Institutional logics is commonly defined as “the socially constructed, historical pattern of material practices, assumptions, values, beliefs, and rules by which individuals produce and reproduce their material subsistence, organize time and space, and provide meaning to their social reality” (Thornton & Ocasio, 1999, p. 804). A similar definition is “the belief systems and associated practices that predominate in an organizational field” (Scott et al., 2000). Both definitions emphasize the belief systems (assumptions, values, rules), the practices (actions) associated with these, and the institutional framework surrounding them. Logics are interconnected to practices (i.e., human actions), as logics guide and give meaning to practices, and practices constitute and shape logics (Lounsbury et al., 2021; Ocasio et al., 2017).

Institutional logics have been studied on several different levels, either at a society level, linked to the societal institutions of family, community, religion, state, market, profession and corporation (Friedland & Alford, 1991; Thornton et al., 2012), in organizational fields like healthcare (Scott et al., 2000), within single organizations, or among (groups of) individuals (Johansen & Waldorff, 2017). This SLR will explore institutional logics at two levels, governance logics within the public sector, and field-levels logics within the healthcare field.

The public administration literature (i.e., De Waele et al., 2021; Pollitt & Bouckaert, 2017; Torfing et al., 2020) link reforms and changes to archetypes like Public Administration (PA), New Public Management (NPM) (Hood, 1991) and New Public Governance (NPG) (Osborne, 2006). Theoretical literature on institutional logics does not emphasize these archetypes, nor their influence on field-level logics or practices (i.e., Greenwood et al., 2017; Thornton et al., 2012).

Wiesel and Modell (2014) combine the public administration and institutional logics research streams by describing PA, NPM and NPG as governance logics, with distinct features regarding citizen interests, legislative preferences, structures and forms of organizing, primary tasks of agencies and aspects of control and performance. Waldorff et al. (2014, p. 71) describe how these governance logics have their “own embedded social norms for the creation of meaning, behaviors and decision-making”. Framing PA, NPM and NPG as distinctive governance logics, not only enriches the conceptual understanding of these archetypes, but also provides analytical tools for interpreting institutional complexity, particularly in contexts where these governance logics intersect, and underpins different practices (Waldorff et al., 2014).

Healthcare is a field with such institutional complexity, confronted by “incompatible prescriptions from multiple institutional logics” (Greenwood et al., 2011, p. 318). Scott et al. (2000) described two distinct field-level logics in healthcare, a medical-professional and a market-managerial, the latter linked to a neoliberal trend of marketization, but without applying the label NPM to this. The dichotomy between these two logics have been studied both in and between organizations within the field of healthcare (Alvehus & Andersson, 2018), but later research has revealed a multiplicity of logics, for instance a care logic, highlighting integrated, patient-centred care, a science logic, emphasizing evidence-based medicine, and a democratic logic, focusing on inclusion and equity in provision (Mountford & Cai, 2022).

Are institutional logics (regardless of level) real-world phenomena, or just analytical concepts defined by researchers? Following the argument of Ocasio et al. (2017), logics are real in the same way as bureaucracy or culture is real. The analytical representation of logics on the other hand, either as archetypical governance logics or as a multitude of field-level logics, are defined and constructed by researchers, and their validity is an empirical question (Ocasio et al., 2017, p. 511). It is these analytical representations of the logics that are applied as interpretive tools in the empirical literature.

The co-existence of conflicting and conflating logics on different levels has urged a large stream of literature, exploring how such co-existence is handled in different contexts, and possible consequences thereof (Ocasio et al., 2017; Thornton & Ocasio, 1999; Thornton et al., 2012). Co-existence can lead to replacement, whereby an emerging logic displaces a previously dominant logic, to blending, where competing logics are combined and modified to a new logic where the elements of the original logics no longer are observable, or to layering, where logics are combined like sediments in different parts or levels within a field or an organization (Polzer et al., 2016).

