Kajsa Lindberg

Market, entrepreneurship and practice: Pharmacy in transition


This is a study of the ongoing reregulation of the Swedish pharmacy market. The backdrop to the study is that Sweden’s pharmacy market is being transformed and, with effect from 1 July 2009, other actors than the state-owned Apoteket AB will be able to retail pharmaceuticals directly to the consumer. From having been a national matter, Sweden’s pharmacy market is now being opened up to new actors while the briefs of already-established actors are being changed, with the possibility of new services also being developed. All in all, this means that the reconstruction of the pharmacy market, the emergence of institutional entrepreneurs, and how day-to-day work is conducted will all be interconnected, entailing that they cannot be studied separately. Our overarching question is: How can the connections between market, entrepreneurship, and practice be understood when reregulation occurs? In answering the question, we intend to contribute towards theories concerning markets, institutional entrepreneurship, and practice.
The purpose of the study is to create understanding of the complexity characterizing the evolution of markets, organisations, and professional groups and provide deeper understanding of how norms change and stabilize. Through established collaboration with researchers in other countries, we will also be making comparisons with the pharmacy systems of Italy, the UK, and the US. The systems of these different countries differ widely and are also undergoing change.

Final report

Kajsa Lindberg, Gothenburg University

2009-2015

Aim of the project
The overarching aim of the project has been to study the complexity characterizing the pharmacy market, as well as the development of organisations and professional groups, and how norms change and stabilize.
We have fulfilled this aim by describing and analysing the development of the pharmacy market, e.g. how relations between new and old actors are formed and which norms take precedence, on the basis of a constructivist perspective on markets. The empirical findings from parts of the study have contributed towards shifting our original analytical focus away from institutional entrepreneurship to institutional logics. By means of ethnographically-inspired methods, we have also studied how market practices are emerging, how different actors' interests are being expressed, and how work at pharmacies is being shaped and organised. The most significant findings are presented below.

The most important findings of the project are:
1. Practice and the position of the profession
There is a lengthy tradition in the pharmacies of combining practices based on, on the one hand, a professional medical logic and, on the other, a logic that builds on sales and markets. Re-regulation has contributed towards clarifying these differences and, in certain cases, bringing them to a head, e.g. with regard to the supervision of over-the-counter medicines in the retail trade.
There is historical variation in who is allowed to own/run/work at pharmacies which is also of interest from an international perspective. In our comparisons between the US, the UK, and Italy, we see that there is a clear trend whereby the ownership of pharmacies is moving towards ever larger chains led by a "general manager" rather than a pharmacist. The actors' competence thus has to encompass not just pharmaceutical expertise but also, for instance, marketing, finances, legal aspects, something that is also reflected in other requirements concerning parts of the university education in pharmaceutics.

2. Construction of the market
The pharmacy market is "framed" to a great degree by procedures and techniques that are checked by government actors, e.g. pricing and the use of e-prescriptions. Such procedures contribute towards creating and clarifying boundaries between different actors, e.g. patient, pharmacist, prescriber, supplier. This boundary-creation is a prerequisite for these boundaries to also be able to be exceeded, and a functional market practice created.
The market is also "framed" by different types of regulations and provisions (e.g. concerning price, stock-keeping, confidentiality, safety) which partly limit minor actors on the market, but which also affect the management of over-the-counter medicines in the retail trade. The different ways in which the market is "framed" contribute towards both including and excluding actors.

3. Actors and relationships
The study shows that, in times of change, previously established boundaries between actors and professions can be challenged.
Pharmacists (and other professional groups working at pharmacies) can be described in terms of being "in-between" in several respects:
*they act "in-between" private financiers and owners, on the one hand, and laws, regulations and control systems, on the other.
*they also act "in-between" private interests where the confidentiality of individuals is crucial simultaneous to the existence of a public interest in documentation and statistics concerning the use of pharmaceuticals.
*some pharmacists also act "in-between" pharmaceutical and medical competence, as well as more market and management-wise competencies.

New research questions
We have studied the re-regulation of the pharmacy market over time, and using an ethnographically-inspired method of working. In doing so, our knowledge has gradually developed and new and interesting research questions arise. It is primarily two fields that we will develop further:

1. The changing prerequisite of the profession of pharmacist entails consequences for relationships with other professions
2. The significance of materiality for market construction; how values/logics are written into objects and how these contribute towards stabilising practice.

