The creation of a management fashion - contextualization in practice: A case study of value-based health care's introduction at the Karolinska University Hospital, in Stockholm, Sweden

Abstract: This study charts how "Value based health-care delivery", a management idea created by Michael Porter and Elizabeth Teisberg, and promoted by the Boston Consulting Group, has been translated in a Swedish context, up until August 2017. It traces the travel of the concept, from its origins, to its meteoric rise within the Swedish healthcare system, culminating in its operationalization at the Karolinska University Hospital, as the cornerstone of a wide ranging reorganization. In doing so, it provides a rich description of the various actors, agendas, and actions central to its contextualization; providing a perspective on a contemporary societal phenomenon, at the intersection of private, public, and academic sectors, which carries with it potentially far reaching implications for both its users and creators. The empirics are largely based on primary research, consisting of interviews with the concept's key proponents and consumers, on a top management level, as well as various third parties who were key to its contextualization, or otherwise had significant insight into the process. To examine the process of institutionalization, as opposed to its outcomes in posterior, this study drafts a theoretical framework. The framework is grounded in the sociology of translation, and (re)introduces the concepts of power and sensemaking - drawing inspiration from Czarniawska's metaphor of emerging institutions as anthills (2009), and Røvik's calls for an instrumental theory of knowledge transfer as translation (2016). In other words, providing a pluralistic and pragmatic take on institutional entrepreneurship. Thus, the study offers a peek into the inner workings of a large scale change effort, the instrumental capacity of a management idea, and the challenges met when trying to affect the sensemaking apparatus of a highly institutionalized organization. Providing a telling example of how a management idea, turned fashion, can function as a powerful instrument creating sustainable competitive advantage in the business of ideas, among the merchants of meaning. Yet, it was not only useful for its creators, but this is an idea which seemingly became such strong a fashion due to its ability to be utilized by several actors to pursue forceful change, each to their own agenda. In other words, an examination of contextualization in practice, and "what the process of institutionalization looks like" (Ahrne et al., 2007) in its early stages.