An Institutional Perspective on Accountable Care Organizations

Area of Science:

• Organizational Theory
• Healthcare Management
• Sociology of Health

Background:

• Accountable Care Organizations (ACOs) operate within complex environments with multiple, often conflicting, institutional pressures.
• Understanding these competing principles (institutional logics) is crucial for ACO effectiveness.

Purpose of the Study:

• To explore how ACOs can manage institutional complexity and conflicting logics.
• To identify strategies for ACOs to effectively balance diverse principles for improved patient and community service.

Main Methods:

• Application of institutional theory, specifically the concept of institutional logics.
• Analysis of strategies for combining or segregating institutional logics on a continuum.
• Identification of practical approaches for ACOs to navigate complexity.

Main Results:

• ACOs face a spectrum of options for managing multiple institutional logics, from segregation to full hybridization.
• A middle-ground approach, balancing segregation and hybridization, is suggested as most productive.
• Three specific strategies are identified: reinterpreting practices, leveraging synergy, and fostering frontline innovation.

Conclusions:

• ACOs can effectively manage institutional complexity by adopting a balanced approach to conflicting logics.
• Strategic combination of logics, short of full integration, enables effective responses and innovation.
• This nuanced approach supports ACOs in better serving patients and communities.