Adjustmentalisation - digitalisation as transformation process and the interplay between a digital logic and diverse primary care logics in Sweden.

Abstract

Purpose: This study aims to contribute with knowledge on the characteristics of the process of co-existence of value conflicts between managers, markets/businesses, patients, professionals and digital technology in primary care practices, to be able to nuance the array of descriptions of the consequences of introducing a digitalised care practice, such as telemedicine, into an already existing primary care organisation. Due to its organisational structure and dynamic environment with a multitude of professions and patients as well as influenced by managerial and market drivers, the primary care setting provides fertile ground for studying value conflicts from an institutional logic perspective.

Design/methodology/approach: This multi-source study utilises qualitative thematic content analysis on empirical data collected through interviews, a survey and documents, followed by an iterative analysis in regard to institutional logics based on the themes developed from empirical data.

Findings: Coexistence and Adaptation: Different logics coexist and transform through adjustmentalisation rather than competing or dominating each other. Digital Technology's Influence: Digital technology influences and interacts with all established logics, potentially acting as a separate, evolving logic. Changing Healthcare Conditions: New conditions and digital solutions in healthcare may shift the balance of logics, potentially normalising managerial and market logics. Patient Empowerment and Data Ownership: Increasing emphasis on patient empowerment and transparent data processing under regulations like General Data Protection Regulation (GDPR) and Medical Devices Regulation (MDR).

Research limitations/implications: With its qualitative design there is not an emphasis on generalisability. The study is performed in a Swedish primary care setting.

Practical implications: Regarding its practical implications, this study examines digitalisation and the introduction of eHealth solutions in primary care in Sweden. The adjustmentalisation of diverse institutional logics described in this study was used to try to facilitate the implementation of eHealth and telemedicine in primary care. This practical contribution could be used in other primary care organisation that plans to introduce eHealth solutions as part of their practices. This study may also have practical implications for other healthcare organisations since the presence of diverse institutional logics is not unique to primary care.

Originality/value: Firstly, this study confirms earlier studies that argue that co-existence of diverse logics is possible in everyday practice. However, we show that adjustmentalisation of the diverse logics rather than the balance of strengths between them, facilitates the transformation, regulation and coordination of the new eHealth practice in relation to established practices. Secondly, this study shows that the adjustmentalisation derives from societal challenges such as an ageing population, accessibility problems and the COVID pandemic that are used to legitimise the adjustmentalisation of diverse logics. Digital technology influences and interacts with all established logics, potentially acting as a separate, evolving logic.

Key findings: Coexistence and adaptation: Different logics coexist and transform through adjustmentalisation rather than competing or dominating each other.Digital technology's influence: Digital technology influences and interacts with all established logics, potentially acting as a separate, evolving logic.Changing healthcare conditions: New conditions and digital solutions in healthcare may shift the balance of logics, potentially normalising managerial and market logics.Patient empowerment and data ownership: Increasing emphasis on patient empowerment and transparent data processing under regulations like GDPR and MDR.Future research directions: Need for further research on digital technology's impact on shift and balance between logics, business development, patient participation and its potential to become a dominant logic.