The term hybrid logic is often applied to a new logic formed by the blending of two conflicting logics in a given level or context (Thornton & Ocasio, 2008). But, the terms ‘hybrids’ or ‘hybridization’ is applied to several different phenomena “produced out of two or more elements normally found separately” (Miller et al., 2008, p. 943), from hybrid logics incorporating different rationalities (Pache & Santos, 2013), hybrid practices combining actions associated with different logics (Battilana et al., 2017), hybrid organizational forms embedded in different logics (De Waele et al., 2021), hybrid processes integrating elements from different logics into a specific context (Wiesel & Modell, 2014), to hybrid expertise where distinctive knowledge and skills are combined (Miller et al., 2008). In this SLR the type of hybrid phenomenon referred to in the included literature will be specified.

Resource allocation practices are studied across multiple academic disciplines, such as public administration and political studies where a core theme is distribution of scarce resources, in management accounting literature where resource allocation principles are an important issue in any management control system (Paulsson, 2016), and in accounting and budgeting literature where resource allocation is a fundamental function of public sector budgeting (Anessi-Pessina et al., 2016). In addition, other practices, like quality improvement or process design, can imply changes in the way resources are allocated. This interdisciplinary relevance provides an opportunity in this SLR to integrate and compare insights from diverse scholarly perspectives.

The governance logics of PA, NPM and NPG guides and give meaning to different resource allocation practices. Table 1 is the authors’ compilation from the studies by Wiesel and Modell (2014), Waldorff et al. (2014) and Wällstedt and Almqvist (2017), highlighting the different rationalities, principles, foci, and aspects, as well as providing examples of resource allocation practices related to these governance logics.

The PA logic builds on a processual rationality, where policy decisions are executed by hierarchic, centralized bureaucratic public agencies. Resource allocation is traditional, based on incremental adjustments in cash budgets from last year, focus is on input control and intra-organizational processes, and performance is measured in degree of compliance to budgets and plans (Osborne, 2006).

The NPM logic build on neo-liberal principles and was in the 1980s presented as an alternative to “bureaucracy” associated with low efficiency and waste. It builds on an instrumental rationality, where public agencies facilitate and involve in exchanges in competitive markets. Resource allocation is transactional, and the task of decentralized, competitive organised public agencies is market exchange. Performance is measured in efficiency, as output (units produced) in relation to input (resources spent), and other financial results based on accrual accounting. Marketization is applied, either with contracting out to private providers, or by internal quasi-markets with competition between public corporations (purchaser-provider-split) (Hood, 1991; Osborne, 2006).

NPG evolved as a counterreaction to NPM (Osborne, 2006), building on a communicative rationality, where collaborative public agencies engage in network coordination. Focus is on intra-organizational processes, and performance is measured in effectiveness, as outcome (results for citizens) in relation to input (resources spent). Resource allocation is dialogue-based, applying tools like participatory budgeting with involvement of stakeholders, resource pooling across organizational borders, and involvement of the civil society through co-production and co-creation (Osborne, 2006; Wiesel & Modell, 2014).

Table 1 is in the method section employed to identify relevant categories of resource allocation practices for inclusion of literature, while the table throughout the findings sections will be expanded both with the main field-level logics described in the literature and resource allocation practices applied in a healthcare context, before the discussion on how coexisting and conflicting field-level logics within healthcare are managed, under the different governance logics.

This SLR has focused on empirical literature applying the institutional logics perspective in studies of resource allocation practices in healthcare. The restriction in terms of theoretical perspective, context, and practices may result in the exclusion of literature relevant for either appliance of logics, or for healthcare resource allocation. On the other hand, the chosen focus allowed a deeper understanding of the application of this theoretical perspective in relation to a set of specific practices in an institutionally complex setting.

The review applies three archetypes of governance logics. Although this is based in literature, there are other analytical representations of this, identifying several more governance logics and assigning other names or descriptions to these (e.g., Grossi & Argento, 2022; Torfing et al., 2020). Although further refinement could provide a more nuanced analysis, priority was given to the simplicity of this trichotomy and its widespread use in literature.

Given the aim of the paper, the focus is placed on the main field-level logics identified in several of the included studies. This implies that field-level logics mentioned in one or a few studies are not highlighted or elaborated upon in the findings or discussion. To also include those in the analysis could contribute to an even deeper understanding of the institutional complexity of the field.

