If It Is Complex, Let It Be Complex – Dealing With Institutional Complexity in Hospitals Comment on "Dual Agency in Hospitals: What Strategies Do Managers and Physicians Apply to Reconcile Dilemmas Between Clinical and Economic Considerations?"

Abstract

Waitzberg and colleagues identified strategies that managers and physicians in hospitals apply to reconcile dilemmas between clinical and economic considerations. Contributions that actually acknowledge the institutional complexity of hospitals and describe how to deal with it are rare. This comment explains the reason behind the institutional complexity in healthcare organizations and argues that institutional complexity is a good foundation for a well-functioning and sustainable healthcare, as long as we are able to deal with this complexity. This point underscores the importance of their contribution. However, even if the identified strategies on how to reconcile and balance different, competing demands are important, they are not easy to apply in practice. First, the strategies require frequent and high-quality interaction between different actors adhering to different institutional logics. Second, even when the strategies are applied successfully, it is difficult to make them sustainable since they rest on a fragile balance between competing logics. However, these are important avenues for future research for researchers who want to follow the route of Waitzberg and colleagues.

Clinicians' psychological empowerment to engage in management as part of their daily work

“…Furthermore, our study empirically confirms what conceptual papers (e.g. Andersson, 2022 ) have claimed: that managerial work and clinical work have different time frames, where clinical work is more focused on the here-and-now, while managerial work has longer time frames. Both physicians and nurses in our study claim that when they perceive outcomes of engaging in managerial work, these outcomes are related more to conditions for future work than to operational outcomes.…”

“…The strongest conflict tends to be between managerial logic of health care managers and professional logic of physicians (Andersson and Liff, 2018), but there are many more logics in play that further increase complexity, such as professional logic of nurses and other professions and community logics of politicians (van den Broek et al, 2014;Currie and Spyridonidis, 2016). However, the main problem is not that there are different logics in health care organizations, but that they are poorly integrated with each other (Andersson, 2022). Institutional logics guide individual behavior, but since clinicians and managers in health care tend to adhere mainly to different institutional logics (Andersson and Liff, 2018;Martin et al, 2017), the differences in the logics create conflict in the workplace between them because of different values, priorities, and focus.…”

“…, 2014 ; Currie and Spyridonidis, 2016 ). However, the main problem is not that there are different logics in health care organizations, but that they are poorly integrated with each other ( Andersson, 2022 ). Institutional logics guide individual behavior, but since clinicians and managers in health care tend to adhere mainly to different institutional logics ( Andersson and Liff, 2018 ; Martin et al.…”

Dual Agency: A Fresh Perspective to Identify Dilemma Mitigation Strategies – A Response to the Recent Commentaries

“…3 European Observatory on Health Systems and Policies, Brussels, Belgium. 4 Department of Health Systems Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.…”

“…We were pleased to read the eight commentaries on our paper entitled “Dual agency in hospitals: how do managers and physicians reconcile clinical and economic considerations?,” 1 and are happy to respond to them in this short correspondence. It was interesting to see how our article created a broad echo, and was relevant to various disciplines, ranging from medical ethics 2 to sociology of professions, 3 management of organizations, 4 to name a few. Commentaries originate from several European countries (Spain, the Netherlands, Sweden, Germany, Norway, and the United Kingdom), Singapore and Australia (see Table).…”