Remaking “Community” Mental Health: Contested Institutional Logics and Organizational Change

Spitzmueller, Matthew C.

doi:10.1080/23303131.2017.1422071

Cited by 12 publications

(6 citation statements)

References 66 publications

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“…Aligning healthcare with evidence-based (or -informed) practice can be challenging [5]. What clinicians do, how they do it, when they do it and who (or what) they do it with is shaped by myriad factors and processes, some of which are not readily conducive to change, like institutional logics [4,6,7,11,13]. Despite progress to address the oft-cited 'quality chasm' [206], evidence-based population health is far from ideal, particularly in low-and middle-income nations.…”

Section: Discussionmentioning

confidence: 99%

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Implementation science in maternity care: a scoping review

Piper

Coates

2021

Implementation Sci

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Background Despite wide recognition that clinical care should be informed by the best available evidence, this does not always occur. Despite a myriad of theories, models and frameworks to promote evidence-based population health, there is still a long way to go, particularly in maternity care. The aim of this study is to appraise the scientific study of methods to promote the systematic uptake of evidence-based interventions in maternity care. This is achieved by clarifying if and how implementation science theories, models, and frameworks are used. Methods To map relevant literature, a scoping review was conducted of articles published between January 2005 and December 2019, guided by Peters and colleagues’ (2015) approach. Specifically, the following academic databases were systematically searched to identify publications that presented findings on implementation science or the implementation process (rather than just the intervention effect): Business Source Complete; CINAHL Plus with Full Text; Health Business Elite; Health Source: Nursing/Academic Edition; Medline; PsycARTICLES; PsycINFO; and PubMed. Information about each study was extracted using a purposely designed data extraction form. Results Of the 1181 publications identified, 158 were included in this review. Most of these reported on factors that enabled implementation, including knowledge, training, service provider motivation, effective multilevel coordination, leadership and effective communication—yet there was limited expressed use of a theory, model or framework to guide implementation. Of the 158 publications, 144 solely reported on factors that helped and/or hindered implementation, while only 14 reported the use of a theory, model and/or framework. When a theory, model or framework was used, it typically guided data analysis or, to a lesser extent, the development of data collection tools—rather than for instance, the design of the study. Conclusion Given that models and frameworks can help to describe phenomenon, and theories can help to both describe and explain it, evidence-based maternity care might be promoted via the greater expressed use of these to ultimately inform implementation science. Specifically, advancing evidence-based maternity care, worldwide, will require the academic community to make greater explicit and judicious use of theories, models, and frameworks. Registration Registered with the Joanna Briggs Institute (registration number not provided).

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Section: Discussionmentioning

confidence: 99%

“…A linear understanding of evidence translation-from 'bench to bedside' [10]-is naïve. This is because those who deliver, manage and receive healthcare, negotiate multiple forms and sources of evidence, which complement and compete with each other [2,11,12] within a complex system of institutional logics [11,13].…”

Section: Introductionmentioning

confidence: 99%

Implementation science in maternity care: a scoping review

Piper

Coates

2021

Implementation Sci

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“…Finally, transition scholars may take notice of processes of institutional change within organizations and accompanying institutional entrepreneurship on a micro-level. We observed multiple studies in our dataset showcasing such processes (Heinze and Weber, 2015;Spitzmueller, 2018;Tumbas et al, 2018;Whittle et al, 2011). For example, Heinze and Weber (2015) describe institutional change processes within two large established healthcare centers, while Tumbas et al (2018) provides a bigger study on institutional entrepreneurship within 35 companies (both in manufacturing and service sectors).…”

Section: Lessons Related To Actor Characteristicsmentioning

confidence: 95%

“…Its wide applicability is a strength of the theory, but in some cases also poses a threat of 'over-use' of certain theoretical concepts. For example, some of the cases we studied described processes of institutional change within a single organization/company (Heinze and Weber, 2015;Spitzmueller, 2018;Tumbas et al, 2018;Whittle et al, 2011). This micro-level focus raises the question whether institutional entrepreneurship theory as posed by provides the most applicable theoretical handhelds to describe change processes occurring inside a single organization, given that the enabling conditions are described on the level of an organizational field.…”

Section: General Conclusionmentioning

confidence: 99%

“…In contrast, MMV focused on building a continuous platform with one goal to fight a specific disease, built around the expertise of its diverse members, for which they applied a goal-end socialization process relying on functional divisions within the project. What is more, while some studies investigated intra-organizational processes using institutional entrepreneurship theory as reviewed in Chapter 2 (Heinze & Weber, 2015;Spitzmueller, 2018;Tumbas et al, 2018;Whittle et al, 2011), such studies point to perhaps an over-use of this theory. Institutional entrepreneurship has its explanatory strength in understanding divergent change at the niche level vis-à-vis the regime level, not so much in analyzing intra-organizational processes within single organizations.…”

Section: How Actors Create and Leverage Institutional Hybriditymentioning

confidence: 99%

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Mixing and Matching Institutions

Hoogstraaten¹

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In innovation and transition processes institutional change is pivotal. This is especially true when it comes to the diffusion of radical innovations, as the properties of such innovations do not match existing institutional frameworks. The role of institutions and institutional change has been acknowledged and incorporated in innovation and transition studies. Traditionally, however, scholars in those fields have had a tendency to emphasize the structural deterministic influence of institutions on innovation processes. Institutional theory offers theoretical and empirical insights into both the structural influences of institutions and the agency that actors exert over institutions and institutional change. In relation to institutional agency, notions of institutional heterogeneity and institutional complexity are considered from a structural deterministic viewpoint, as they are presumed to influence change agents’ activities. When heterogeneous institutional elements are strategically combined, however, the resulting institutional hybridity becomes the object and goal of change. In this thesis, I explore institutional hybridity from an agency perspective. I define institutional hybridity as the mixture or (re)combination of institutional elements that occurs in innovation processes, facilitating innovations to diffuse. The novelty of this approach is that it emphasizes the agentic role of innovators vis-à-vis institutional complexity. In addition to the structural influence of institutional complexity, I argue that institutionally complex environments and the hybridization of institutions can be actively and purposefully created and leveraged by actors to foster innovation. I analyze the process of institutional hybridization by researching three empirical cases. Each case focuses on a different level of institutional analysis (macro, meso, micro) and a congruent institutional agency framework. I research institutional hybridity at the macro-level by investigating two intermediary organizations which coordinate product-development partnerships (PDPs) focusing on the development of drugs for neglected tropical diseases. To do so, they actively straddle public and private institutional logics within one hybrid organization. I apply the literature on hybrid organizing to analyze their strategies. I research MedTech entrepreneurs in their efforts to tackle healthcare challenges, which represents the meso-level of institutional hybridity as they straddle multiple regimes – in this case the (information) technology sector and the healthcare sector. For this case, I adopted the institutional work framework. Finally, I focus on the micro-level by adopting a categorical perspective and investigating producers of meat substitutes and their efforts to straddle the categories of meat – which meat substitutes explicitly reference – and the category of vegetarian and vegan products. I describe what implications can be derived from these cases for innovation and transition studies. I provide an overview of four important frameworks focused on institutional agency that I have incorporated in this thesis (i.e. institutional entrepreneurship, hybrid organizing, institutional work and strategic categorizing), relate them to the Multi-Level Perspective framework and highlight their analytical strengths and weaknesses when it comes to understanding processes of institutional hybridization. As such I clarify and strengthen the embedding of institutional theories in innovation and transition studies. Furthermore, I reflect on what these insights can mean in terms of optimizing innovative policies and provide avenues for future research.

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