Co-optation as a response to competing institutional logics: Professionals and managers in healthcare

Researchers working under the institutional logics perspective find the struggle between managerial logic and various professional logics one of the most intriguing issues in healthcare organizations. Previous research provided several explanations at both the organizational level (mediation, hybridization, and selective coupling) and the individual actor level (hierarchization, sense making, re-interpretation, and hijacking) for the coexistence of professional and managerial logics in healthcare. However, all of these explanations are based on the underlying institutional logics not changing. In this article, we show that co-optation can explain the coexistence of institutional logics, but that it also causes the underlying institutional logics to change. Co-optation means that an actor adopts a strategic element from another logic that retains the most important elements of its own logic. Empirically, this article illustrates co-optation processes through a qualitative study of outpatient units in child and adolescent psychiatric care in Sweden. Using an institutional logics framework, we describe and explain how managers co-opted elements of professional logics and professionals co-opted elements of managerial logic in their attempts to support their own interests. Even if co-optation is performed to protect the home logic, the co-opted elements ultimately change it. This study contributes to the institutional logics framework by describing and explaining how co-optation can be a dynamic response to competing logics at the individual actor level.