‘What matters to you?’ Normative integration of an intervention to promote participation of older patients with multi-morbidity – a qualitative case study
Abstract Background Interventions in which individual older patients with multi-morbidity participate in formulating goals for their own care are being implemented in several countries. Successful service delivery requires normative integration by which values and goals for the intervention are shar...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-02-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-021-06106-y |
| _version_ | 1818971152257646592 |
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| author | Jannike Dyb Oksavik Turid Aarseth Marit Solbjør Ralf Kirchhoff |
| author_facet | Jannike Dyb Oksavik Turid Aarseth Marit Solbjør Ralf Kirchhoff |
| author_sort | Jannike Dyb Oksavik |
| collection | DOAJ |
| description | Abstract Background Interventions in which individual older patients with multi-morbidity participate in formulating goals for their own care are being implemented in several countries. Successful service delivery requires normative integration by which values and goals for the intervention are shared between actors at macro-, meso- and micro-levels of health services. However, health services are influenced by multiple and different institutional logics, which are belief systems guiding actors’ cognitions and practices. This paper examines how distinct institutional logics materialize in justifications for patient participation within an intervention for patients with multi-morbidity, focusing on how variations in the institutional logics that prevail at different levels of health services affect vertical normative integration. Methods This qualitative case study of normative integration spans three levels of Norwegian health services. The macro-level includes a white paper and a guideline which initiated the intervention. The meso-level includes strategy plans and intervention tools developed locally in four municipalities. Finally, the micro-level includes four focus group discussions among 24 health professionals and direct observations of ten care-planning meetings between health professionals and patients. The content analysis draws on seven institutional logics: professional, market, family, community, religious, state and corporate. Results The particular institutional logics that justified patient participation varied between healthcare levels. Within the macro-level documents, seven logics justified patients’ freedom of choice and individualization of service delivery. At meso-level, the operationalization of the intervention into tools for clinical practice was dominated by a state logic valuing equal services for all patients and a medical professional logic in which patient participation meant deciding how to maintain patients’ physical abilities. At micro-level, these two logics were mixed with a corporate logic prioritizing cost-efficient service delivery. Conclusion Normative integration is challenging to achieve. The number of institutional logics in play was reduced downwards through the three levels, and the goals behind the intervention shifted from individualization to standardization. The study broadens our understanding of the dynamic between institutional logics and of how multiple sets of norms co-exist and guide action. Knowledge of mechanisms by which normative justifications are put into practice is important to achieve normative integration of patient participation interventions. |
| first_indexed | 2024-12-20T14:47:50Z |
| format | Article |
| id | doaj.art-43ca256e320643698860767a42ef376c |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-20T14:47:50Z |
| publishDate | 2021-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-43ca256e320643698860767a42ef376c2022-12-21T19:37:03ZengBMCBMC Health Services Research1472-69632021-02-0121111510.1186/s12913-021-06106-y‘What matters to you?’ Normative integration of an intervention to promote participation of older patients with multi-morbidity – a qualitative case studyJannike Dyb Oksavik0Turid Aarseth1Marit Solbjør2Ralf Kirchhoff3Department of Health Sciences, Ålesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and TechnologyFaculty of Business Administration and Social Sciences, Molde University College, Specialized University in LogisticsDepartment of Public Health and Nursing, Trondheim, Faculty of Medicine and Health Sciences, Norwegian University of Science and TechnologyDepartment of Health Sciences, Ålesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and TechnologyAbstract Background Interventions in which individual older patients with multi-morbidity participate in formulating goals for their own care are being implemented in several countries. Successful service delivery requires normative integration by which values and goals for the intervention are shared between actors at macro-, meso- and micro-levels of health services. However, health services are influenced by multiple and different institutional logics, which are belief systems guiding actors’ cognitions and practices. This paper examines how distinct institutional logics materialize in justifications for patient participation within an intervention for patients with multi-morbidity, focusing on how variations in the institutional logics that prevail at different levels of health services affect vertical normative integration. Methods This qualitative case study of normative integration spans three levels of Norwegian health services. The macro-level includes a white paper and a guideline which initiated the intervention. The meso-level includes strategy plans and intervention tools developed locally in four municipalities. Finally, the micro-level includes four focus group discussions among 24 health professionals and direct observations of ten care-planning meetings between health professionals and patients. The content analysis draws on seven institutional logics: professional, market, family, community, religious, state and corporate. Results The particular institutional logics that justified patient participation varied between healthcare levels. Within the macro-level documents, seven logics justified patients’ freedom of choice and individualization of service delivery. At meso-level, the operationalization of the intervention into tools for clinical practice was dominated by a state logic valuing equal services for all patients and a medical professional logic in which patient participation meant deciding how to maintain patients’ physical abilities. At micro-level, these two logics were mixed with a corporate logic prioritizing cost-efficient service delivery. Conclusion Normative integration is challenging to achieve. The number of institutional logics in play was reduced downwards through the three levels, and the goals behind the intervention shifted from individualization to standardization. The study broadens our understanding of the dynamic between institutional logics and of how multiple sets of norms co-exist and guide action. Knowledge of mechanisms by which normative justifications are put into practice is important to achieve normative integration of patient participation interventions.https://doi.org/10.1186/s12913-021-06106-yHealth care reformPractice guidelinePatient participationPatient care planningInstitutional logicsNormative integration |
| spellingShingle | Jannike Dyb Oksavik Turid Aarseth Marit Solbjør Ralf Kirchhoff ‘What matters to you?’ Normative integration of an intervention to promote participation of older patients with multi-morbidity – a qualitative case study BMC Health Services Research Health care reform Practice guideline Patient participation Patient care planning Institutional logics Normative integration |
| title | ‘What matters to you?’ Normative integration of an intervention to promote participation of older patients with multi-morbidity – a qualitative case study |
| title_full | ‘What matters to you?’ Normative integration of an intervention to promote participation of older patients with multi-morbidity – a qualitative case study |
| title_fullStr | ‘What matters to you?’ Normative integration of an intervention to promote participation of older patients with multi-morbidity – a qualitative case study |
| title_full_unstemmed | ‘What matters to you?’ Normative integration of an intervention to promote participation of older patients with multi-morbidity – a qualitative case study |
| title_short | ‘What matters to you?’ Normative integration of an intervention to promote participation of older patients with multi-morbidity – a qualitative case study |
| title_sort | what matters to you normative integration of an intervention to promote participation of older patients with multi morbidity a qualitative case study |
| topic | Health care reform Practice guideline Patient participation Patient care planning Institutional logics Normative integration |
| url | https://doi.org/10.1186/s12913-021-06106-y |
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