Maack Karl, Gillberg Nanna, Wikström Ewa
Department of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Goteborg, Sweden.
Department of Business Administration, School of Business, Economics and Law, University of Gothenburg, Gothenburg, Sweden.
J Health Organ Manag. 2025 Jun 25;39(5):744-763. doi: 10.1108/JHOM-07-2024-0281.
PURPOSE: This study aims to contribute with knowledge on the characteristics of the process of co-existence of value conflicts between managers, markets/businesses, patients, professionals and digital technology in primary care practices, to be able to nuance the array of descriptions of the consequences of introducing a digitalised care practice, such as telemedicine, into an already existing primary care organisation. Due to its organisational structure and dynamic environment with a multitude of professions and patients as well as influenced by managerial and market drivers, the primary care setting provides fertile ground for studying value conflicts from an institutional logic perspective. DESIGN/METHODOLOGY/APPROACH: This multi-source study utilises qualitative thematic content analysis on empirical data collected through interviews, a survey and documents, followed by an iterative analysis in regard to institutional logics based on the themes developed from empirical data. FINDINGS: Coexistence and Adaptation: Different logics coexist and transform through adjustmentalisation rather than competing or dominating each other. Digital Technology's Influence: Digital technology influences and interacts with all established logics, potentially acting as a separate, evolving logic. Changing Healthcare Conditions: New conditions and digital solutions in healthcare may shift the balance of logics, potentially normalising managerial and market logics. Patient Empowerment and Data Ownership: Increasing emphasis on patient empowerment and transparent data processing under regulations like General Data Protection Regulation (GDPR) and Medical Devices Regulation (MDR). RESEARCH LIMITATIONS/IMPLICATIONS: With its qualitative design there is not an emphasis on generalisability. The study is performed in a Swedish primary care setting. PRACTICAL IMPLICATIONS: Regarding its practical implications, this study examines digitalisation and the introduction of eHealth solutions in primary care in Sweden. The adjustmentalisation of diverse institutional logics described in this study was used to try to facilitate the implementation of eHealth and telemedicine in primary care. This practical contribution could be used in other primary care organisation that plans to introduce eHealth solutions as part of their practices. This study may also have practical implications for other healthcare organisations since the presence of diverse institutional logics is not unique to primary care. ORIGINALITY/VALUE: Firstly, this study confirms earlier studies that argue that co-existence of diverse logics is possible in everyday practice. However, we show that adjustmentalisation of the diverse logics rather than the balance of strengths between them, facilitates the transformation, regulation and coordination of the new eHealth practice in relation to established practices. Secondly, this study shows that the adjustmentalisation derives from societal challenges such as an ageing population, accessibility problems and the COVID pandemic that are used to legitimise the adjustmentalisation of diverse logics. Digital technology influences and interacts with all established logics, potentially acting as a separate, evolving logic. KEY FINDINGS: Different logics coexist and transform through adjustmentalisation rather than competing or dominating each other. Digital technology influences and interacts with all established logics, potentially acting as a separate, evolving logic. New conditions and digital solutions in healthcare may shift the balance of logics, potentially normalising managerial and market logics. Increasing emphasis on patient empowerment and transparent data processing under regulations like GDPR and MDR. Need for further research on digital technology's impact on shift and balance between logics, business development, patient participation and its potential to become a dominant logic.
目的:本研究旨在提供有关基层医疗实践中管理者、市场/企业、患者、专业人员和数字技术之间价值冲突共存过程特征的知识,以便细化将远程医疗等数字化护理实践引入现有基层医疗组织所产生后果的描述范围。由于其组织结构和动态环境,涉及众多专业人员和患者,且受到管理和市场驱动因素的影响,基层医疗环境为从制度逻辑角度研究价值冲突提供了肥沃土壤。 设计/方法/途径:本多源研究对通过访谈、调查和文件收集的实证数据进行定性主题内容分析,随后基于从实证数据中得出的主题对制度逻辑进行迭代分析。 研究结果:共存与适应:不同逻辑通过调整化共存并转变,而非相互竞争或主导。数字技术的影响:数字技术影响所有既定逻辑并与之相互作用,可能作为一种独立且不断演变的逻辑发挥作用。不断变化的医疗条件:医疗保健中的新条件和数字解决方案可能会改变逻辑平衡,有可能使管理和市场逻辑常态化。患者赋权与数据所有权:在《通用数据保护条例》(GDPR)和《医疗器械条例》(MDR)等法规下,对患者赋权和透明数据处理的重视日益增加。 研究局限性/启示:因其定性设计,未强调可推广性。该研究在瑞典基层医疗环境中进行。 实际意义:就其实际意义而言,本研究考察了瑞典基层医疗中的数字化以及电子健康解决方案的引入。本研究中描述的各种制度逻辑的调整化被用于尝试促进电子健康和远程医疗在基层医疗中的实施。这一实际贡献可用于其他计划将电子健康解决方案作为其实践一部分引入的基层医疗组织。由于各种制度逻辑的存在并非基层医疗所独有,本研究可能对其他医疗组织也具有实际意义。 原创性/价值:首先,本研究证实了早期研究的观点,即不同逻辑在日常实践中可以共存。然而,我们表明,各种逻辑的调整化而非它们之间的力量平衡,促进了新电子健康实践相对于既定实践的转变、规范和协调。其次,本研究表明,调整化源于诸如人口老龄化、可及性问题和新冠疫情等社会挑战,这些挑战被用来使各种逻辑的调整化合法化。数字技术影响所有既定逻辑并与之相互作用,可能作为一种独立且不断演变的逻辑发挥作用。 主要研究结果:不同逻辑通过调整化共存并转变,而非相互竞争或主导。数字技术影响所有既定逻辑并与之相互作用,可能作为一种独立且不断演变的逻辑发挥作用。医疗保健中的新条件和数字解决方案可能会改变逻辑平衡,有可能使管理和市场逻辑常态化。在GDPR和MDR等法规下,对患者赋权和透明数据处理的重视日益增加。需要进一步研究数字技术对逻辑转变和平衡、业务发展、患者参与及其成为主导逻辑潜力的影响。
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