Research has demonstrated how the translation of a new management concept into organizational practices is impacted by the translators’ engagement with their local context. We expand this literature by demonstrating how a heterogeneous institutional context prompts translators to create practice change and also practice maintenance. Building upon an interpretive analytical framework we offer a way forward to examine relationships between societal institutions and distributed collective work in change processes. Our longitudinal qualitative study based upon interviews and observations examines how the concept of value-based healthcare was translated at a hospital. The translators developed three micro-tactics: disregard, maintenance and displacement, grounded in their narration of practice changes. Translators enacted institutional logics differently at the levels of meaning and practice when they framed, rationalized and contextualized the potentialities of a new concept, and this complexity provided the possibility of various practice outcomes. We contribute to the understanding of translation by demonstrating how a heterogeneous institutional context encourages translators to change selected practices but also to decouple and maintain most of the existing practices due to their enactment of institutionalized rationalities. Moreover, we discuss how translation outcomes are impacted by collaborating actors’ shared interpretations of their institutional context. Collaborating translators need to agree on whether and what practice change is valuable for the organization, and change is only possible when they interpret that they have the leverage to align a new idea with dominant institutional logics.

For more than 30 years policy action across sectors has been celebrated as a necessary and viable way to affect the social factors impacting on health. In particular intersectoral action on the social determinants of health is considered necessary to address social inequalities in health. However, despite growing support for intersectoral policymaking, implementation remains a challenge. Critics argue that public health has remained naïve about the policy process and a better understanding is needed. Based on ethnographic data, this paper conducts an in-depth analysis of a local process of intersectoral policymaking in order to gain a better understanding of the challenges posed by implementation. To help conceptualize the process, we apply the theoretical perspective of organizational neo-institutionalism, in particular the concepts of rationalized myth and decoupling. On the basis of an explorative study among ten Danish municipalities, we conducted an ethnographic study of the development of a municipal-wide implementation strategy for the intersectoral health policy of a medium-sized municipality. The main data sources consist of ethnographic field notes from participant observation and interview transcripts. By providing detailed contextual description, we show how an apparent failure to move from policy to action is played out by the ongoing production of abstract rhetoric and vague plans. We find that idealization of universal intersectoralism, inconsistent demands, and doubts about economic outcomes challenge the notion of implementation as moving from rhetoric to action. We argue that the ‘myth’ of intersectoralism may be instrumental in avoiding the specification of action to implement the policy, and that the policy instead serves as a way to display and support good intentions and hereby continue the process. On this basis we expand the discussion on implementation challenges regarding intersectoral policymaking for health.

This study explores the dynamics involved in establishing discourses necessary for constructing organizational change within the public sector. Drawing upon critical discourse analysis, the study identifies two competing discourses – a ‘patient’ and a ‘healthy citizen’ discourse, which exist as strategic resources in health care. The case study focuses on a municipality in Denmark and the way the organizational actors translated meaning into the development of a new healthcare centre. The analysis contributes to our understandings of translation by focusing on discursive legitimizing strategies in the context of public sector change. First, the study shows that discourses not only provide different senses of meaning and warrant particular social actors a louder voice than others, but that these actors also develop discursive legitimizing strategies and translate particular meanings into the organization and organizational practices. Second, when the strategies make a discourse resonate with the local context, in this case a highly political context, then specific organizational practices become more legitimate than others, and the discourse is more inclined to become manifest. Finally, the findings indicate that the manifestation of a discourse can also be explained by how successful this discourse can be carried out in practice.

Collaborative safety practices between construction site managers and workers are considered essential in occupational safety and health (OSH). However, establishing joint OSH engagement between managers and workers is still a challenge. Little is known about how managers and workers’ “complaining” about OSH affects collective OSH action and the quality of manager-worker relations. Drawing on an understanding of complaining as “boundary work”, this study empirically analyses how managers and workers’ verbalisations either downplay (collaboration) or build (demarcation) boundaries. Interviews and observations between managers and workers were carried out on a construction project in Denmark to identify why and how complaining is used. A typology consisting of four “complaining” mechanisms was developed, highlighting their associated relational dynamics: (1) Shifting responsibility for advancing OSH, (2) Defending oneself against strained working conditions, (3) Dealing strategically with criticism, and (4) Blaming other occupational groups. Complaining about OSH as boundary work – both collaboration and demarcation – between managers and workers furthers professional fragmentation and conflicts OSH collaboration, yet it occurs in a “safe space” for professional disagreement. We suggest that these communicational aspects and associated relational dynamics should be an area of increased focus in order to promote managers and workers’ OSH collaboration.