Change and Power Play: What's the Diagnosis? A Case Study on the Effects of Economisation in the German Healthcare Sector

Abstract

The purpose of this study lies in understanding the impacts of economization in the German healthcare sector on individuals as well as on the organisation as a whole. Special interest is on the change of roles and interaction between management and physicians, which are the groups of actors analysed. The researched field is characterised by multiple institutional logics - the managerial logic and the medical logic, which provide the foundation for this study. These logics are explored and linked to concepts of power and identity within the complex setting of a university hospital. The chosen case organisations, a German university hospital, is facing difficult times with decreasing financial performance. Therefore, the organisation has to implement organisational changes. However, this causes difficulties which this thesis investigates. In order to investigate the changes introduced by the hospital’s management and the effect it has on the different actors, this thesis draws on a multi-method case study approach. Accordingly, data is gathered from conducting qualitative interviews which serve as the foundation for the analysis and enriched by data from secondary sources. By doing so, the thesis explores the case of a German university hospital in times of change more indepth. We adopt an abductive research approach, in order to rotate between the collected data and theories of power, identity and institutional logics. The findings of our study show that the actualisation of managerial intentions in the chosen case study is hampered because of power dynamics in the interaction between physicians and managers. Our approach enabled us to find out that the physicians in the case organisation are able to reduce uncertainty and set the agenda in the setting under investigation. Further, by nuancing existing literature on sources and mobilisation of power with the concepts of identity, we conclude that the physicians are enabled to stabilize the norms in their favour and thus, become dominant by making their institutional logic hegemonic in the interaction platform under investigation and the hospital as whole. This thesis concludes that the mobilisation of power can evolve and accrue over time so that systemic power evolves, manifested in more enduring institutional structures and thereby considered substantial. Conclusively, this thesis reveals how change in an organisation characterised by competing logics and embedded in institutional pluralism is influenced and how power dynamics can lead to hampering the successful implementation of managerial actions