Pathways to Autonomy: Chinese Physicians' Responses to Clinical Pathways amid Institutional Complexity

Professionals increasingly encounter tools aimed at rationalizing and standardizing their work. Existing research largely conceptualizes their responses to these tools on a continuum from professional resistance to managerial control. But the institutional logics perspective and emerging empirical evidence suggest more varied responses and diverse, possibly non-zero-sum, outcomes. Using survey data from 1,116 physicians in China's public hospitals, we systematically examined physicians' reactions to pathway implementation and the impacts on clinical autonomy and job satisfaction. Cluster analysis identified four response types: (a) ignoring, where physicians avoided pathways and maintained autonomy; (b) coerced, where imposed pathways reduced autonomy and satisfaction; (c) decoupling, where pathways were adopted superficially, preserving autonomy; and (d) embracing, where physicians actively participated in pathway implementation and enforcement, experiencing high satisfaction and autonomy. The findings help broaden the conceptualization of professionals' reactions to rationalizing tools, uncover multiple pathways to clinical autonomy, and illustrate how professionals navigate institutional complexity in ever-evolving environments.