Health care organizations are experiencing a rising demand for change in the organization of preventive health services. Many initiatives designed to cater for change fail to achieve their aim. To understand how organizational dynamics in health care organizations influence the adoption of new initiatives, I explored the implementation of motivational interviewing, a health behavior concept that was introduced into ten general practice clinics in Denmark. Within an institutional framework I explored how modern ideas of prevention related to this concept were translated into medical practices. Using a qualitative multiple-case study design, I examined the institutionalization process in different clinical settings. I found that clinics constructed various types of preventive routines and thereby imposed new meaning on the health behavior concept. In adopting the concept, clinics developed a new routine against the background of existing practice, (re)producing an alternative, self-contained routine that diverged from their usual medical practice.
Album, D., & Westin, S. ( 2008). Do diseases have a prestige hierarchy? A survey among physicians and medical students. Social Science & Medicine , 66, 182-188. doi:10.1016/j.socscimed.2007.07.003
2.
Bazeley, P. ( 2007). Qualitative data analysis with NVivo. London: Sage.
3.
Berger, P.L., & Luckmann, T. ( 2004). Den sociale konstruktion af virkeligheden [The social construction of reality]. Copenhagen: Akademisk Forlag.
4.
Bowker, G.C., & Star, S.L. ( 1999). Sorting things out. Classification and its consequences (2nd ed.) Cambridge, MA: MIT Press.
5.
Britt, E., Hudson, S.M., & Blampied, N.M. (2004). Motivational interviewing in health settings: A review. Patient Education and Counseling , 53, 147-155. doi:10.1177/1049732308329481
6.
Brunsson, N., & Jacobsson, B. ( 2000). A world of standards. New York: Oxford University Press.
7.
Charles-Jones, H., Latimer, J., & May, C. ( 2003). Transforming general practice: The redistribution of medical work in primary care. Sociology of Health and Illness , 25, 71-92. doi:10.1111/1467-9566.t01-1-00325
8.
Charmaz, K. ( 2006). Constructing grounded theory: A practical guide through qualitative analysis. London: Sage .
9.
Checkland, K., Harrison, S., McDonald, R., Grant, S., Campbell, S., & Guthrie, B. ( 2008). Biomedicine, holism and general medical practice: Responses to the 2004 general practitioner contract. Sociology of Health & Illness, 30, 788-803. doi:10.1111/j.1467-9566.2008.01081.x
10.
Cheek, J. ( 2008). Healthism: A new conservatism?Qualitative Health Research, 18,974-982. doi:10.1177/1049732308320444
11.
Coffey, A., & Atkinson, P. ( 1996). Making sense of qualitative data. Complementary research strategies. Thousand Oaks, CA: Sage.
12.
Crabtree, B.F., Miller, W.L., Tallia, A.F., Cohen, D.J., DiCicco-Bloom, B., & McIlvain, H.E. (2005). Delivery of clinical preventive services in family medicine offices. Annals of Family Medicine , 3, 430-435. doi:10.1370/afm.345
13.
Cummings, S.M., Cooper, R.L., & Cassie, K.M. ( 2009). Motivational interviewing to affect behavioral change in older adults. Research on Social Work Practice, 19, 195-204. doi:10.1177/1049731508320216
14.
Czarniawska, B., & Sevón, G. (1996). Translating organizational change. Berlin: Walter de Gruyter .
15.
Dahler-Larsen, P. ( 2008). Displaying qualitative data. Odense, Denmark: University Press of Southern Denmark. Douglas, M. ( 1986). How institutions think. Syracuse, NY: Syracuse University Press.
16.
Emerson, R.M. ( 2001). Contemporary field research. Perspectives and formulations (2nd ed.) Prospect Heights, IL: Waveland Press.
17.
Flocke, S.A., Crabtree, B.F., & Stange, K.C. ( 2007). Clinician reflections on promotion of healthy behaviors in primary care practice. Health Policy, 84, 277-283. doi:10.1016/j. healthpol.2007.04.003
18.
Gao, G., Burke, N., Somkin, C.P., & Pasick, R. ( 2009). Considering culture in physician-patient communication during colorectal cancer screening. Qualitative Health Research , 19, 778-789. doi:10.1177/1049732309335269
19.
Grimshaw, J.M., Shirran, L., Thomas, R., Mowatt, G., Fraser, C., Bero, L., . . . O’Brien, M.A. (2001). Changing provider behavior: An overview of systematic reviews of interventions. Medical Care, 39(8,Suppl.2), 2-45.
20.
Grol, R., & Grimshaw, J. ( 2003). From best evidence to best practice: Effective implementation of change in patients’ care. Lancet, 362, 1225-1230.
