From Agents to Principles: The Changing Relationship between Hospitalist Identity and Logics of Health care

Institutional logics and collective identities are closely intertwined: logics shape the emergence and evolution of identities, which in turn play a crucial role in mediating the influence of the logics themselves. Though there exists a significant body of research on the intersection of the two phenomena, relatively little attention has been given to changes in the strength, content, and permanence of particular logic–identity associations. In this paper we explore empirically the question of whether and how a logic and identity may become severed, through an inductive case study of the development of the hospitalist identity in health care in the United States. Based on this study, we propose a set of mechanisms through which the distancing of a logic and an identity may occur. We also discuss potential counterfactual outcomes, in order to build theory regarding the longitudinal relationship between logics and identities.