The project's international grounding
We collaborate with Professor Davide Nicolini (Warwick Business School), Professor Giuseppe Delmestri (Vienna University), Professor Trish Reay (University of Alberta), and Associate Professor Beth Goodrick (Florida Atlantic University). This collaboration has resulted in several presentations being made to Italian and British pharmacists, as well as presentations of a joint paper entitled Look What's back! Reversibility and the Knotting of Conflicting Institutional Logics at the Academy of Management (Texas, US, August 2011), which is now being reviewed for the British Journal of Management. In this article, we do a historical analysis of pharmacies with respect to ownership, establishment possibilities, range of products, and which merits are needed in order to work.

During the project, we have taken part in several international conferences and workshops:
2014 How to study complex practice in the making. Workshop on Shadowing, University of Warwick, UK, March 26-27.
2012 Logics in practice. The role of pharmaceuticals at the grocery store. The 28th EGOS Colloquium, Sub-theme: Performativity by Design!? Helsinki, July 5-7.
2010 Mimesis and practices of organizing. Workshop on Mimesis, University of Warwick, UK, March 15.


Research-informing endeavours outside the scientific community
We have conducted presentations in various contexts for people working at pharmacies and for people dealing with over-the-counter medicines in the retail trade. The research project has also received attention in trade journal Dagens Apotek.

2010 Pharmaceuticals - ordinary goods or special treatment? Nordic Retail and Wholesale Conference, 10-11 November.
2011 Workshop Den nya apoteksmarkanden sett ur ett organisationsperspektiv [The new pharmacy market seen from an organisational perspective]. Swedish Pharmaceutical Society. 5 May. We arranged and held a workshop.
2013 Logics in Pharmacy Practice. Keynote speakers at Nordic Social Pharmacy Conference, 12-13 June.

During the project, we supervised five essays which, in various ways, touched upon the organisation of the pharmacy. Emma Otterström and Ida Nilsson's essay Alla vill sälja piller. En studie av den svenska farmaceutprofessionens gränser på en avreglerad apoteksmarknad [Everyone wants to sell pills. A study of the boundaries of the Swedish pharmacist profession on a deregulated pharmacy market] won the best essay award from both Jusek and Sveriges HR-förening (Region West).

The project's two most important publications and the publication strategy
The two hitherto most important publications presenting parts of the findings we reported on above are:
Lindberg, K. (2014) Performing multiple logics in practice. Scandinavian Journal of Management, 30, 485-497.
Adolfsson, Petra & Ylva Ulfsdotter Eriksson (2014) Doctors with Borders: Professional Disputes in Times of Deregulation. Knowledge Management: An International Journal, 13 (4) s. 1-13. ISSN: 2327-7998, E-ISSN: 2327-9249


Our strategy has been to publish empirical examples in order to disseminate knowledge of what is happening on the Swedish pharmacy market and, on the basis of our empirical material, to take part in the development of theories concerning institutional logics, materiality, and profession.
Whenever possible, we use parallel publishing via the profiles on the University website.

Publications

Adolfsson, Petra & Ylva Ulfsdotter Eriksson (2014) Doctors with Borders: Professional Disputes in Times of Deregulation. Knowledge Management: An International Journal, 13 (4) s. 1-13. ISSN: 2327-7998, E-ISSN: 2327-9249
Adolfsson, Petra (2014) Pharmicies and Different Logics: Job Advertisements in Sweden, 1903-2013 Organizational Cultures: An International Journal, 13 ( 2 ) s. 37-48, http://ijmoc.cgpublisher.com/product/pub.258/prod.46/m.2. ISSN: 2327-8013
Lindberg, K. (2014) Performing multiple logics in practice. Scandinavian Journal of Management, 30, 485-497.
Lindberg, K., Styhre, A. and L. Walter (2012) Assembling Healthcare Organizations: Practice, Materiality and Institutions. Houndmills: Palgrave Macmillan.
Adolfsson, Petra (2012) Just a box of pills? When pharmaceuticals came to the supermarket. Sociologica, Issue3 http://www.sociologica.mulino.it/journal/article/index/Article/Journal:ARTICLE:630/Item/Journal:ARTICLE:630. ISSN: 1971-8853
Lindberg, K., Czarniawska, B. and R. Solli (in press) After NPM?. Scandinavian Journal of Public Administration, 19(2).

 

Grant administrator
Göteborg University
Reference number
P09-0409:1-E
Amount
SEK 3,975,000.00
Funding
Projects
Subject
Business Administration
Year
2009