Cost-conscious medical professionals: individual responses to multiple institutional logics in a Chinese regional hospital

Liu, Jing (2024). Cost-conscious medical professionals: individual responses to multiple institutional logics in a Chinese regional hospital. University of Birmingham. Ph.D.

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Abstract

Healthcare expenditure is expensive, and it is anticipated to see continuous growth in the future, driven by a variety of factors relating to social, political, technological and economic conditions. The generation of medical expenses is often attributed to the decisions made by healthcare professionals during their medical practice. As a result, the integration of cost consciousness into the mindset and actions of medical professionals has received significant attention, emerging as a key focal point in healthcare reforms across the globe.

Healthcare reforms have seen numerous endeavours aimed at instilling a sense of cost-consciousness among doctors, such as the incorporation of cost-control techniques into medical practice. This study focuses on the efforts made by a developing context of China in this regard, primarily addressing the question of how doctors perceive the relationship between cost control and healthcare activities by employing the institutional logics as the theoretical perspective. The study conducted 31 semi-structured interviews with medical professionals in two types of departments at a large Chinese provincial hospital: the lab department and clinical departments, and collected documentaries as a supplement to the interviews. Thematic analysis was employed to elaborate on medical professionals’ perceptions toward cost control, methods developed to control costs and their reasons for controlling medical expenditures. The study shows that medical professionals displayed a context-based perception of cost control, and their reasons for cost control were derived from medical, and cultural considerations.

This study has identified two institutional logics in the case hospital, namely commercial logic and medical logic. Medical professionals exhibited different perceptions regarding the relationship between these two logics in clinical departments and the lab department. Specifically, there was a perceived conflict between cost control and healthcare activities in clinical departments, whereas such conflict was not experienced in the laboratory department. The divergent perceptions of healthcare professionals regarding these two logics also influenced their approach towards handling the multiple logics context. When perceiving conflicting situations, medical professionals adopted three methods, namely combination, avoidance, and defiance to manage the institutional requirements from these logics. Conversely, when doctors perceived a non-conflicting situation, they utilized the acquisition approach to manage the two logics. This study additionally demonstrates that, influenced by cultural factors, the identities of medical professionals could undergo a transformation into hybrid professionals. Cultural factors also enabled doctors to strike a balance between the demands of cost control and maintaining medical quality. Through an examination of doctors' perceptions of various institutional logics in medical practice, this study suggests that the existence or absence of logic conflicts is primarily a contextual artifact, significantly influenced by the nature of medical practice. Moreover, individuals exhibit considerable agency in managing demands stemming from multiple institutional logics, developing diverse responses to these logics.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):