Abstract

AbstractThis article aims to gain a better understanding on micro processes of how frontline professionals use institutional logics in their day-to-day work. It contributes to the growing literature on the dynamics between institutions and the professional frontline. To further develop this field of study, a conceptual framework is presented that integrates institutional logics, vocabularies of practice, and narratives as central concepts. By adopting a composite narrative approach and identifying vocabularies of practice, the article interprets how frontline professionals make use of different logics to make sense of a new principle introduced in their professional field. Findings are based on a case study of professional patient collaboration in healthcare. The article composes five narratives that act as vehicles through which healthcare professionals use five logics: a medical professional logic, managerial logic, commercial logic, consultation logic, and patient-centeredness logic. It argues that frontline professionals use vocabularies of practice to assemble narratives that help them to navigate between a plurality of logics. It further shows that professionals move fluently from one narrative to another, critiquing the ideas of adherence to a dominant logic and conflict solving. The article finalizes with a discussion that advocates for a process studies perspective and a stronger focus on micro processes in research on professional performance in the context of institutional plurality.

Highlights

  • The professional frontline is characterized by the prevalence of multiple, sometimes competing, logics such as professionalism, managerialism, and commercialism (Reay and Hinings 2009; McPherson and Sauder 2013; Bode, Lange and Marker 2017)

  • To contribute to and further develop this micro-level understanding of how professionals use multiple institutional logics in their day-to-day work we introduced a conceptual framework of which the foundation can be found in a narrative approach

  • From the vocabularies in the narratives, we identify five institutional logics: a medical professional logic, a managerial logic, a commercial logic, and a consultation logic, and we recognize a new logic of patient-centeredness

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Summary

Introduction

The professional frontline is characterized by the prevalence of multiple, sometimes competing, logics such as professionalism, managerialism, and commercialism (Reay and Hinings 2009; McPherson and Sauder 2013; Bode, Lange and Marker 2017). Professionals’ interests, identities, values, and assumptions are embedded within such institutional logics. Each institutional logic provides a set of assumptions and values that guide the behavior of professionals (Thornton and Ocasio 1999). Institutional logics send multiple, ambiguous, or conflicting messages and formats that need to be organized at the frontline (Goodrick and Reay 2011; Andersson and Liff 2018). The means and ends of professionals’ interests and agency are both enabled and constrained by these logics (Thornton and Ocasio 2008). Professionals, as agents working on the frontline, can change and reinterpret symbols and practices in order to try and change social

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