Institutional aspects brought up by the five actor groups based on the regulative, normative and culture-cognitive pillars
| Regulative | Normative | Culture-cognitive | |
|---|---|---|---|
| Managers | Increased financial responsibility generated information about post-discharge care | Strong incentives to minimise post-discharge care. How to involve other professions differed | The VBRP imposed a holistic perspective on healthcare, which managers embraced differently |
| Management may have additional external demands to take into account, affecting the response to the new commissioning contract | Highly influenced by spine surgeons' perception | Time to comprehend and understand the new contract is important in finding strategies when adapting the business | |
| Crucial with a good dialogue with the commissioning organisation | |||
| Spine surgeons | Increased financial responsibility generated information about post-discharge care | The significance of involving other healthcare professionals in spine surgery was debated and whether post-discharge care should be their responsibility | Broaden their perspective to see the entire care chain instead of only the surgical procedure |
| Physiotherapists | Information about the VBRP was buffered through management and spine surgeons | Opposed to their morals when physiotherapy was seen as a cost that should be minimised rather than a quality aspect | Difficult for physiotherapist to find their way of contributing when the focus was on how to facilitate spine surgery |
| Nurses | Less informed about the new regulative framework | It was unfortunate that quality aspects within nursing had to suffer in order to better facilitate surgeons | Nurses were responsible for providing adequate care from a nursing perspective but functioned also as a facilitator for spine surgery. The introduction of the VBRP refined the role of nurses to focus more on one of the two aspects |
| Some received new tasks to ease the workload of surgeons to increase efficiency | Taking responsibility for quality aspects within nursing requires air in the system to allow reflection and quality assessment | ||
| Administrators | The VBRP entailed more manual auditing when assessing invoices and medical records | Increased workload that also made administrators dependent on surgeons. However, the positive attitude from spine surgeons made the workload acceptable | Impossible to do their work without supporting infrastructure |
| Regulative | Normative | Culture-cognitive | |
|---|---|---|---|
| Managers | Increased financial responsibility generated information about post-discharge care | Strong incentives to minimise post-discharge care. How to involve other professions differed | The VBRP imposed a holistic perspective on healthcare, which managers embraced differently |
| Management may have additional external demands to take into account, affecting the response to the new commissioning contract | Highly influenced by spine surgeons' perception | Time to comprehend and understand the new contract is important in finding strategies when adapting the business | |
| Crucial with a good dialogue with the commissioning organisation | |||
| Spine surgeons | Increased financial responsibility generated information about post-discharge care | The significance of involving other healthcare professionals in spine surgery was debated and whether post-discharge care should be their responsibility | Broaden their perspective to see the entire care chain instead of only the surgical procedure |
| Physiotherapists | Information about the VBRP was buffered through management and spine surgeons | Opposed to their morals when physiotherapy was seen as a cost that should be minimised rather than a quality aspect | Difficult for physiotherapist to find their way of contributing when the focus was on how to facilitate spine surgery |
| Nurses | Less informed about the new regulative framework | It was unfortunate that quality aspects within nursing had to suffer in order to better facilitate surgeons | Nurses were responsible for providing adequate care from a nursing perspective but functioned also as a facilitator for spine surgery. The introduction of the VBRP refined the role of nurses to focus more on one of the two aspects |
| Some received new tasks to ease the workload of surgeons to increase efficiency | Taking responsibility for quality aspects within nursing requires air in the system to allow reflection and quality assessment | ||
| Administrators | The VBRP entailed more manual auditing when assessing invoices and medical records | Increased workload that also made administrators dependent on surgeons. However, the positive attitude from spine surgeons made the workload acceptable | Impossible to do their work without supporting infrastructure |
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