The studies included in this SLR were published between 2005 and 2025, with a noticeable increase in publication volume over the two decades (see table 3). Although no restrictions were placed on publication year during the search process, only ten studies published prior to 2005 were identified, none of which met the inclusion criteria outlined above. This trend aligns with previous literature reviews on the institutional logics perspective (e.g., Lounsbury et al., 2021), particularly regarding its application in healthcare settings (Mountford & Cai, 2022). While the institutional logics framework originates from the foundational work of Friedland and Alford (1991), its seminal application within healthcare is widely attributed to Scott et al. (2000) (see Lounsbury et al., 2021).

The 55 articles were published in 35 different journals. Following the journals’ own descriptions of their aim, they were classified into the fields of accounting, management, social sciences in general, healthcare, and interdisciplinary journals (see Table 3). Most occurrences were in “Financial Accountability and Management” (6 articles) but also journals that combine social sciences and healthcare have several occurrences, like “Journal of Health Organization and Management” (5), “Social Science and Medicine” (2), “Journal of Health and Social Behavior” (2) and “Sociology of Health & Illness” (2).

The empirical studies included in this review were conducted across 16 different countries, including two cross-national comparative studies. The institutional logics perspective was originally developed and first empirically applied within healthcare in the United States and Canada (e.g., Reay & Hinings, 2005). However, the geographical locus of recent research appears to have shifted toward Northern Europe. Of the 55 studies reviewed, 39 were conducted in Scandinavian countries (Denmark, Sweden, Finland, and Norway), the United Kingdom, and the Netherlands, indicating a growing concentration of scholarship in these regions.

All studies included in this review employed qualitative research methods. Three of these studies adopted a mixed-methods approach, integrating qualitative techniques with quantitative data. Approximately one-fourth of the studies relied on a single qualitative method, such as document analysis, interviews with healthcare professionals, managers, and/or patients, or observational techniques. Observations typically focus on interactions either among professionals and managers or between patients and professionals. The majority of studies, however, utilized a combination of these three qualitative methods, reflecting a triangulation approach to data collection.

Some of the most frequently cited contributions on institutional logics are longitudinal studies that trace the “rise and fall” of dominating logics over time (Ocasio et al., 2017). In this review, 14 studies follow change processes over a period of 3 to 6 years, offering insights into the dynamics of institutional transformation. The remaining studies are cross-sectional in design, examining one or more cases at a single point in time.

A large part of the literature applies a “pattern matching” approach (Reay & Jones, 2016), where logics from literature are compared to field-level data, especially shown in studies of the rivalry between the market-managerial and the medical-professional logics. The studies that apply a “pattern inducing” approach (Reay & Jones, 2016), seems to reveal several new emerging field-level logics.

This SLR aims to synthesize empirical research results from healthcare contexts that employ institutional logics as a theoretical framework and explore the relationships between resource allocation practices and field-level logics, as shaped and managed over time under the governance logics of PA, NPM, and NPG. The following part will elaborate on the field-level logics described in the included literature, and their links to the governance logics.

A large majority of the studies describe a medical-professional logic, highlighting professional discretion in clinical decision-making, autonomy in individualizing customised treatment for each patient, and authority over other actors (Bailey et al., 2020; Nigam & Ocasio, 2010). This field-level logic is in most of the studies associated with physicians and the medical profession, although some studies identify separate field-level logics for nurses (Van Den Broek et al., 2014) or physiotherapists (Eriksson et al., 2021), and some studies emphasize the need for an interdisciplinary holistic field-level logic beyond the borders of different professions (Arman et al., 2014; Cain, 2019; Eriksson et al., 2021; Liff & Andersson, 2011).

Most studies do not link this field-level logic to a governance logic, as it is associated with the 'initial state' prior to initiatives to change resource allocation practices. This ‘initial state’ fits undoubtfully the description of PA with “the hegemony of the professional in the service delivery system” (Osborne, 2006, p. 378) but is implied rather than thoroughly elaborated. But, a few studies do explicitly link the medical-professional logic to PA, with descriptions like: “The professional logic in healthcare can be characterized as the dominance of professionals over not just clinical but organizational decision-making, and deference among others (managers, patients and lower-status clinicians) to (medical) professional knowledge” (Martin et al., 2017, p. 108), or “purchasers played the role of passive financiers, giving physicians’ strong authority over clinical decisions that drove resource use ” (Nigam & Ocasio, 2010, p. 831). In line with this, Major et al. (2025, p. 4) state that “the public administration logic reinforces the perspective that clinical practice is a form of public service, providing legitimization for physicians’ professional dominance and autonomy”.

