New Public Management and Hybridity in Healthcare: The Solution or the Problem?

New Public Management and Hybridity in Healthcare: The Solution or the Problem?

The research aim of this chapter is to understand how different institutional logics affect the day-to-day activities of healthcare providers and whether the cohabitation of professional logics with business-like logics increases medical providers’ effectiveness and gives chance to constrain healthcare costs. This research is based on longitudinal case study about the restructuring of the Canadian healthcare system in Alberta in 1992–2008, described in two papers (Reay & Hinings, 2005, 2009). We identify the situation after encroachment of a new, business-like logic into a healthcare system as more complex than described in the extant literature. We challenge the findings of the case study authors that there are two cohabitating logics in healthcare: the business-like logic supported by the government and the logic of medical professionalism. From our research it appears that there are two other logics: a managerial logic derived from business-like logic, and a hybrid professional logic that is a modification of the logic of medical professionalism. Across the healthcare field in general, business-like logic has been competing with the logic of medical professionalism, but on the medical providers’ level these logics become uncoupled. Within a medical provider, on the external, symbolic layer, physicians follow their professional logic and managers show conformity with governmental principles. But on the backstage layer, where the day-to-day work is actually performed, these two logics are subject to modification, creating a space for compromise and cooperation, leading to a growth of the number of unnecessary medical services preventing cost containments in healthcare.