"Pricing" injury and death : institutional logics of medical dispute resolution from a hospital's perspective

Abstract

In contemporary China, we can find competing institutional logics in the handling of medical disputes. There are, for example, professional logic based on technical fact and expert opinions, state-danwei logic that regards public hospitals as part of the state bureaucracy, and corporate logic which centers on cost-benefit calculations of economic interests. However, how the various logics are invoked and executed by hospitals in practice to handle medical disputes has yet to be investigated. This research asks: how does a hospital, especially its frontline administrators, carry out competing institutional logics in medical dispute resolution? To understand the micro-processes of multiple institutional logics in a concrete social context, this project conducts ethnographic case research in a public hospital. Through 7 months of fieldwork, I observed or participated in 58 medical disputes. Based on the ethnographic data, this research found that: 1) multiple identities, goals and scripts were established based on different institutional logics but conflicts between those logics were rarely encountered by hospital administrators in practice; 2) the separation between front and backstage gives frontline administrators an advantage in flexibly managing different logics to achieve the desired outcome in a case; and 3) frontline administrators can invoke different logics in their interactions with complainants to achieve their practical goals, but the use of each logic is restricted by situational factors and the characteristics of complainants. Overall, this dissertation argues that hospital frontline administrators enact different institutional logics through managing the front and backstage, and working to fit into varied situations and audiences. Theoretically, this research enriches the micro-foundations of the institutional logics perspective through bringing in dramaturgical concepts. More specifically, this combination fills the gap of the relative ignorance of social situation or immediate context in activating different logics, and makes the institutional logics perspective especially useful in depicting and explaining interactions in conditions of information asymmetry.