Thérèse Eriksson, Lars-Åke Levin and Ann-Charlotte Nedlund
Using financial incentives has been criticised for putting too much focus on things that can be measured. Value-based reimbursement may better align professional values with…
Abstract
Purpose
Using financial incentives has been criticised for putting too much focus on things that can be measured. Value-based reimbursement may better align professional values with financial incentives. However, professional values may differ between actor groups. In this article, the authors identify institutional logics within healthcare-providing organisations. Further, the authors analyse how the centrality and compatibility of the identified logics affect the institutionalisation of external demands.
Design/methodology/approach
41 semi-structured interviews were conducted with representatives from healthcare providers within spine surgery in Sweden, where a value-based reimbursement programme was introduced. Data were analysed using thematic content analysis with an abductive approach, and a conceptual framework based on neo-institutional theory.
Findings
After the introduction of the value-based reimbursement programme, the centrality and compatibility of the institutional logics within healthcare-providing organisations changed. The logic of spine surgeons was dominating whereas physiotherapists struggled to motivate a higher cost for high quality physiotherapy. The institutional logic of nurses was aligned with spine surgeons, however as a peripheral logic facilitating spine surgery. To attain holistic and interdisciplinary healthcare, dominating institutional logics within healthcare-providing organisations need to allow peripheral institutional logics to attain a higher centrality for higher compatibility. Thus, allowing other occupations to take responsibility for quality and attain the feeling of professional pride.
Originality/value
Interviewing spine surgeons, physiotherapists, nurses, managers and administrators allows us to deepen the understanding of micro-level behaviour as a reaction (or lack thereof) to macro-level decisions.
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Anna-Therése Järvenpää, Johan Larsson and Per Erik Eriksson
This paper aims to identify how a public client’s use of control systems (process, output and social control) affect innovation possibilities in construction projects.
Abstract
Purpose
This paper aims to identify how a public client’s use of control systems (process, output and social control) affect innovation possibilities in construction projects.
Design/methodology/approach
Semi-structured interviews about six infrastructure projects were conducted to identify respondents’ views on innovation possibilities. These possibilities were then analyzed from an organizational control perspective within principal–agent relationships between the Swedish Transport Administration (STA) and their contractors.
Findings
How the client uses control systems affects innovation possibilities. Relying on process control could negatively affect innovation opportunities, whereas output control could have a positive influence. In addition, social control seems to have a weak effect, as the STA appears not to use social control to facilitate joint innovation. Public clients must comply with the Public Procurement Act and, therefore, retain the requirements specified in the tendering documents. Much of the steering of the execution is connected to the ex ante phase (before signing the contract), which affects innovation possibilities in the design and execution phases for the contractor.
Research limitations/implications
This study was conducted with only one client, thus limiting its generalizability. However, the findings provide an important stepping stone to further investigation into balancing control systems and creating innovation possibilities in a principal–agent relationship.
Originality/value
Although public procurement has increasingly been emphasized as a major potential source of innovation, studying how a public client’s use of organizational control systems affects innovation possibilities in the construction sector has received scant attention.
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Therese Hellman, Fredrik Molin, Tomas Eriksson and Magnus Svartengren
The purpose of this paper is to explore and describe the perspective of the management group regarding how they reasoned when deciding to engage in a model focussing on systematic…
Abstract
Purpose
The purpose of this paper is to explore and describe the perspective of the management group regarding how they reasoned when deciding to engage in a model focussing on systematic work environment management, and what motives that influenced their decision.
Design/methodology/approach
This qualitative study with semi-structured interviews includes 18 representatives from the management groups in 18 Swedish municipalities. Data were analysed with a constant comparative method.
Findings
The participants described two aspects that were of importance when making the decision; establishing commitment before making the decision and establishing strategies to legitimise the decision. Furthermore, they expressed motives that were linked both to their individual expectations and wishes and to policies and facts in their organisations. The participants experienced the model as a valuable tool in their organisations to increase employee participation and to provide structured support to their first-line managers.
Practical implications
The managers’ motives were linked to individual expectations and external directives. These were often intertwined and influenced their decisions. When implementing this type of model, it is important to discuss decisions in a larger group to avoid building an organisational initiative on one person’s expectations. Furthermore, it is important to support the management’s work to establish commitment for the model in the municipal organisation.
Originality/value
This study adds to knowledge of the complexity of deciding and implementing models to support systematic work environment management in organisations.
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Anna-Therése Järvenpää, Johan Larsson and Per Erik Eriksson
For a number of years, the construction industry has seen an ongoing shift from design-bid-build to design-build contracts. This transition in contract type entails changes for…
Abstract
Purpose
For a number of years, the construction industry has seen an ongoing shift from design-bid-build to design-build contracts. This transition in contract type entails changes for both the organizations and the individuals involved. Consequently, the purpose of this paper is to investigate how the client manages the transition between the different contract types from an organizational change perspective in a project-led organization.
Design/Methodology/Approach
A multiple case study of six infrastructure projects with DB contracts, all managed by the Swedish Transport Administration, was conducted. The major source of data is semi-structured interviews with respondents from both the client and the contractors.
Findings
Results suggest that the transition has resulted in a mix of design-bid-build and design-build as contract type owing to issues when changing in a project-led organization. A change in vision also requires a concomitant change in culture, systems and roles.
Research Limitations/Implications
The study only includes cases from the Swedish transport infrastructure sector, which limits the generalizability. The findings are also indicative owing to the small number of cases.
Practical Implications
The findings further our understanding of managing change in complex projects, which might help practitioners to manage change in a more integrated way.
Originality/Value
The findings enrich our understanding of the systemic change that a switch in contract types can have in inter-organizational complex projects such as transport infrastructure projects. Furthermore, it emphasizes the intricate task of change management in project-led organizations and its effects on roles and responsibilities.