This shows how the roles of medical professionals and other actors (managers, purchasers, etc) were separated under a PA logic, and how their corresponding field-level logics was layered in different domains of the organizations or the organizational fields, with the medical-professional logic superior to other field-level logics.

The other field-level logic included in most studies is the market-managerial logic. The various terms used to denote this field-level logic illustrate its different aspect, like productivity (Börjesson et al., 2021), cost-efficiency (Bishop & Waring, 2016; Kokko & Laihonen, 2022; Oksavik et al., 2021), cost-savings (Arman et al., 2014), accountability (Armstrong et al., 2018), management control (Kantola & Järvinen, 2012; Wolf et al., 2024), finance (Bailey et al., 2020), economic-administrative (Mæhle et al., 2021; Mæhle et al., 2020), for-profit (Villani et al., 2017) and business-like (Gurses & Danisman, 2021; Reay & Hinings, 2005; Van Den Broek et al., 2014).

This field-level logic is described as embedded mainly among managers on different levels and positions, but also among staff with other administrative roles, like accounting and control, purchasing and contracting, as well as organizing.

The market-managerial logic is undoubtedly linked to the governance logic of NPM, with principles and tools adopted and adapted from private-sector management (Osborne, 2006). Nearly half of the studies do explicitly describe changes as rooted in NPM, for the rest the connection is implicit but still clear through descriptions of new logics and practices that have the characteristics of NPM (Hood, 1991).

The rivalry between the market-managerial and the medical-professional logics are a core theme in much of the included literature. This dichotomy is shown when the governance logic of NPM both underpins new resource allocation practices and gives prominence to the market-managerial logic in the studied field, and these deviate from the principles and prescriptions of the dominating medical-professional logic. This dichotomy is utilized to analyse and explain resistance to change, ceremonial adaptation of new practices (Van Den Broek et al., 2014), or development of disguised practices (Gurses & Danisman, 2021; Ryngelblum et al., 2019).

Several studies show how the NPM logic encompasses an integration of the market-managerial and the medical-professional logics through blending of these field-level logics. One key to this seems to be professionals going into managerial roles, becoming “hybrid managers.” This is described in terms of hybrid nurse managers sensemaking of contradictory logics (Kristiansen et al., 2015), doctors hybridizing expertise including and combining accounting competence and information in their practice (Pettersen & Solstad, 2014). Another key can be professional collegiums, shown to be important in hybridization of contradictory principles (like standardization versus individualization) (Martin et al., 2015). The rivalry between the field-level logics is sought solved by integration either on individual or organizational level (Andersson & Liff, 2018). On an organizational level it is shown how these conflicting field-level logics are integrated and blended through negotiations on organizational design, activities, culture, and recruitment (Bishop & Waring, 2016), or through common adaption of NPM principles from both different professional groups and managers (Liff & Andersson, 2011).

Whereas the two most commonly described field-level logics are associated with groups involved in the provision of healthcare, the patient logic is aligned with the perspective of service recipients, highlighting both the process and the result for the patient.

The patient logic can be linked to all three governance logics, depending on highlighted aspects. Some studies describe a patient logic embedded in professional values, where high quality for the patient is secured by professionals acting on behalf of the patient (Kokko & Laihonen, 2022; Mæhle et al., 2020; Oksavik et al., 2021; Tørseth, 2021). This aspect of the patient logic is clearly PA-inspired. Others highlight the NPM-inspired aspect of patient choice, where both quality and efficiency are secured by patients acting as consumers choosing treatment in a healthcare market (Bailey et al., 2020). And finally, some studies highlight involvement of patients as active partners in their own treatment (Börjesson et al., 2021; Eriksson & Andersson, 2024; Mæhle et al., 2021; Ten Dam & Waardenburg, 2020; Waldorff & Madsen, 2022), inspired by the NPG governance logic. A few studies explore several aspects of this, describing a market and a managerial logic emphasizing the ‘patient flow’, and a professional and a patient-centred logic emphasizing the ‘patients journey’ (Olsen et al., 2021), or a logic of care highlighting quality and patient needs, and a logic of business highlighting efficiency and patient as a consumer (Conceição et al., 2023).

