Susanne Boch Waldorff

A Tale of Two Countries: How Different Constellations of Logics Impact Action

We build on the concept of “constellations of logics” (Goodrick & Reay, 2011) to further our understanding of the relationship between institutional logics and action. We do so through a comparative case study of similar primary health care initiatives in Denmark and Canada. We draw on micro- and macro-level data to show how both the arrangement and relationship among logics impacted the design and accomplishment of the initiatives in each country. Based on our data, we theorize five different mechanisms through which logics can simultaneously constrain and enable action.

Are hospitals also for relatives? A survey of hospitals' activities regarding relatives of cardiac patients

Aim: Patients and their close relatives both feel the burden of cardiovascular disease. Relatives of heart patients experience lower quality of life and increased mortality than the general population and relatives of patients with other diseases. Nevertheless, knowledge on health services aimed at relatives of patients with cardiac diseases is sparse. This study aimed to survey the prevalence of health services for relatives of cardiac patients in Denmark. Methods: We surveyed activities offered by Danish hospitals to the relatives of cardiac patients. Data were obtained from an Internet-based survey and 50 of 55 invited hospital departments participated. Results: Almost all departments offer activities to relatives of cardiac patients, but only one-quarter have activities specifically aimed at supporting relatives. Large departments offer activities for relatives more often than smaller departments. Participation rates for relatives are generally low, and the departments experience numerous barriers in providing activities for relatives of heart patients. Conclusions: Danish hospitals focus very little on relatives of cardiac patients, and this seems to be due to several factors, including lack of resources, lack of interest and knowledge among staff, and practical and psychological barriers among patients and relatives. More research is needed on health services concerning relatives of cardiac patients, regarding both the prevalence of activities and barriers to these.

What is the Meaning of Public Sector Health? Translating Discourse into New Organizational Practices

This study explores the dynamics involved in establishing discourses necessary for constructing organizational change within the public sector. Drawing upon critical discourse analysis, the study identifies two competing discourses – a ‘patient’ and a ‘healthy citizen’ discourse, which exist as strategic resources in health care. The case study focuses on a municipality in Denmark and the way the organizational actors translated meaning into the development of a new healthcare centre. The analysis contributes to our understandings of translation by focusing on discursive legitimizing strategies in the context of public sector change. First, the study shows that discourses not only provide different senses of meaning and warrant particular social actors a louder voice than others, but that these actors also develop discursive legitimizing strategies and translate particular meanings into the organization and organizational practices. Second, when the strategies make a discourse resonate with the local context, in this case a highly political context, then specific organizational practices become more legitimate than others, and the discourse is more inclined to become manifest. Finally, the findings indicate that the manifestation of a discourse can also be explained by how successful this discourse can be carried out in practice.

Ambiguous expectations for intersectoral action for health: a document analysis of the Danish case

Abstract Ideas about intersectoral action and policy-making for health (ISA) are prominent among public health professionals. They are often presented as effective ways to address root causes of poor health and health inequality, and as such the best way to promote population health. The implementation of such ideas has proven difficult though. In this paper we argue that neo-institutional theory can help us conceptualize implementation challenges by pointing to implicit expectations and contradictions associated with the ISA idea itself. With Denmark as empirical case, we conducted a document analysis of recommendations for municipal ISA. The analysis shows how the recommendations provide a very abstract conceptualization of ISA that does not give much practical guidance for action. We show how ISA is discursively constructed with buzzword qualities as the natural way to organize health promotion, by being presented as a means to produce better quality services, more cost-effective operations and ensure the future of the welfare state, while at the same time hardly changing much at all. By applying the lens of institutional logics we show how ISA, although being vaguely defined, offer ambiguous normative and symbolic repertoires for action. We discuss the implementation challenges associated with this advocacy rhetoric and suggest that the domination of the corporation logic may appear to reduce the political character of ISA and potentially conflict with the ideals of health as a matter of social justice and human rights.

New Themes in Institutional Analysis: Topics and Issues from European Research

Institutional theory has become one of the dominant organizational approaches in recent decades. Its roots can be traced to Europe, and an important intellectual objective of this book is to examine North American theory strands and reconnect them with European research traditions. In addition, this book focuses on how organizations and individuals handle heterogeneous and challenging social conditions which are subsequently reflected in various forms of change.

What are institutional logics – and where is the perspective taking us?: Topics and Issues from European Research

Christina Berg Johansen and Susanne Boch Waldorff explore the theoretical foundation and analytical contributions of the institutional logics perspective. They identify two fundamental topics: 1) how institutional logics both guide and are guided by overarching institutional orders, and 2) how inter-logics relations create friction and space for change and agency. They use examples from different empirical papers to support and illustrate their investigation of these two topics. Further, they discuss how institutional logics contribute to institutional theory at large and inform our understanding of organizations in society.