ABSTRACT
As a result of developments in their sector, public organizations are being confronted with competing values (Van der Wal et al., 2011). The health care sector is a striking example of a public organizational field where multiple values and demands are at play. Hospitals in many countries are confronted with the challenge to simultaneously enhance the quality and reduce the costs of care. One of the drivers of this development in the Netherlands is the 2006 health care act, forcing Dutch hospitals to consider the cost aspects of care. These developments are also taking place in other countries, such as New Zealand and the United Kingdom. In these countries, New Public Managementinspired reforms are restructuring health care (Doolin, 2001). Bekkers et al. (2011: 9) illustrate this by referring to the health care sector when discussing the ‘introduction of a stronger market orientation’ (9). In addition, Noordegraaf (2007: 773) notices that ‘businesslike managerialism’ and ‘traditional professional values’ are being combined in public organizations. From a theoretical point of view, the institutional logics perspective might be used to analyse these developments in public sector organizations such as hospitals (Thornton et al., 2012). Institutional logics can be defined as ‘the belief systems and associated practices that predominate in an organizational field’ (Scott et al., 2000: 170). Scott et al. (2000) observed a shift from dominance of a professional logic to dominance of a managerial logic through market mechanisms in health care. Furthermore, several authors suggest that health care is an organizational field where multiple institutional logics exist (e.g. Reay and Hinings, 2005, 2009), i.e. an institutional complex field. Reay and Hinings (2009) for example show that both professional and business-like logics coexist in a Canadian health care system. It is expected that in hospitals, physicians and nurses might be acting in accordance with a professional logic that emphasizes the quality of care, while managers and directors might take on a more business-like logic, which is mainly occupied with efficiency (Ruef and Scott, 1998).