While the three described field-logics are associated with groups of actors (doctors, managers, patients), the partnership logic is associated with the relationship between actors, either through partnerships and networks (Shaw et al., 2017; Wankah et al., 2022), through teams (Kelly et al., 2023) or consultation (Ten Dam & Waardenburg, 2020). The partnership logic demands a reinterpretation of professional roles and is described as a prerequisite in managing conflicts between other logics, either between other field-level logics (see above), or conflicting governance logics inherent in new practices (see below). The partnership logic has a potential to bridge these conflicting field level logics through relational work, dialogue, and consultation in networks.

The patient logic is partially rooted in NPG, while the partnership logic is clearly inspired by the NPG governance logic. By introducing new field-level logics, either drawing on all three governance logics to emphasize diverse patient perspectives, or aiming to bridge existing field-level logics through collaborative partnerships grounded in mutual respect and equality, the NPG governance logic appears to manage conflicting field-level logics by acknowledging their diversity, and mobilize them to transcend beyond the dichotomy of the medical-professional and the market-managerial logics.

It is worth mentioning that none of the included studies explicitly mention NPG, even though they describe field-level logics and practices that are clearly aligned with descriptions of this governance logic (Osborne, 2006). Some mention post-NPM approaches, like public value or a public service logic (Eriksson & Andersson, 2024). The absence of a commonly accepted denomination for this governance logic, especially when contrasted with the widespread and standardized use of NPM, reflects the theoretical literature characterizing the post-NPM era as lacking a dominant model (Pollitt & Bouckaert, 2017), or as marked by a plurality of models (Torfing et al., 2020).

This SLR aims to explore the relationships between resource allocation practices, field-level logics, and governance logics, and following part will elaborate on the included resource allocation practices in the healthcare context, and their embeddedness in different governance logics (se descriptions below). Based on this, the practices are placed on a continuum from NPM-inspired to NPG-inspired, and a summary of this is shown in table 4. The included studies describe changes either from PA towards NPM, from PA towards NPG, or from NPM towards NPG-inspired resource allocation practices. Table 4 shows a clear temporal progression from studies of emerging practices rooted in NPM towards studies of new practices rooted (at least partly) in NPG.

10 articles study corporatization and marketization, with studies published evenly in all periods. These change initiatives are clearly rooted in NPM-logics (see table 1), with reorganization of entire organizational fields to more independent corporations managed by market mechanisms (Nigam & Ocasio, 2010; Reay & Hinings, 2005), local implementations (or non-implementation) of such change initiatives (Gurses & Danisman, 2021; Martin et al., 2017; Ryngelblum et al., 2019), introducing new market-inspired accounting frameworks (Makrygiannakis et al., 2025), combining organizational forms in public-private partnerships (Danisman & Özseven, 2025; Martin et al., 2017; Villani et al., 2017), and effects of market-like arrangements with patient choice (Dunér & Gustafsson, 2020). The first of these studies perform the analysis on an organizational field level, while several of the latter analyse the organizational level, as practices and logics on different levels affect and are affected by each other.

11 articles explore performance management, and show different aspects and practices related to this core element of the NPM logic, and how performance management practices influence and are influenced by the field-level logics. Two Finnish studies show different purposes of management accounting, either rooted in a managerial logic, to support management control and support decision-making, or a political logic, to support a public owners’ control (Kantola & Järvinen, 2012; Rautiainen et al., 2022). Norwegian studies of hybrid first-line managers showed that a triangle of enterprise (instrumental) logic, professional logic and political (communicative) logic guided their management control practices (Pettersen & Solstad, 2014), and coping with contradictory demands from the managerial control system through sensemaking (Kristiansen et al., 2015) or enabling practices (Ahlgren et al., 2025). Studies of activity-based costing (ABC) in Portugal reveals that this new accounting practice enabled clinical decision-making, bridging the tensions of conflicting logics (Conceição et al., 2023), and the role of both cognition and emotions in this process (Major et al., 2025). In the British NHS, a population-based medicine logic, including both financing and performance measurement, challenges the medical-professional logic (McDonald et al., 2013). While an Italian study of performance measurement in hospitals reveals that both communication coherence and value coherence are important to understand compatibility between administrative and health professionals logics (Leotta & Ruggeri, 2022), an Irish study on performance monitoring in hospitals shows that a team-based managerial logic among multidisciplinary teams could bridge conflicting field-level logics (Kelly et al., 2023). A central feature of performance management is quantification, which can lead to a hierarchization of logics, where a managerial logic dominates professional logic, through the powerful legitimacy of measurement (Arman et al., 2014).

