Table 1
Study Selection Flowchart.
| STAGE | DETAILS | TOTAL ARTICLES |
|---|---|---|
| Identification | PubMed/Medline = 7; Scopus = 768; Google Scholar = 972 | 1747 |
| Screening | Duplicates and non-journal materials removed (n = 965) | 782 |
| Eligibility | Titles, abstracts, and keywords were screened, excluding 728 articles that did not mention both key concepts: integrated care or its synonyms and institutional logics. | 54 |
| Inclusion | Full-text articles assessed for eligibility, excluding (n = 46) non-peer-reviewed articles, topics that did not primarily focus on both concepts, covered a single institutional logic or were broadly similar in research design, conducted by the same authors. Final articles included for qualitative analysis (n = 8) | 8 |
Table 2
Institutional Logics and Their Interactions in Integrated Care.
| INSTITUTIONAL LOGIC | DESCRIPTION | KEY SYNERGIES AND CONFLICTS | REFERENCES |
|---|---|---|---|
| Managerial | Focuses on efficiency, cost-effectiveness, resource management and evidence-based practices | Conflicts: Contradicts patient-centric logic when efficiency compromises individualized care; clashes with professional logic over standardization vs. clinical autonomy Synergies: Aligns with market logic in promoting innovation and efficiency | Kokko & Laihonen [22]; Mæhle et al. [23]; Mansfield et al. [24]; Allen [25]; Dent & Tutt [26]; Novotná [27] |
| Professional | Emphasises medical expertise and clinical autonomy, integrating clinical research for healthcare quality improvement | Conflicts: Tensions with managerial logic over efficiency measures; challenges with state logic when regulations limit autonomy Synergies: Aligns with patient-centric logic in prioritizing patient needs | Kokko & Laihonen [22]; Oksavik et al. [6]; Mæhle et al. [23]; Mansfield et al. [24]; Goodrick & Reay [28]; Dent & Tutt [26]; Novotná [27] |
| Patient-centric | Prioritises individual patient needs and personalisation of care | Conflicts: Overshadowed by managerial efficiency demands and professional standard practices Synergies: Supports professional logic when personalized care is valued | Kokko & Laihonen [22]; Mæhle et al. [23] |
| State | Aligns with government policies, public health goals and regulatory compliance | Conflicts: Regulatory requirements may limit professional autonomy; policy objectives may conflict with market-driven approaches Synergies: Supports managerial logic through standardization mandates | Goodrick & Reay [28]; Oksavik et al. [6] |
| Market | Represents a business-oriented approach, focusing on competition, efficiency and consumer choice | Conflicts: May conflict with state regulations aimed at equity; challenges patient-centric care when profit motives predominate Synergies: Aligns with managerial logic in efficiency and innovation | Goodrick & Reay [28]; Oksavik et al. [6]; Novotná [27] |
Table 3
Management Strategies for Institutional Diversity in Integrated Care.
| MANAGEMENT STRATEGIES | DESCRIPTION | BENEFITS | CHALLENGES | APPLICATION EXAMPLES | REFERENCES |
|---|---|---|---|---|---|
| Hybrid organisational structures and collaborative governance | Incorporates and synthesises diverse logics to foster new hybrid organisational structures and enhance collaborative governance in social and healthcare | Fosters trust and shared understanding Reconciles different institutional perspectives | Complexity in integrating diverse logics Optimizing coordination and communication in complex hybrid structures | Healthcare alliance model engaging diverse institutional providers Multidisciplinary healthcare teams implementing shared governance | Kokko & Laihonen [22]; Mæhle et al. [23]; Allen [25] |
| Performance management and accountability | Enforces a balanced approach to performance management that acknowledges and integrates various institutional logics for improved accountability | Promotes fact-based decision-making Aligns with diverse stakeholder requirements | Balancing conflicting stakeholder interests Maintaining transparency and accountability | Use of performance metrics in healthcare institutions Data-driven clinical decision-making | Kokko & Laihonen [2]); Dent & Tutt [26]; Allen [25] |
| Patient-centric strategies and care coordination | Prioritises patient-centric logic in integrated care strategies to ensure that care delivery is coordinated and aligns with patients’ multifaceted needs | Aligns care with patient preferences Fosters empathy and inclusivity | Integrating patient perspectives with institutional goals Complexity in coordinating care | Personalised patient care plans in a hospital setting Patient advocacy in treatment decisions | Oksavik et al. [26]; Mæhle et al. [23]; Allen [25] |
| Innovative practices and frontline engagement | Champions innovation by aligning frontline practices with the complex interplay of managerial, professional and patient-centred logics | Encourages responsive and adaptable care Utilises unique frontline insights | Challenges in fostering a culture of innovation Managing changes at the frontline | Frontline staff-led initiatives in a clinical setting Staff-driven process optimisation initiatives | Mansfield et al. [24]; Goodrick & Reay [28]; Dent & Tutt [26] |
| Systemic and strategic transformation | Undertakes systemic transformation by strategically aligning managerial, professional and market logics with the dynamic landscape of patient care | Ensures long-term adaptability Responsive to evolving healthcare needs | Complexity of systemic transformation Aligning diverse frameworks with care demands | Overhaul of policy and financial frameworks in a healthcare organisation Regulatory framework revision | Novotná [27]; Mansfield et al. [24]; Mæhle et al. [23] |