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Title: The institutional logic of integrated care: An ethnography of patient transitions
Authors: Shaw, J
Kontos, P
Martin, W
Victor, C
Keywords: integrated Care;health Policy;transitional Care;ethnography;England’s National Health Service
Issue Date: 20-Mar-2017
Publisher: Emerald
Citation: Shaw, J.A., Kontos, P., Martin, W. and Victor, C. (2017) 'The institutional logic of integrated care: an ethnography of patient transitions', Journal of Health Organization and Management, 31 (1), pp. 82 - 95. doi: 10.1108/JHOM-06-2016-0123.
Abstract: © Shaw, Kontos, Martin and Victor. Purpose: To use theories of institutional logics and institutional entrepreneurship to examine how and why macro-, meso-, and micro-level influences inter-relate in the implementation of integrated transitional care out of hospital in the English National Health Service. Design/Methodology/Approach: We conducted an ethnographic case study of a hospital and surrounding services within a large urban centre in England. Specific methods included qualitative interviews with patients/caregivers, health/social care providers, and organizational leaders; observations of hospital transition planning meetings, community “hub” meetings, and other instances of transition planning; reviews of patient records; and analysis of key policy documents. Analysis was iterative and informed by theory on institutional logics and institutional entrepreneurship. Findings: Organizational leaders at the meso-level of health and social care promoted a partnership logic of integrated care in response to conflicting institutional ideas found within a key macro-level policy enacted in 2003 (The Community Care (Delayed Discharges) Act). Through institutional entrepreneurship at the micro-level, the partnership logic became manifest in the form of relationship work among health and social care providers; they sought to build strong interpersonal relationships to enact more integrated transitional care. Originality/Value: Our study has three key implications. First, efforts to promote integrated care should strategically include institutional entrepreneurs at the organizational and clinical levels. Second, integrated care initiatives should emphasize relationship-building among health and social care providers. Finally, theoretical development on institutional logics should further examine the role of interpersonal relationships in facilitating the “spread” of logics between macro-, meso-, and micro-level influences on inter-organizational change.
metadata.dc.relation.isreplacedby: 2438/14304
ISSN: 1477-7266
Appears in Collections:Dept of Computer Science Research Papers

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