Quality improvement (QI) is the main scope of 8 included articles, all from the last decade. Earlier funding and regulatory authorities demanded high quantity and cost effectiveness from healthcare providers, assuming that health professionals ensured quality, but now change initiatives like QI programs have increased. These can change resource allocation practices through improvement of production processes, standards, and involvement of employees. In this dataset there are studies about implementation of Lean (Akmal et al., 2022; Eriksson, 2017), patient safety programs (Armstrong et al., 2018), national report on quality comparisons (Blomgren & Waks, 2015), hospital accreditation (Conceição et al., 2022), employee engagement in QI (Gadolin & Andersson, 2017), professional collegiums (Martin et al., 2015), and the program ‘Productive Ward: Releasing Time to Care' (Van Den Broek et al., 2014). These initiatives have multiple goals, for “using quality improvement (QI) tools to enhance patient outcomes through delivering timely, safe, efficient and effective service”(Akmal et al., 2022, p. 356) or “quality improvement (QI) work aiming to improve healthcare efficiency and productivity” (Gadolin & Andersson, 2017, p. 410), or providing various actors information “on the quality and resource efficiency of public services” (Blomgren & Waks, 2015, p. 87). They draw on both NPM-elements of efficiency and productivity in service production, as well as NPG-elements of quality and patient outcomes.

12 articles explore different forms of co-production and co-creation. This is shown through patient involvement and collaboration in different stages of their treatment process, explored in the context of end-of-life care (Bailey et al., 2020), housing and support for persons with mental illness (Börjesson et al., 2021), insurance for persons with disabilities (Salignac et al., 2024), hospital care (Ten Dam & Waardenburg, 2020), cancer care (Eriksson & Andersson, 2024), intermediate care (Kvael et al., 2019), and primary care for elderly (Oksavik et al., 2021). The studies illustrate how such practices both are inspired by the PA governance logic, with professionals translating, applying, and enacting patient involvement, and inspired by a NPG governance logic, highlighting patient empowerment and collaboration. It is also shown through multidisciplinary teams (intra- or inter-organizational) organized to face complex healthcare challenges, both in healthcare centers in Denmark and Canada (Waldorff, 2013; Waldorff et al., 2013), child and adolescent psychiatric outpatient care in Sweden (Andersson & Liff, 2018; Liff & Andersson, 2011), and in hospices in US (Cain, 2019). These are clearly embedded in the NPG logic, embodying ideas of collaboration, partnerships, and networks (see table 1).

Also 9 articles about integrated care pathways (ICP) are included, the majority from the last years. This healthcare-specific practice adapts ideas of production planning and value chains to meet challenges from a fragmented healthcare system, regarding professions, (sub)specializations, funding, governmental levels, organizations, technology, etc. ICP have a threefold goal of quality, consumer satisfaction, and economic efficiency, and can alter resource allocation through change of funding arrangements, collaboration between levels and sectors, and standardized plans and timeframes (Kinsman et al., 2010; Kodner & Spreeuwenberg, 2002; WHO, 2016). The enclosed articles study integrated pathways for different patient groups in need of integrated services from different providers, like mental health (Allen, 2014; Mansfield et al., 2021; Tørseth, 2021), cancer (Mæhle et al., 2021; Mæhle et al., 2020) and elderly with complex needs (Olsen et al., 2021; Shaw et al., 2017; Wankah et al., 2022), as well as from a purchasers viewpoint (Noort et al., 2021). ICP as a practice combines NPM elements of efficiency and standardization with NPG elements like quality and outcome for patients.

