How do hospital goals resonate with leaders, clinicians, managers, and patient and family partners? A critical discourse analysis of institutional logics

Abstract

Introduction In pursuit of building person-centered health systems, patient and family engagement (PE) has emerged as a strategy to promote care quality, well-being, and patient experience in hospitals. Institutional logics suggests that institutions are guided by dominant belief systems referred to as logics that represent the fundamental narratives that shape an organization’s ethos, decision-making processes and behaviors. In healthcare, four logics have been identified: public management (i.e., community health and well-being), market (i.e., efficiency and cost containment), medical professional (i.e., care quality), and care professional (i.e., patient well-being). The objective of this research was to explore what hospital documents reveal about the hospital’s goals for PE and how staff and patient and family partners understand and describe such goals. Methods This study employed critical discourse analysis of organizational documents and interviews with 25 participants representing diverse roles (patient and family partners, clinicians, managers, and executives) in one hospital system. Results This study found a strong emphasis on the medical and care professional logics in organizational documents and 25 participant interviews: nine managers and directors, nine clinicians, five patient and family partners and two executive leaders. Managers and clinicians understood and described the hospital’s PE goals in the context of their institutional roles and responsibilities, such as improving patient satisfaction, using clinical tools, and designing new programs. There was also a shared emphasis on the care professional logic in all participant groups and in multiple organizational documents by articulating patients as the primary focus of hospital goals. There was some indication of the public management logic, primarily by executives and directors in their goals to engage communities and somewhat by clinicians and managers in their discussion on equity, diversity, and inclusivity initiatives at the hospital. Finally, there were two mentions of the market logic, one in a single organizational document and by two managers, which referred to the sustainability of health services. Conclusions This study explored what hospital documents convey about goals for PE and how participants understand and describe such goals. Future research on how hospital goals are practiced could provide the data to determine the role of market logic in operationalizing hospital goals.