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EMAC 2020 Annual Conference

Physicians and Institutional Work: Unpacking the Black Box of Institutionalization at the Front Lines of Healthcare

Published: May 27, 2020


Bettina Kriegl, University of Applied Sciences Ingolstadt; Herbert Woratschek, University of Bayreuth; Andrea Raab, University of Applied Sciences Ingolstadt


Innovation; Institutional Work; Healthcare


This study responds to recent calls for work to investigate innovation from an institutional view. Although institutional change has already received considerable attention in healthcare service research, not much has been done so far to investigate the phenomenon at the front lines. In order to fill this gap, we use a case study approach with the orthopedic rehabilitation system in Germany as a case to examine how physicians actively participate in the implementation of changes that differ from existing institutions. The analysis builds on interviews with physicians, observations in clinics, and secondary data. We contribute to existing research on institutional work by identifying, mapping out, and classifying the practices in which physicians engage to disrupt existing institutions, and to create and maintain new ones. In addition, we use Scott’s framework of institutional pillars to examine the sets of practices related to regulative, normative, and cultural-cognitive institutions.