Centrality and compatibility of identified institutional logics among actor groups within healthcare providers in elective spine surgery
| Group | Centrality | Compatibility |
|---|---|---|
| Managers | High | High and low |
| Managers were an essential link to receive reimbursement and facilitate provision of healthcare | Managers had strong impact on other actor groups but were highly influenced by spine surgeons. Neglecting quality aspects of peripheral logics could cause contestation and estrangement | |
| Spine surgeons | High | High and low |
| Spine surgeons had the knowledge of how to perform the surgeries that generated reimbursement. Also crucial to assess invoices after the introduction of the VBRP | The spine surgeon logic had strong influence on other logics within the organisation. Following VBRP, the dominance of the spine surgery logic was challenged by other logics. If spine surgeons were unwilling to allow higher centrality for other logics, the compatibility decreased and the balance between logics was estranged | |
| Physiotherapists | High and low | High and low |
| Peripheral in facilitating spine surgery. Central to improve back problems and minimising cost of post-discharge care | If physiotherapists experienced support from managers and/or spine surgeons, the logics attained high compatibility. If physiotherapists experienced that quality aspects were neglected, the compatibility was low | |
| Nurses | Low | High |
| Nurses cared for patients before and after surgery. Nurses facilitated surgeons by taking over tasks previously performed by surgeons | Having a supportive function in facilitating spine surgeons and contributing with a nursing perspective. Following VBRP, the role of nurses was refined with a more clear focus on one of these aspects | |
| Administrators | High | High |
| Crucial to receive reimbursement by sending correct information to the commissioning organisation and assessing invoices | Having a supportive function in facilitating provision of healthcare |
| Group | Centrality | Compatibility |
|---|---|---|
| Managers | ||
| Managers were an essential link to receive reimbursement and facilitate provision of healthcare | Managers had strong impact on other actor groups but were highly influenced by spine surgeons. Neglecting quality aspects of peripheral logics could cause contestation and estrangement | |
| Spine surgeons | ||
| Spine surgeons had the knowledge of how to perform the surgeries that generated reimbursement. Also crucial to assess invoices after the introduction of the VBRP | The spine surgeon logic had strong influence on other logics within the organisation. Following VBRP, the dominance of the spine surgery logic was challenged by other logics. If spine surgeons were unwilling to allow higher centrality for other logics, the compatibility decreased and the balance between logics was estranged | |
| Physiotherapists | ||
| Peripheral in facilitating spine surgery. Central to improve back problems and minimising cost of post-discharge care | If physiotherapists experienced support from managers and/or spine surgeons, the logics attained high compatibility. If physiotherapists experienced that quality aspects were neglected, the compatibility was low | |
| Nurses | ||
| Nurses cared for patients before and after surgery. Nurses facilitated surgeons by taking over tasks previously performed by surgeons | Having a supportive function in facilitating spine surgeons and contributing with a nursing perspective. Following VBRP, the role of nurses was refined with a more clear focus on one of these aspects | |
| Administrators | ||
| Crucial to receive reimbursement by sending correct information to the commissioning organisation and assessing invoices | Having a supportive function in facilitating provision of healthcare |
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