Abstract
European health systems face sustainability challenges driven by demographic change, rising complexity of user needs, and persistent workforce shortages. Municipal health and care services are at the frontline of these pressures, tasked with implementing policy ideals such as aging-in-place while managing resource constraints and fragmented structures. Despite reforms promoting integration and efficiency, implementation often falters. This study examines how competing institutional logics—professional, managerial, and policy—shape organisational responses to sustainability imperatives in Norwegian municipalities. Understanding these dynamics is critical for future-proofing health systems and designing governance and management strategies that reconcile efficiency with person-centred care.
We conducted a qualitative study in two Norwegian municipalities differing in size and organisational structure. Using purposive sampling, we recruited managers and frontline staff from short-term care units, home care, rehabilitation teams, and service allocation offices. Fourteen semi-structured interviews (including four group interviews) were carried out, lasting 40–90 minutes. Interviews explored experiences with collaboration, resource constraints, and organisational priorities. Data were transcribed verbatim and analysed using an inductive–deductive approach informed by the institutional logics perspective.
Three overarching institutional logics emerged: professional (care, medical, rehabilitation), managerial (administrative/financial, operational, coordination), and policy/societal (aging-in-place). These logics coexist but frequently collide, producing tensions in resource allocation, discharge decisions, and service design.
Our findings highlight that sustainability challenges cannot be addressed solely through structural reforms or efficiency measures. Institutional complexity shapes how reforms are enacted, creating hybrid practices rather than full convergence. For managers and policymakers, this underscores the need for governance models that accommodate multiple logics and foster dialogue across professional and organisational boundaries. Practical strategies include investing in coordination arenas, aligning policy ambitions with local capacity, and supporting workforce adaptability. By linking sustainability imperatives to the micro-dynamics of institutional logics, this study offers actionable insights for designing resilient, people-centred systems capable of navigating demographic and resource pressures.