Pathways to Autonomy: Chinese Physicians' Responses to Clinical Pathways amid Institutional Complexity.

Chinese physicians are not only facing heavy work overloads, but also abuse and injury because of patient mistrust of physicians. The primary objective of the present study was to measure psychological distress, burnout levels and job satisfaction among Chinese emergency physicians. All the physicians from the EDs of three large general hospitals were recruited to undertake a questionnaire-based survey from March to April 2012. The Hospital Anxiety and Depression Scale (HADS), Maslach Burnout Inventory-General Survey and Minnesota Satisfaction Questionnaire were used. Correlations between job satisfaction and psychological distress and burnout were calculated using the Pearson correlation. An outcome was considered statistically significant if P < 0.05. Completed questionnaires were received from 205 (82.0%) physicians. The mean HADS anxiety subscale scores for the ED physicians and general population were 7.8 ± 3.4 and 4.7 ± 3.5, respectively (t = 1.526, P < 0.05). Additionally, the mean HADS depression subscale scores were 7.9 ± 3.6 and 4.7 ± 3.9, respectively (t = 1.567, P < 0.05). Fifty-two (25.4%) exhibited high levels of career burnout. All aspects of job satisfaction were significantly lower in the ED physicians compared with a previous report (P < 0.05). Burnout was significantly negatively correlated with intrinsic and extrinsic job satisfaction in the sampled population. Psychological distress is prevalent in this group of ED physicians, and it deserves attention from the whole society. Burnout and job satisfaction among ED physicians are at a 'moderate' level. Burnout is negatively associated with higher job satisfaction.

Pulmonary embolism (PE) is a leading cause of cardiovascular mortality. We intended to evaluate the awareness and management status of PE among Chinese physicians and provide the basis for establishing Chinese clinical guidelines on PE. We designed a nationwide survey to collect data on physicians' awareness of diagnosis, treatment and follow-up on PE. The questionnaires were distributed to physicians during offline academic meetings and by the online platforms from August 2016 to October 2016. Also, results were sub-grouped by age, hospital grades, departments and trained or not. A total of 2954 valid questionnaires were collected. We observed that there were several defects in the management of PE among Chinese physicians. First, a considerable proportion of physicians chose the incorrect clinical prediction rules for acute PE. Second, a considerable percentage of hospitals could not carry out computed tomographic pulmonary angiography (22.4%) or ventilation-perfusion scintigraphy (65.2%). Third, only a few physicians knew the use of new oral anticoagulants clearly (33.4%). Fourth, only 49% of physicians achieved follow-up management in over half of their patients. Additionally, physicians in the tertiary hospitals, aged > 35years, trained and from respiratory department have a better knowledge of the management of PE. In conclusion, our survey demonstrates the enhancement of PE-related trainings, especially for physicians in lower-level hospitals, aged ≤ 35years and from non-respiratory department, can help to improve the management of PE in Chinese physicians. And our study also highlights the need for the establishment of national guidelines for the management of PE in China.

The qualification of physicians is a key factor in controlling type 1 diabetes (T1D) since they provide crucial information to their patients about self-management. To investigate whether Chinese physicians' medical strategies influence the control of T1D in their patients, we designed a questionnaire to survey Chinese physicians, which covered their diagnosis and patient-management strategies for T1D. A total of 442 completed questionnaires were received from 35 public hospitals in 12 cities. The results showed Chinese physicians mainly diagnosed T1D based on the clinical features and islet dysfunction. One-third of physicians in this study still prescribed non-basal-bolus insulin regimens to their T1D patients. More than 80% of the doctors prescribed alpha-glucosidase inhibitors as adjunctive therapy, in addition to insulin therapy. Moreover, most of the physicians in China did not pay attention to identify coexistent autoimmune diseases. T1D patients in China were not armed with self-management knowledge and skills, which should be provided by their doctors. One of the circumstances leading to insufficient disease control in Chinese T1D patients is the ineffective therapeutic strategy prescribed by their physicians. We need to promote knowledge of efficient strategies among physicians in China to achieve better disease control in Chinese T1D patients in the future.

Practising medicine in China: an unsolved dilemma.