21.
Holstein, J.A., & Gubrium, J.F. ( 2005). Interpretive practice and social action. In N. K. Denzin & Y. S. Lincoln (Eds.), The Sage handbook of qualitative research (3rd ed., pp. 483-505). Thousand Oaks, CA: Sage.
22.
Holstein, J.A., & Gubrium, J.F. ( 2008). Constructionist impulses in ethnographic fieldwork. In J. A. Holstein & J. F. Gubrium (Eds.), Handbook of constructionist research (pp. 373-395). New York: Guilford Press.
23.
Hroscikoski, M.C., Solberg, L.I., Sperl-Hillen, J.M., Harper, P.G., McGrail, M.P., & Crabtree, B.F. (2006). Challenges of change: A qualitative study of chronic care model implementation. Annals of Family Medicine, 4, 317-326. doi:10.1370/afm.570
24.
Hughes, J., Humphrey, C., Rogers, S., & Greenhalgh, T. (2002). Evidence into action: Changing practice in primary care. Occasional Paper Royal College of General Practice, 84, 1-51.
25.
Jensen, U.J. ( 2008). Sundhedsbegreber, selvansvarlighed og stat [The concept of health, self-responsibility and the state]. Kvan, 28, 7-26.
26.
Jepperson, R.L. ( 1991). Institutions, institutional effects, and institutionalism . In W. W. Powell & P. J. DiMaggio (Eds.), The new institutionalism in organizational analysis (Repr. ed., pp. 143-163). Chicago: University of Chicago Press.
27.
Kleinman, A. ( 1995). Writing at the margin: Discourse between anthropology and medicine. Berkeley, CA: University of California Press.
28.
Kvale, S. ( 2004). InterView. Copenhagen, Denmark: Hans Reitzel.
29.
Larsen, J.H., Risor, O., & Putnam, S. ( 1997). P-R-A-C-T-I-C-A-L: A step-by-step model for conducting the consultation in general practice. Family Practice, 14, 295-301. doi:10.1093/fampra/14.4.295
30.
Mabeck, C.E. ( 2005). Introduktion til den motiverende samtale [Motivational interviewing. An introduction]. Copenhagen, Denmark: Munksgaard Denmark.
31.
Macfarlane, F., Greenhalgh, T., Schofield, T., & Desombre, T. ( 2004). RCGP quality team development programme: An illuminative evaluation. Quality and Safety in Health Care, 13, 356-362.
32.
Malterud, K., & Tonstad, S. ( 2009). Preventing obesity: Challenges and pitfalls for health promotion. Patient Education and Counseling, 76, 2, 254-259. doi:10.1016/j.pec.2008.12.012
33.
March, J.G., & Olsen, J.P. ( 1989). Rediscovering institutions. The organizational basis of politics. New York: Free Press .
34.
Maxwell, J.A. ( 2005). Qualitative research design. An interactive approach (2nd ed.) Thousand Oaks, CA : Sage.
35.
May, C., Rapley, T., Moreira, T., Finch, T., & Heaven, B. ( 2006). Technogovernance: Evidence, subjectivity, and the clinical encounter in primary care medicine. Social Science & Medicine , 62, 1022-1030. doi:10.1016/j.socscimed.2005.07.003
36.
McDonald, R., Campbell, S., & Lester, H. ( 2009). Practice nurses and the effects of the new general practitioner contract in the English National Health Service: The extension of a professional project?Social Science & Medicine, 68, 1206-1212. doi:10.1016/j.socscimed.2009.01.039
37.
McKinlay, J., & Marceau, L. ( 2008). When there is no doctor: Reasons for the disappearance of primary care physicians in the US during the early 21st century. Social Science & Medicine, 67, 1481-1491. doi:10.1016/j.socscimed.2008.06.034
38.
Meyer, J.W., Boli, J., & Thomas, G.M. ( 1994). Ontology and rationalization in the Western cultural account. In W. R. Scott & J. W. Meyer (Eds.), Institutional environments and organizations (pp. 9-27). Thousand Oaks, CA: Sage.
Mohr, J.W. ( 1998). Measuring meaning structures. Annual Review of Sociology, 24, 345-370. doi:10.1146/annurev.soc.24.1.345
41.
vretveit, J. ( 1998). Evaluating health interventions. Maiden-head, UK: Open University Press
42.
Oxman, A.D., Thomson, M.A., Davis, D.A., & Haynes, R.B. ( 1995). No magic bullets: A systematic review of 102 trials of interventions to improve professional practice. Canadian Medical Association Journal, 153, 10, 1423-1431.
