دانلود رایگان مقاله محدودیت در سازمان های بهداشتی دانشگاهی

abstract

Policy makers view academic healthcare organisations as important to healthcare innovation because they act as boundary-spanning organisations that integrate science and care institutional logics. Institutional logics are implicit and socially shared rules of the game that prescribe behaviour within a social group. This paper explores how individuals affiliated with academic healthcare organisations negotiate science and care institutional logics within their day-to-day work through a qualitative case study of research and healthcare within academic healthcare organisations in Vancouver, Canada. It highlights that there is less hybridisation of institutional logics than policy makers might hope: some researchers hosted in academic healthcare organisations are not part of the care institutional logic, others are not well integrated with the research institutional logic. Clinician–scientists often struggle to integrate the science and care institutional logics in their day-to-day work; other workers do integrate science and care institutional logics through experiments of nature but their research may not be viewed as high quality science. Because of poor hybridisation, academic healthcare organisations may not be as effective in facilitating healthcare innovation as policy makers assume.

6. Discussion and conclusion

Table 2 shows the distribution of participants across the organisations by job focus. Because participants are distributed across 10 different organisations, definitively connecting organisational policy to institutionaltensionnegotiationis challenging. The exception is Organisation B where experiments of nature were used as an explicit strategy to combine and create a hybrid science/care institutional logic. Participants in other organisations (such as Virgil) based some of their work on experiments of nature. In experiments of nature, problems and questions—in addition to patients and their data—moved between the care and science institutional logics and helped facilitate hybridisation of institutional logics. The perceived directionality of translation also reversed; participants strongly influenced by the science institutional logic viewed translation as moving from bench to bedside while participants conducting experiments of nature viewed translation as moving from bedside to bench.