(1) Background: Chinese physicians have encountered serious physical and verbal attacks in recent decades due to poor patient–physician relationships, leading to a broad spectrum of negative consequences. This study aims to assess the status of intergroup threats perceived by physicians and explore its association with organizational psychology, behavior, and well-being during the COVID-19 pandemic. (2) Methods: We conducted a cross-sectional online survey with physicians from November to December 2020 in three provinces: Heilongjiang Province, Henan Province, and Zhejiang Province, in China. A total of 604 physicians were recruited to complete an anonymous questionnaire. There were 423 valid questionnaires. (3) Results: We developed a 25-item intergroup threat scale with four dimensions: interest damage, performance impairment, value derogation, and unjust sentiment. Internal consistency reliability analyses showed that the four dimensions and overall scale exhibited high internal consistency (0.756–0.947). Additionally, the average scores for physicians’ perceived overall intergroup threat, interest damage, performance impairment, value derogation, and unjust sentiment were 4.35 ± 0.51, 4.24 ± 0.73, 4.33 ± 0.58, 4.22 ± 0.65, and 4.53 ± 0.55, respectively. Moreover, this study shows that the intergroup threats perceived positively by physicians were associated with psychological stress (β = 0.270, p < 0.01), emotional exhaustion (β = 0.351, p < 0.01), turnover intention (β = 0.268, p < 0.01), and defensive medical behavior (β = 0.224, p < 0.01), and were negatively associated with job satisfaction (β = −0.194, p < 0.01) and subjective well-being (β = −0.245, p < 0.01). (4) Conclusions: The newly developed scale in this study is a reliable tool for measuring intergroup threats perceived by Chinese physicians. Physicians in China were suffering high-level intergroup threats during the anti-COVID-19 pandemic, which has a significant impact on damage to organizational psychology, behavior, and well-being. Intergroup threats perceived by physicians not only enlarged the risk of emotional exhaustion and psychological stress but also threatened organizational well-being. Moreover, greater intergroup threats were associated with a lower job satisfaction, more frequent defensive medical behavior, and a higher turnover intention for physicians. The results of this study suggest that essential intervention and governance measures should be considered to protect physicians’ well-being and benefits in China, which are urgently needed.

Digital technologies have fundamentally changed organizations, industries, and even the society. Although institutional theory provides rich array of perspectives to both the content and dynamics of such changes, research at the intersection of institutional scholarship and digitalization has remained scarce. In this essay, I draw on the institutional logics perspective to elaborate digitalization as involving a new set of interconnected managerial beliefs and norms, organizational practices, and diverse material and social structures that together complement and challenge the established logics in organizations and institutional fields. I draw attention to two central organizing principles in the logic of digitalization: the pursuit of digital omniscience – the efforts to represent and conceive the world through digital data – and digital omnipotence – the efforts to bring activities inside and outside organizations under the control of information systems. I conclude the essay by elaborating how the institutional logics perspective can help understand organization-level efforts to leverage digitalization by incumbent corporations and new digital-native companies.

BackgroundTobacco use by physicians represents a significant barrier in promoting smoking cessation through physician interventions. To assess the need for and nature of smoking cessation services among physicians in China,...

This chapter conceptualises aspects of accounting for sustainability using insights from the institutional logics perspective. An institutional logics theoretical lens, with its emphasis on the role of multiple and competing logics in shaping organisational behaviour and practices, offers useful pointers to critically understand some of the issues related to accounting for sustainability. To date, institutional logics theory has been used by a handful of scholars in the accounting for sustainability field, whereas in other closely-related disciplines (e.g. organization studies), there is a more mature institutional logics-led strand of research. I will draw on such extant works to introduce some key conceptual tenets of this theory and in particular, the notions of institutional logics, institutional complexity and pluralism, and the role that accounting may play in regulating the institutional logics-related dynamics. The purpose of this chapter is to illustrate this theory and to discuss how it might assist scholars to theorize and make sense of accounting for sustainability practices.

Background:To summarize the cases of physicians overwork death between Jan 2007 and Dec 2018, the tragedy merits the attention of the authorities and policy-makers to increase their efforts to reduce death among physicians in China.Methods:Data were extracted from medical databases, local mass media, official documents and medical Bulletin Board System (BBS), in which only included articles, reports and news listed in the retrieval strategy, and unpublished data were excluded.Results:Overall, 110 cases (7 females and 103 males) were enrolled in this study. Most incidents have occurred since 2012, especially in 2017. Of these, 86 (78.18%) physicians worked in public tertiary hospitals, four times more than the number of cases taking place in secondary hospitals. Additionally, overwork death was the most common in surgery-related departments that account for up to 65 (59.1%). Notably, these events, taking place in first-tier cities and the southeastern coastal areas of China, included 27 chief physicians, 31 associate of chief physicians, 21 attending physicians, 10 resident physicians and 4 standardized training physicians.Conclusion:Overwork death among Chinese physicians is not only a contemporary health problem but also a critical social issue. The laws and regulations should be perfected to prevent the events. Meanwhile, the public should be aware of the need for more understanding and trust in physicians in China.

Tools meant to standardize and rationalize clinical practice have been widely used in healthcare institutions. One tool in particular, clinical pathways, has been a key component of the recent public hospital reform in China. Clinical pathways regulate how the core activities of the medical professional should be performed. Examining pathway implementation and physicians’ attitude toward them may shed light on the extent of discretion and autonomy physicians have in their core activities. Therefore, this study takes clinical pathways as a lens through which to study Chinese physicians’ work and autonomy and asks three questions: First, what is the attitude of physicians toward clinical pathways? Second, how are pathways implemented in physicians’ practice? And third, what are the determinants of physicians’ attitude? Both quantitative and qualitative data are used to explore the research questions. The quantitative data come from a survey of 158 physicians in three tertiary hospitals in two provincial capitals. The qualitative data are from all online discussions about clinical pathways on one of the most popular social networking websites for physicians and hospital administrators. The findings are consistent with the prediction based on sociological theorization of rationalization in professional work. Namely, there are two distinct dimensions in physicians’ attitude toward clinical pathways: physicians felt that pathways made their practice more scientific, but they also felt that the pathways were burdensome and restrictive. Physicians were in general heavily involved in the process of pathway implementation, and restrictive monitoring and sanctioning practices were relatively uncommon. Factors associated with pathway implementation were important predictors of physicians’ attitude, whereas professional orientation and concerns with the status of the profession had limited effect. Taken together, the findings from this exploratory study suggest that although physicians in China's public hospitals are dependent on their organizations, they retain considerable discretion in the implementation and use of clinical pathways. On the other hand, physicians’ views of clinical pathways are more prominently shaped by organizational factors than by their professional orientation.

