In view of the growing need for rehabilitation worldwide due to demographic changes and health trends, healthcare organizations are facing increasing pressure to innovate. This study focuses on the institutional dynamics shaping service innovation in orthopedic rehabilitation settings in Germany. Using Scott’s framework of institutional pillars and carriers, we conduct a multiple case study analysis. Based on interviews with physicians and managers from six different clinics, conducted in two rounds and supplemented by secondary data analysis, we investigate the influence of regulative, normative, and cultural-cognitive institutions on healthcare service innovation. By distinguishing between the various institutional barriers and facilitators, our research provides valuable insights for healthcare practitioners and managers, equipping them with the necessary knowledge to effectively navigate and utilize the institutional environment.
WHO. Rehabilitation 2030: A call for action, Geneva: WHO, 2017.
2.
CiezaACauseyKKamenovK, et al.Global estimates of the need for rehabilitation based on the global burden of disease study 2019: a systematic analysis for the global burden of disease study 2019. Lancet2020; 396: 2006–2017.
3.
LuschRFNambisanS. Service innovation: a service-dominant logic perspective. MIS Q2015; 39: 155–175.
4.
GalloujFSavonaM. Towards a theory of innovation in services: a state of the art. In: GalloujFDjellalF (eds). The Handbook of Innovation and Services: A Multi-Disciplinary Perspective. Cheltenham: Elgar, 2010, pp. 27–48.
5.
VargoSLWielandHAkakaMA. Innovation through institutionalization: a service ecosystems perspective. Ind Market Manag2015; 44: 63–72.
6.
VargoSLLuschRF. Evolving to a new dominant logic for marketing. J Market2004; 68: 1–17.
AkakaMAVargoSLLuschRF. An exploration of networks in value cocreation. A service-ecosystems view. In: VargoSLLuschRF (eds). Special Issue - Toward a Better Understanding of the Role of Value in Markets and Marketing (Review of Marketing Research. Bingley: Emerald Group Publishing Limited, 2012, vol 9, pp. 13–50.
11.
LaurellH. An international new venture’s commercialization of a medical technology innovation: the role of institutional healthcare settings. Int Market Rev2018; 35: 136–163.
12.
DamEWaardenburgM. Logic fluidity: how frontline professionals use institutional logics in their day-to-day work. J Prof Organ2020; 7: 188–204.
13.
DenisJ-Lvan GestelN. Medical doctors in healthcare leadership: theoretical and practical challenges. BMC Health Serv Res2016; 16: 158.
14.
ScottWR. Institutions and organizations: ideas, interests and identities. 4th ed.Thousand Oaks: Sage, 2014.
15.
KulkovITsvetkovaAIvanova-GongneM. Identifying institutional barriers when implementing new technologies in the healthcare industry. EJIM2023; 26: 909–932.
16.
CarreraAZoccaratoFMazzeoM, et al.What drives patients' acceptance of digital therapeutics? establishing a new framework to measure the interplay between rational and institutional factors. BMC Health Serv Res2023; 23: 145.
17.
YinRK. Case study research and applications: design and methods. 6th ed.Los Angeles: Sage, 2018.
18.
EisenhardtKM. Building theories from case study research. Acad Manag Rev1989; 14: 532–550.
19.
McColl-KennedyJRVargoSLDaggerTS, et al.Health care customer value cocreation practice styles. J Serv Res2012; 15: 370–389.
20.
ScottWR. Reflections: the past and future of research on institutions and institutional change. J Change Manag2010; 10: 5–21.
21.
BeckertJ. Agency, entrepreneurs, and institutional change: the role of strategic choice and institutionalized practices in organizations. Organ Stud1999; 20: 777–799.
22.
LawrenceTBSuddabyR. Institutions and institutional work. In: CleggSRHardyCLawrenceTB, (eds). The Sage Handbook of Organization Studies. 2 ed.London: Sage, 2006, pp. 215–254.
23.
KukkPMoorsEHMHekkertMP. Institutional power play in innovation systems: the case of herceptin®. Res Pol2016; 45: 1558–1569.
24.
WallinAJFuglsangL. Service innovations breaking institutionalized rules of health care. J Serv Manag2017; 28: 972–997.
25.
Go JefferiesJBishopSHibbertS. Customer boundary work to navigate institutional arrangements around service interactions: exploring the case of telehealth. J Bus Res2019; 105.
26.
van DijkSBerendsHJelinekM, et al.Micro-institutional affordances and strategies of radical innovation. Organ Stud2011; 32: 1485–1513.
27.
SpurgeonPLongPClarkJ, et al.Do we need medical leadership or medical engagement?Leader Health Serv2015; 28: 173–184.
28.
KesselMHannemann-WeberHKratzerJ. Innovative work behavior in healthcare: the benefit of operational guidelines in the treatment of rare diseases. Health Pol2012; 105: 146–153.
29.
HanEHudson ScholleSMortonS, et al.Survey shows that fewer than a third of patient-centered medical home practices engage patients in quality improvement. Health Aff2013; 32: 368–375.
30.
OclooJMatthewsR. From tokenism to empowerment: progressing patient and public involvement in healthcare improvement. BMJ Qual Saf2016; 25: 626–632.
31.
LettlC. User involvement competence for radical innovation. J Eng Technol Manag2007; 24: 53–75.
32.
SmithSWSfekasA. How much do physician-entrepreneurs contribute to new medical devices?Med Care2013; 51: 461–467.