5 articles, all from the last 5 years, analyse a transition in financing from activity-based to value-based healthcare (VBHC). VBHC was introduced by Porter (2010), claiming that high value for patients, defined as health-related outcomes (measured both by improved health-related quality of life and by patient satisfaction) in relation to cost, is the overarching goal for healthcare delivery. This definition is the same as the NPG concept of effectiveness (outcome/cost) and follows the NPG focus on user satisfaction (see table 1). The studies shows different responses to this new programme, either micro-tactics like disregard, maintenance and displacement (Waldorff & Madsen, 2023), hybridization of management and accounting systems (Kokko & Laihonen, 2022), change in the relative dominance of logics of different healthcare professionals (Eriksson et al., 2021), shift from a “managerial control logic of care production” to a “professional care and cure logic” (Wolf et al., 2024), and clinical managers combining a qualitative professional understanding and an instinctive cost approach (Møberg & Malmmose, 2024).

Several of the practices described above, clearly inspired by NPG, are nonetheless categorized exclusively as NPM-inspired, either in studies of QI (Conceição et al., 2022; Gadolin & Andersson, 2017), ICP (Tørseth, 2021) or VBHC (Møberg & Malmmose, 2024; Wolf et al., 2024). These studies tend to attribute all changes involving measurement and quantification in healthcare to NPM, regardless of what is being measured or the purpose of the quantification. As illustrated in Table 1, both NPM and NPG can involve quantification, NPM typically focuses on production metrics (outputs), while NPG emphasizes outcomes such as health effects, quality, and patient satisfaction. Practices within QI, ICP, and VBHC inherently require attention to both outcomes and processes. When changes inspired by NPG are implemented within an NPM-dominated framework, and only the introduction of new metrics is highlighted, without acknowledging the role of interdisciplinary collaboration, inter-organizational networks, and patient involvement, such initiatives risk being interpreted as extensions of NPM rather than genuine NPG-driven changes.

The findings above show the plurality of field-level logics and resource-allocation practices within a healthcare context described in empirical literature over the last two decades, as shaped by the shifting governance logics of PA, NPM and NPG. It shows a temporal evolution from studies of practices rooted in NPM towards practices rooted in NPG, but also an entanglement with practices combining both PA, NPM and NPG elements. In the following we discuss how tensions and conflicts between the field-level logics and practices in the healthcare context are addressed and managed under different governance logics, highlighting the different strategies employed within PA, NPM and NPG.

Although no studies focus exclusively on PA, it is consistently described as the foundation from which NPM- and NPG-inspired changes emerge. Several studies elaborate on PA-inspired field-level logics and practices, revealing a distinct separation between the field-level logic embedded in the medical profession and among managers (the market element of the latter was introduced later by NPM). These two field-level logics are often compartmentalized or layered within organizations, with the medical-professional logic taking precedence over the managerial logic in both clinical and organizational decision-making (Major et al., 2025; Martin et al., 2017). Within this framework, autonomous clinical decisions made by individual physicians aggregate into resource allocation patterns at the organizational level, where managers primarily serve to secure resources, normally through traditional cash budgets, for activities prescribed by doctors (Nigam & Ocasio, 2010). Given constraints on inputs, such as personnel, infrastructure, equipment, or funding, such resource allocation practice is frequently criticized for contributing to issues like overspending and long waiting lists (e.g., Martin et al., 2015), thereby creating momentum for NPM-inspired reforms. Moreover, potential synergies from involving other professionals, organizations, and patients remain largely untapped.

The included literature discussing implementation of new resource allocation practices inspired by NPM, reveals a strategy of integration of the medical-professional and the market-managerial logics, through blending of these logics. The main tool for such integration is engagement of healthcare professionals into managerial positions (hybrid managers), adding managerial and accounting skills to their professional competence (hybrid skills), and facilitate for the application of cost-information and other metrics in their clinical decisions (hybrid processes) (Conceição et al., 2023; Pettersen & Solstad, 2014).