43.
Parker, L.E., Kirchner, J.E., Bonner, L.M., Fickel, J.J., Ritchie, M.J., Simons, C.E., & Yano, E.M. ( 2009). Creating a quality-improvement dialogue: Utilizing knowledge from frontline staff, managers, and experts to foster health care quality improvement. Qualitative Health Research, 19, 229-242. doi:10.1177/1049732308329481
44.
Pedersen, K.M., Christiansen, T., & Bech, M. ( 2005). The Danish health care system: Evolution-not revolution- in a decentralized system. Health Economics, 14, 41-57. doi:10.1002/hec.1028
45.
Pelletier-Fleury, N., Le Vaillant, M., Szidon, P., Marie, P., Raineri, F., & Sicotte, C. ( 2007). Preventive service delivery: A new insight into French general practice. Health Policy, 83, 268-276. doi:10.1016/j.healthpol.2007.01.004
46.
Powell, W.W., & DiMaggio, P.J. (1991). The new institutionalism in organizational analysis (Repr. ed.)Chicago: University of Chicago Press.
47.
Praktiserende Lægers Organisation. ( 2006). Anvendelse af landsoverenskomstens ydelser [Collective agreements]. Retrieved from http://www.laeger.dk/portal/page/portal/LAEGERDK/Laegerdk/P_L_O/Overenskomster/Landsoverenskomst/VEJLEDNINGER1
48.
Prior, L. ( 2002). Using documents in social research. London: Sage.
49.
Prochaska, J.O., DiClemente, C.C., & Norcross, J.C. (1992). In search of how people change. Applications to addictive behaviors. American Psychologist , 47, 1102-1114.
50.
Ragin, C.C. ( 1989). The comparative method. Moving beyond qualitative and quantitative strategies. Berkeley, CA: University of California Press.
51.
Regeringen. (2002). Sund hele livet. De nationale mål og strategier for folkesundheden 2002-10. [Staying healthy throughout life. Danish government program on public health and health promotion 2002-10]. Copenhagen, Denmark: Indenrigs-og Sundhedsministeriet.
52.
Rollnick, S., & Miller, W.R. ( 1995). What is motivational interviewing?Behavioural and Cognitive Psychotherapy, 23, 325-334. doi:10.1017/S135246580001643X
53.
Sahlin-Andersson, K. ( 1996). Imitating by editing success: The construction of organization fields. In B. Czarniawska & G. Sevón (Eds.), Translating organizational change (pp. 69-92). Berlin: Walter de Gruyter.
Shaw Hughner, R., & Schultz Kleine, S. (2008). Variations in lay health theories: Implications for consumer health care decision making. Qualitative Health Research, 18, 1687-1703. doi:10.1177/1049732308327354
56.
Smircich, L. ( 1983). Organizations as shared meaning. In L. R. Pondy (Ed.), Organizational symbolism (pp. 55-68). Greenwich, CT: Jai Press.
57.
Stake, R.E. ( 2000). Case studies. In N. K. Denzin & Y. S. Lincoln (Eds.), The Sage handbook of qualitative research (2nd ed., pp. 435-454). Thousand Oaks, CA: Sage.
58.
Stake, R.E. ( 2005). Qualitative case studies. In N. K. Denzin & Y. S. Lincoln (Eds.), The Sage handbook of qualitative research (3rd ed., pp. 443-466). Thousand Oaks, CA: Sage.
59.
Strauss, A., & Corbin, J. ( 1998). Basics of qualitative research. Techniques and procedures for developing grounded theory (2nd ed.) Thousand Oaks, CA: Sage.
60.
Swidler, A. ( 2001). What anchors cultural practices? In T. R. Schatzki, K. Knorr Cetina, & E. von Savigny (Eds.), The practice turn in contemporary theory (pp. 74-92). London: Routledge.
61.
Tolbert, P.S., & Zucker, L.G. ( 1999). The institutionalization of institutional theory. In S. R. Clegg & C. Hardy (Eds.), Studying organization. Theory & method (pp. 169-184). London: Sage.
62.
Vallgarda, S. ( 2001). Governing people’s lives: Strategies for improving the health of the nations in England, Denmark, Norway and Sweden. European Journal of Public Health, 11, 386-392. doi:10.1093/eurpub/11.4.386
63.
Zilber, T.B. ( 2008). The work of meanings in institutional processes and thinking . In R. Greenwood, C. Oliver, K. Sahlin-Andersson, & R. Suddaby (Eds.), The Sage handbook of organizational institutionalism (pp. 151-169). London: Sage.
