quality improvement (QI) work. Design/methodology/approach Qualitative case study based on interviews ( n=27) and observations ( n=10). Findings The main conditions that influence how employees engage in healthcare QI work are professions, work structures and working relationships. These conditions can both prevent and facilitate healthcare QI. Professions and work structures may cement existing institutional logics and thus prevent employees from engaging in healthcare QI work. However, attempts to align QI with professional logics, together with work structures that empower employees, can make these conditions increase employee engagement, which can be accomplished through positive working relationships that foster institutional work, which bridge different competing institutional logics, making it possible to overcome barriers that professions and work structures may constitute. Practical implications Understanding the conditions that influence how employees engage in healthcare QI work will make initiatives more likely to succeed. Originality/value Healthcare QI has mainly been studied from an implementer perspective, and employees have either been neglected or seen as passive resisters. Weak employee perspectives make healthcare QI research incomplete. In our research, healthcare QI work is studied closely at the actor level to understand healthcare QI from an employee perspective.

Organizational Change Around an Older Workforce

Purpose of the Study

Demographic, economic, political, and technological transformations-including an unprecedented older workforce-are challenging outdated human resource logics and practices. Rising numbers of retirement-eligible Boomers portend a loss of talent, skills, and local knowledge. We investigate organizational responses to this challenge-institutional work disrupting age-graded mindsets and policies.

Design and Methods

We focus on innovative U.S. organizations in the Minneapolis-St. Paul region in the state of Minnesota, a hub for businesses and nonprofits, conducting in-depth interviews with informants from a purposive sample of 23 for-profit, nonprofit, and government organizations.

Results

Drawing on an organizational change theoretical approach, we find organizations are leading change by developing universal policies and practices, not ones intentionally geared to older workers. Both their narratives and strategies-opportunities for greater employee flexibility, training, and scaling back time commitments-suggest deliberate disrupting of established age-graded logics, replacing them with new logics valuing older workers and age-neutral approaches. Organizations in the different sectors studied are fashioning uniform policies regardless of age, exhibiting a parallel reluctance to delineate special policies for older workers.

Implications

Developing new organizational logics and practices valuing, investing in, and retaining older workers is key 21st century business challenges. The flexibility, training, and alternative pathways offered by the innovative organizations we studied point to fruitful possibilities for large-scale replacement of outdated age-biased templates of work, careers, and retirement.

Technology meets tradition: The perceived impact of the introduction of information and communication technology on ward rounds in the intensive care unit

BACKGROUND

Public policy in many health systems is currently dominated by the quest to find ways to 'do more with less'-to achieve better outcomes at a reduced cost. The success or failure of initiatives in support of this quest are often understood in terms of an adversarial dynamic or struggle between the professional logics of medicine and of management. Here, we use the case of the introduction of information and communication technology (ICT) to a well-established ritual of medical autonomy (the medical ward round) to articulate a more nuanced explanation of how and why new ways of working with technology are accepted and adopted (or not).

METHODS

The study was conducted across four intensive care units (ICUs) in major teaching hospitals in Sydney, Australia. Using interviews, we examined 48 doctors' perceptions of the impact of ICT on ward round practice. We applied the concept of institutional logics to frame our analysis. Interview transcripts were analysed using a hybrid of deductive and inductive thematic analysis.

RESULTS

The doctors displayed a complex engagement with the technology that belies simplistic characterisations of medical rejection of managerial encroachment. In fact, they selectively welcomed into the ward round aspects of the technology which reinforced the doctor's place in the healthcare hierarchy and which augmented their role as scientists. At the same time, they guarded against allowing managerial logic embedded in ICT to de-emphasise their embodied subjectivity in relation to the patient as a person rather than as a collection of parameters.

CONCLUSION

ICT can force the disruption of some aspects of existing routines, even where these are long-established rituals. Resistance arose when the new technology did not fit with the 'logic of care'. Incorporation of the logic of care into the design and customisation of clinical information systems is a challenge and potentially counterproductive, because it could attempt to apply a technological fix to what is essentially a social problem. However, there are significant opportunities to ensure that new technologies do not obstruct doctors' roles as carers nor disrupt the embodied relationship they need to have with patients.

The state of domestic affairs: Housework, gender and state-level institutional logics

Multi-level cross-national research consistently shows individual housework arrangements are structured by broader contexts of equality. Across this body of research, the United States is treated as a single entity. Yet, individual-level housework time may vary by state-to-state differences in institutional market, family and legislative logics. To test these relationships, we pair individual-level data from the American Time Use Survey (2003-2012; aged 18 to 64 n = 106,190) with three state-level indices - female labor force empowerment, family traditionalism and state government liberalism. For market institutional logics, we find wives and husbands spend more but mothers less time in housework in states where women have more labor market power. For family logics, we find mothers spend more and husbands less time in housework in more traditional states. For legislative logics, we find women and husbands spend more time in housework in more liberal states. Our results highlight the importance of state-to-state institutional logics on individuals' housework time.

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.