Shaw James A, Kontos Pia, Martin Wendy, Victor Christina
Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Canada.
Toronto Rehabilitation Institute-University Health Network , Toronto, Canada.
J Health Organ Manag. 2017 Mar 20;31(1):82-95. doi: 10.1108/JHOM-06-2016-0123.
Purpose The purpose of this paper is to use theories of institutional logics and institutional entrepreneurship to examine how and why macro-, meso-, and micro-level influences inter-relate in the implementation of integrated transitional care out of hospital in the English National Health Service. Design/methodology/approach The authors conducted an ethnographic case study of a hospital and surrounding services within a large urban centre in England. Specific methods included qualitative interviews with patients/caregivers, health/social care providers, and organizational leaders; observations of hospital transition planning meetings, community "hub" meetings, and other instances of transition planning; reviews of patient records; and analysis of key policy documents. Analysis was iterative and informed by theory on institutional logics and institutional entrepreneurship. Findings Organizational leaders at the meso-level of health and social care promoted a partnership logic of integrated care in response to conflicting institutional ideas found within a key macro-level policy enacted in 2003 (The Community Care (Delayed Discharges) Act). Through institutional entrepreneurship at the micro-level, the partnership logic became manifest in the form of relationship work among health and social care providers; they sought to build strong interpersonal relationships to enact more integrated transitional care. Originality/value This study has three key implications. First, efforts to promote integrated care should strategically include institutional entrepreneurs at the organizational and clinical levels. Second, integrated care initiatives should emphasize relationship-building among health and social care providers. Finally, theoretical development on institutional logics should further examine the role of interpersonal relationships in facilitating the "spread" of logics between macro-, meso-, and micro-level influences on inter-organizational change.
目的 本文旨在运用制度逻辑和制度创业理论，研究在英国国民医疗服务体系中，宏观、中观和微观层面的影响因素如何以及为何在院外综合过渡性护理的实施过程中相互关联。 设计/方法/途径 作者对英格兰一个大城市中心的一家医院及其周边服务机构进行了人种志案例研究。具体方法包括对患者/护理人员、健康/社会护理提供者和组织领导者进行定性访谈；观察医院过渡计划会议、社区“枢纽”会议以及其他过渡计划实例；查阅患者记录；以及分析关键政策文件。分析是迭代式的，并以制度逻辑和制度创业理论为依据。 研究结果 健康和社会护理中观层面的组织领导者倡导综合护理的伙伴关系逻辑，以应对2003年颁布的一项关键宏观层面政策（《社区护理（延迟出院）法案》）中存在的相互冲突的制度理念。通过微观层面的制度创业，伙伴关系逻辑以健康和社会护理提供者之间的关系工作形式得以体现；他们试图建立牢固的人际关系，以实施更综合的过渡性护理。 原创性/价值 本研究有三个关键意义。第一，促进综合护理的努力应在战略上纳入组织和临床层面的制度创业者。第二，综合护理倡议应强调健康和社会护理提供者之间的关系建设。最后，制度逻辑的理论发展应进一步研究人际关系在促进逻辑在宏观、中观和微观层面影响组织间变革过程中的“传播”作用。
