Competing and coexisting logics in the changing field of English general medical practice |
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| Affiliation: | 1. Business School North Building, University of Nottingham, Jubilee Campus, Nottingham NG8 1BB, United Kingdom;2. University of Manchester, United Kingdom;1. Vanderbilt University Medical Center, Nashville, Tennessee;2. Johns Hopkins University, Baltimore, Maryland;3. National Heart, Lung, and Blood Institute, Bethesda, Maryland;4. Tandigm Health, West Conshohocken, Pennsylvania;5. Vanderbilt University Owen Graduate School of Management, Nashville, Tennessee;6. Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina;7. Morristown Medical Center, Morristown, New Jersey;8. Washington Hospital Center, Washington, District of Columbia;9. Geisinger Health System, Danville, Pennsylvania;10. Intermountain Medical Center, Murray, Utah;11. The Lexis Group, LLC, Dillsburg, Pennsylvania;12. Cleveland Clinic, Cleveland, Ohio;13. Children’s Healthcare of Atlanta, Atlanta, Georgia;14. Piedmont Heart Institute, Atlanta, Georgia;15. MPA Healthcare Solutions, Inc, Chicago, Illinois;p. University of Pennsylvania and Navigant Consulting, Inc, Philadelphia, Pennsylvania;q. Mayo Clinic, Rochester, Minnesota;r. Massachusetts General Hospital, Boston, Massachusetts;s. Centers for Medicare and Medicaid Services, Baltimore, Maryland;t. The Ohio State University Heart Center, Columbus, Ohio;u. The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania;v. Mount Sinai Medical Center, New York, New York;w. Bluhm Cardiovascular Institute of Northwestern University, Chicago, Illinois;x. American Board of Internal Medicine and the ABIM Foundation, Philadelphia, Pennsylvania;y. US Ignite, Washington, District of Columbia;z. University of Chicago Medicine, Chicago, Illinois;11. MedStar Health Research Institute, Washington, District of Columbia;22. Thomas Jefferson University, Philadelphia, Pennsylvania;33. Adult Congenital Heart Association, Philadelphia, Pennsylvania;1. Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA;2. Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA;3. University of Texas Southwestern Medical Center, Dallas, TX, USA;4. American Association of Hip and Knee Surgeons, Rosemont, IL, USA;5. Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA;6. Department of Orthopaedic Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA;1. University of Gothenburg, Department of Economics, Centre for Finance, Vasagatan 1, 40530 Gothenburg, Sweden;2. Hanken School of Economics, Department of Finance and Statistics, Arkadiagatan 22, 00101 Helsinki, Finland;3. University of Innsbruck, Department of Banking and Finance, Universitätsstrasse 15, 6020 Innsbruck, Austria;1. School of Physics, Northeast Normal University, Changchun 130024, China;2. School of Mathematics and Statistics, Northeast Normal University, Changchun 130024, China;3. Jilin Cancer Hospital, Changchun 130021, China |
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| Abstract: | ![]()
Recent reforms, which change incentive and accountability structures in the English National Health Service, can be conceptualised as trying to shift the dominant institutional logic in the field of primary medical care (general medical practice) away from medical professionalism towards a logic of "population based medicine". This paper draws on interviews with primary care doctors, conducted during 2007–2009 and 2011–2012. It contrasts the approach of active management of populations, in line with recent reforms with responses to patients with medically unexplained symptoms. Our data suggest that rather than one logic becoming dominant, different dimensions of organisational activity reflect different logics. Although some aspects of organisational life are relatively untouched by the reforms, this is not due to ‘resistance’ on the part of staff within these organisations to attempts to ‘control’ them. We suggest that a more helpful way of understanding the data is to see these different aspects of work as governed by different institutional logics. |
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| Keywords: | Primary care Health policy England Incentives Organisations Institutional theory |
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