We investigated how professional role identity change can be accomplished in highly institutionalized contexts characterized by resiliency. We show that the collective professional role identity of family physicians was changed through a process of reinterpreting multiple logics and their relationships. Through our inductive analyses, we identified four mechanisms that occurred through social interactions and collectively served to rearrange the constellation of logics guiding physician role identity: (1) revealing the influence of a hidden logic, (2) reinforcing the conflict between logics, (3) reframing the meaning of a dominant logic, and (4) re-embedding the new arrangement of logics. We found that the change in physician professional role identity required significant identity work by a group of actors, but particularly by the managers who had been charged with leading the reform initiative. We contribute to the professional role identity and institutional literatures by showing how others can engage in social interactions with professionals to facilitate the reinterpretation and rearranging of institutional logics that guide collective professional role identity. Key words: Professional role identity; Institutional logics; Social interactions INTRODUCTIONFamily doctors are the last bastion of "I'm going to run my own shop and do it my way" and "I've been expected all along to do everything so that's what I've done and I'm not about to change just because you say some nurse is going to come in here and do some work for me now. (Physician interviewed before change initiative) Yes, absolutely it's different [than before]. Physicians are still the key decision-maker, but involving other healthcare professionals. And I think it's almost like a family. You want to know who's in charge of the family. And make sure that there is one person ultimately that becomes kind of like the person to go to -we are that person. (Physician interviewed at end of our study)The above quotes illustrate how family physicians (called general practitioners or GPs in many countries) viewed themselves at the beginning of our study (T0) compared to the end (T3).It is notable that before the implementation of a Canadian government-designed initiative to reform primary health care and family physicians' role, physicians saw themselves as independent, autonomous professionals who treated patients one-by-one in their offices with little, if any, help from anyone else. The heart of the reform initiative was to create multi-3 disciplinary teams of health professionals that included physicians, thereby improving patient care and reducing health system costs. Initially, there was a small group of 'renegade' physicians who visualized a new role identity; however, the majority of physicians were skeptical or disinterested in change. Over the three years of our study, we heard from interviewees how managers became involved in the change initiative, and facilitated (together with renegade physicians and other professionals) the development ...

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BackgroundFor more than 30 years policy action across sectors has been celebrated as a necessary and viable way to affect the social factors impacting on health. In particular intersectoral action on the social determinants of health is considered necessary to address social inequalities in health. However, despite growing support for intersectoral policymaking, implementation remains a challenge. Critics argue that public health has remained naïve about the policy process and a better understanding is needed. Based on ethnographic data, this paper conducts an in-depth analysis of a local process of intersectoral policymaking in order to gain a better understanding of the challenges posed by implementation. To help conceptualize the process, we apply the theoretical perspective of organizational neo-institutionalism, in particular the concepts of rationalized myth and decoupling.MethodsOn the basis of an explorative study among ten Danish municipalities, we conducted an ethnographic study of the development of a municipal-wide implementation strategy for the intersectoral health policy of a medium-sized municipality. The main data sources consist of ethnographic field notes from participant observation and interview transcripts.ResultsBy providing detailed contextual description, we show how an apparent failure to move from policy to action is played out by the ongoing production of abstract rhetoric and vague plans. We find that idealization of universal intersectoralism, inconsistent demands, and doubts about economic outcomes challenge the notion of implementation as moving from rhetoric to action.ConclusionWe argue that the ‘myth’ of intersectoralism may be instrumental in avoiding the specification of action to implement the policy, and that the policy instead serves as a way to display and support good intentions and hereby continue the process. On this basis we expand the discussion on implementation challenges regarding intersectoral policymaking for health.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-2864-9) contains supplementary material, which is available to authorized users.

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This study presents new insights into the explanatory power of the institutional logics perspective. With outset in a discussion of seminal theory texts, we identify two fundamental topics that frame institutional logics: overarching institutional orders guided by institutional logics, as well as change and agency generated by friction between logics. We use these topics as basis for an analysis of selected empirical papers, with the aim of understanding how institutional logics contribute to institutional theory at large, and which social matters institutional logics can and cannot explore and explain.