How the interplay between institutional logics and managers' actions shapes management in a hospital in Sweden during the COVID-19 pandemic

Purpose Management in health care organisations is generally shaped by the interplay between managers' actions and the institutional logics in which organisations are embedded. However, during the COVID-19 pandemic this interplay changed significantly and research on how such shifts evolve over time remains limited. The aim of this study is to contribute to an understanding of how the interplay between institutional logics and managers' actions shape management and creates both constraints and opportunities for generating organisational change or stability in a Swedish hospital before, during, and after the COVID-19 pandemic. Design/methodology/approach The study is based on 15 in-depth, semi-structured interviews with managers from several hierarchical levels who were responsible for handling the COVID-19 pandemic in a regional hospital in Sweden. The interviews were transcribed, and the study employed an abductive, thematic analytic approach. Theoretically, the study draws on strong structuration theory in conjunction with institutional theory. Findings The findings reveal a sequential shift in institutional logics. Before the COVID-19 pandemic, managerial logic dominated, was reproduced by managers' and created organisational stability while constraining managers' actions. During the crisis, managers' replaced managerial logic with professional logic, enabling greater autonomy and organisational change. After the crisis, managerial logic was reinstalled, again limiting and managers' actions restoring the previous organisational order. The study also identifies the conditions that enable such shifts and demonstrates that changes in institutional logics are also linked to power relations tied to managers' hierarchical positions. Originality/value This study contributes to a deeper understanding of how shifts in management occur during a crisis, creating organisational change or stability within a hospital. This study also advances understanding of how management and organisations evolve, change or remain stable over time, and underscores the need for greater awareness of strategies that enhance the organisational capacity to prepare for and respond to uncertain, demanding, and complex situations. This study also contributes theoretically by demonstrating how the application of strong structuration theory, in conjunction with institutional theory, can be employed within management research in the health care sector.