Contradicting logics in everyday practice.

Abstract

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. 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. The study provides new insight into how managers and nurses reshape internal organisational structures to cope with contradicting logics in nursing homes.