This study tested the effect of person–organization fit (P-O fit) in mediating the link between job satisfaction and hospital performance with income as a moderator. A questionnaire survey was conducted on 301 physicians from two public hospitals in Zhejiang province of China. Respondents were asked to rate their job satisfaction, value congruence (P-O fit) with the hospital, and the hospital’s performance. The mediating effect of P-O fit on the link between job satisfaction and hospital performance was tested through partial least squares-structural equation modeling (PLS-SEM). Income was introduced to the model as a moderator on the “P-O fit → hospital performance” and “job satisfaction → hospital performance” path, respectively. Higher job satisfaction and P-O fit were associated with higher ratings on hospital performance (p < 0.01). P-O fit had a partial mediating effect on the association between job satisfaction and hospital performance, accounting for 73% of the total effect. The effects of P-O fit and job satisfaction on hospital performance were stronger in the respondents with higher income. Overall, high job satisfaction is associated with high ratings on hospital performance, which is partially mediated through P-O fit. Value congruence is particularly important when financial tools are used to incentivize hospital physicians.

PurposeThis paper reviews management control literature which draws on the institutional logics perspective as the theoretical lens to understand the current grounding of this perspective on management control research. It identifies gaps in the current literature and offers possible future research directions.Design/methodology/approachFor the purpose of this paper, five search engines (ABI INFORM, EBSCO, Emerald insight, JSTOR and Science Direct) were consulted, and 35 papers across 16 journals, which specifically fall within the area of management controls and institutional logics, were reviewed.FindingsThe review revealed that the institutional logics perspective has provided theoretical anchoring to management control-related areas such as budgeting, performance management and control tools in organizations. The extant studies have either used institutional logics as a single theoretical perspective or have integrated it with other theories such as neo-institutional theory, agency theory and structuration theory. The research settings of the papers span across firm level, industry level and government organizations and non-profit organizations. Most of the studies have used the qualitative case study approach, whereas a few have taken the mixed method research design.Originality/valueAlthough there are a number of review papers in the area of management controls as well as on institutional theory in general, such reviews have not specifically been focused on the institutional logics perspective, which is a significant development within institutional theory, having provided theoretical backing to a wide range of management control studies over the years. Addressing this omission, this paper provides important insights for future researchers on what research has been done using the lens of institutional logics and what else is worth doing. In that sense, this paper contributes to the domain of management control research, as well as to the development of institutional theory in general and the institutional logics perspective in particular.

Traditional institutional analysis and the conceptualization of a competent actor—an ordinary individual at times culturally disembedded and capable of proactively engaging with institutional complexity—have not made the best bedfellows so far. This is about to change. Limitations in the institutional logics perspective regarding its microfoundations are now beginning to be addressed and attention has shifted to the theorizing of actorhood. Recent work on institutional biography and reflexivity stresses the importance of agency in bringing the actor back into the debate around institutional logics or institutional orders in a broader sense. This commentary speaks to the growing research interest in actor’s “on the ground” dealing with multiple logics. The notion of the competent actor and its potential to be further developed from an institutional logics perspective together with French pragmatist sociology are discussed.

ObjectivesThis study aimed at examining the extent of turnover intention among the Chinese resident physicians who entered the newly established national standardised residency training programme (SRTP), and exploring factors associated...

How do institutions influence and shape cognition and action in individuals and organizations, and how are they in turn shaped by them? Various social science disciplines have offered a range of theories and perspectives to provide answers to this question. Within organization studies in recent years, several scholars have developed the institutional logics perspective. An institutional logic is the set of material practices and symbolic systems including assumptions, values, and beliefs by which individuals and organizations provide meaning to their daily activity, organize time and space, and reproduce their lives and experiences. In tracing the development of the institutional logics perspective from earlier institutional theory, the book analyzes seminal research, illustrating how and why influential works on institutional theory motivated a distinct new approach to scholarship on institutional logics. The book shows how the institutional logics perspective transforms institutional theory. It presents novel theory, further elaborates the institutional logics perspective, and forges new linkages to key literatures on practice, identity, and social and cognitive psychology. It develops the micro-foundations of institutional logics and institutional entrepreneurship, proposing a set of mechanisms that go beyond meta-theory, integrating this work with macro theory on institutional logics into a cross-levels model of cultural heterogeneity.