Centrality and compatibility of institutional logics when introducing value-based reimbursement

Area of Science:

• Healthcare management
• Organizational sociology
• Health economics

Background:

• Financial incentives in healthcare often prioritize measurable outcomes.
• Value-based reimbursement (VBR) aims to align professional values with financial incentives.
• Professional values can vary significantly among different healthcare stakeholders.

Purpose of the Study:

• To identify institutional logics within healthcare organizations.
• To analyze how the centrality and compatibility of these logics influence the adoption of external demands, such as VBR.
• To understand the impact of VBR on professional values and organizational dynamics.

Main Methods:

• Conducted 41 semi-structured interviews with healthcare providers in Swedish spine surgery.
• Utilized thematic content analysis with an abductive approach.
• Applied a conceptual framework grounded in neo-institutional theory.

Main Results:

• VBR altered the centrality and compatibility of institutional logics within organizations.
• Spine surgeons' logic dominated, while physiotherapists faced challenges justifying higher costs for quality care.
• Nurses' logic, peripheral to spine surgery, supported surgical goals, highlighting the need for greater integration.

Conclusions:

• Understanding micro-level behaviors in response to macro-level healthcare policy is crucial.
• Achieving holistic, interdisciplinary care necessitates elevating peripheral institutional logics.
• Allowing diverse professional groups greater responsibility fosters quality and professional pride.