Högskolan i Skövde

This study examines how interactions between individual actors can form institutional work in a highly institutionalized setting. Recent progress within the institutional logics perspective has directed focus to the roles of individual actors, their strategic actions, and how institutional logics may be interpreted and rebalanced. However, these contributions are founded on individual actors’ identity processes, but not on how institutional work can be performed through interactions among individual actors adhering to different institutional logics. We performed a qualitative case study, based on observations and interviews, with a focus on quality-improvement work performed in a hospital. The study affirmed that institutional work primarily maintains and upholds the rigidity of healthcare organizations, by interactions that either preserve the distance between different institutional logics or prevent their mutual influence on each other. However, when institutional work transcends maintaining – towards creating or disrupting – the interaction is characterized both by acts of claiming influence and acts of granting influence between actors adhering to different institutional logics. Nonetheless, these interactions are dependent upon the approaches of the physicians; such interactions start with the physicians either being granted influence or granting influence – influence that can later be claimed by the other actor. As such, although the coexistence of different institutional logics is currently an established phenomenon in healthcare, we illustrate how institutional work is contingent upon the dominating professional logic of physicians.