Designs of an organizational response to institutional complexity in healthcare: A focus group and statistical study of management control in French hospitals

Open Access

Abstract

This paper looks at hospitals' organizational structure through an institutional lens in order to examine how these organizations respond to the institutional complexity of the healthcare sector. Drawing on multiple and complementary sources of data, extracted from a focus group study, a statistical national database and a survey inquiry, we investigate one structural response of French hospitals to the emergence of a new managerial logic bringing more complexity in their field. We observe that this response, namely the implementation of management control systems, addresses this complexity by combining different institutional logics in a segmented system of actors, and that this arrangement of logics is not a strict homothetic translation of its correspondent field logic. We use the concept of hybridity to describe the distribution of institutional logics guiding organizational actors' behavior and conclude that cooperation within the system is related to the scope of action of most hybrid actors. We therefore contribute to the literature on institutional logics in healthcare by identifying organizational translation of field logics and hybrid actors' agency as key parameters in the structural design of hospitals' responses to institutional complexity.