"We're Here to Fix Your Ass Not Kiss It:" Developing a Contested Market Orientation to Deliver Patient-Centric Care

As firms adopt customer centricity, health-care systems have been slow to embrace the concept given their complexity. Some health-care systems have developed ways to deliver more patient-centric care, but the process through which they have done so is unclear. In a multiyear ethnographic study of five large U. S. health-care systems, we identify the process through which these systems deliver more patient-centric care. We find that health-care systems operate with a hierarchy of multiple institutional logics that are inconsistent, conflicting, and even irreconcilable, which creates a contested culture and makes a conventional market orientation difficult to achieve. Instead, health-care systems manage inconsistent institutional logics using paradoxical cognition to develop a contested market orientation. With such an orientation, health-care systems produce patient-centric outcomes, including enhanced patient experience, reduced medical errors, improved patient outcomes, and increased patient and employee satisfaction. A contested market orientation, however, does not eliminate the fundamental conflict among institutional logics or foster common values, beliefs, or behaviors as in a conventional market orientation. We identify the process health-care systems use to create a contested market orientation, compare our findings with existing literature on market orientation, and present managerial implications of our results.