Kristiansen Margrethe, Obstfelder Aud, Lotherington Ann Therese
Department of Health and Care Sciences, Uit The Arctic University of Norway, Tromsø, Norway.
J Health Organ Manag. 2016;30(1):57-72. doi: 10.1108/JHOM-11-2013-0265.
Performance management is criticised as a direct challenge to the dominant logic of professionalism in health care organisations. The purpose of this paper is to report an ethnographic study that investigates how performance management and professionalism as contradicting logics are interpreted and implemented by managers and nurses in everyday practice within Norwegian nursing homes.
DESIGN/METHODOLOGY/APPROACH: The paper presents an analysis of 18 semistructured interviews and 100 hours of observation of managers and nurses from three nursing homes. The study draws on the institutional logic perspective as a theoretical framework. In the analysis, the authors searched for patterns of activities and interactions that reflected managers and nurses' coping strategies for handling contradicting logics. Qualitative content analysis was used to systematically code the data, supported by NVIVO software.
The authors identified three forms of coping strategies: the adjustment of professionalism to standards, the reinforcement of professional flexibility and problem solving, and the strategic adoption of documentation. These patterns of activities and interactions reflect new organisational structures that allowed contradicting logics to co-exist. The study demonstrates that a new complex dimension of governing processes within nursing homes is the way in which managers and nurses handle the tension between contradicting logics in their daily work and clinicians' everyday practice.
ORIGINALITY/VALUE: The study provides new insight into how managers and nurses reshape internal organisational structures to cope with contradicting logics in nursing homes.
绩效管理被批评为对医疗保健机构中专业主义主导逻辑的直接挑战。本文的目的是报告一项人种志研究，该研究调查了在挪威养老院的日常实践中，管理人员和护士如何解释和实施作为相互矛盾逻辑的绩效管理和专业主义。
设计/方法/途径：本文对来自三家养老院的管理人员和护士进行的18次半结构化访谈以及100小时的观察进行了分析。该研究以制度逻辑视角作为理论框架。在分析中，作者寻找反映管理人员和护士处理相互矛盾逻辑的应对策略的活动和互动模式。使用定性内容分析法对数据进行系统编码，并得到NVIVO软件的支持。
作者确定了三种应对策略形式：使专业主义适应标准、增强专业灵活性和解决问题，以及战略性地采用文件记录。这些活动和互动模式反映了允许相互矛盾的逻辑共存的新组织结构。该研究表明，养老院管理过程的一个新的复杂维度是管理人员和护士在日常工作和临床医生的日常实践中处理相互矛盾逻辑之间紧张关系的方式。
原创性/价值：该研究为管理人员和护士如何重塑内部组织结构以应对养老院中相互矛盾的逻辑提供了新的见解。