The literature shows several positive effects of such integration, with engagement in managerial teams (Danisman & Özseven, 2025; Kelly et al., 2023), facilitation of negotiations and other tools for balancing complex demands (Ahlgren et al., 2025; Bishop & Waring, 2016; Kristiansen et al., 2015), empowerment in an increasing range of decisions (Pettersen & Solstad, 2014), improved communication and alignment of values (Conceição et al., 2023; Leotta & Ruggeri, 2022) as well as attention to professional identity and emotions (Major et al., 2025). But, the literature also provides examples of failure in integration of these field-level logics, leading to high level of intra-organizational or inter-organizational conflict, new practices that are not (sufficiently) implemented and intended goals of efficiency and quality that are not achieved (Gurses & Danisman, 2021; Liff & Andersson, 2011; Ryngelblum et al., 2019; Van Den Broek et al., 2014). There are also examples that the separation of these field-level logics associated with PA persists, where they co-exist in different domains of the organization (Kantola & Järvinen, 2012), in different aspects of work (McDonald et al., 2013), or are hierarchized through quantification (Arman et al., 2014). Also, possible synergies from broader involvement are not utilized.

Within the NPG framework the aim is diversification, introducing new field-level logics of partnership and patient involvement, aiming to bridge the gap between the medical-professional and the market-managerial logics. By “opening up” this relationship with other organizational and professional actors (Allen, 2014; Van Den Broek et al., 2014; Waldorff et al., 2013), as well as patients (Cain, 2019; Eriksson & Andersson, 2024; Martin et al., 2015; Oksavik et al., 2021), new roles and new dynamics can evolve. Diversification, with adaption of multiple field-level logics, involvement of different public, non-profit and private organizations (Villani et al., 2017), inclusion of several professions (Eriksson et al., 2021), and acknowledgement of knowledge from both patients, employees, and managers (Eriksson & Andersson, 2024; Waldorff et al., 2013), can contribute to flexibility and agility in solving the complex challenges facing healthcare. As stated in one of the studies:

The identification of a separate partnership logic aiming to bridge the conflicting field-level logics is a clear sign of such diversification (Shaw et al., 2017; Wankah et al., 2022). Also, the evolving hybrid practices, like QI, ICT and VBHC point to diversification, as they combine and draw on element from different governance logics. This is also shown on an individual level, where actors apply NPM-inspired arguments (like measurements and control) to address NPG-inspired expectations (like public value and relations) (Eriksson & Andersson, 2024).

The research shows some promising results regarding resource allocation following this NPG logic, from the perspectives of many of the engaged actors. But the long-term effects are yet to be proved. One danger is that this diversification adds complexity, regarding more field-level logics, more professions, more organizations, more measurements, and more funding arrangements, to an already institutionally complex context. On the other hand, complex problems require diversified and sophisticated strategies. The NPM approach, which seeks to address complex issues through simplistic market-based solutions, has demonstrated its limitations (Pollitt & Bouckaert, 2017).

Another issue is austerity, as resource constraints seem to increase conflicts between the field-level logics (McDonald et al., 2013). Resource allocation practices following NPG, with inclusion of a diversity of field-level logics and actors, therefore seems to be vulnerable for austerity. This is shown when cutback demands can lead to more simplistic practices highlighting (perceived) cost control (Cain, 2019), underbudgeting undermining participatory budgeting (Rautiainen et al., 2022), or more costly services from including other professions leads to a fallback to the dominance of the medical-professional logic (Eriksson et al., 2021)

The differences between the governance logics regarding the management of conflicting field-level logics are illustrated in figure 2.

By systematically reviewing literature across disciplines this study offers insight into the evolvement of new resource allocation practices and field-level logics within healthcare over the last two decades, and the interconnections between these and the governance logics of PA, NPM, and NPG. The SLR demonstrates how governance logics not only influence emerging resource allocation practices but also embody different rationalities for managing conflicting field-level logics. The findings regarding field-level logics and resource allocation practices within healthcare, and the discussion on how these have been shaped and managed over time under the governance logics of PA, NPM, and NPG, are summarized in table 5.

The healthcare field has been recognized for its institutional complexity, and the literature demonstrates that many NPM-inspired changes have failed for not recognizing this. Nevertheless, despite some promising results from the NPG-inspired changes embracing diversity by including new field-level logics and new resource-allocation practices embedded in several governance logics, the long-term effects of such changes are yet to be demonstrated. This calls for further research, especially in context with resource scarcity and austerity. Also, the introduction of NPG-inspired practices highlighting only quantification of outcome, without changing processes and relationships between actors, is an interesting research topic.