Adopting the Municipal Enterprise Form in Finland: Core Dilemmas in the Transformation of Public Healthcare Organizations

Using a combination of institutional and dilemma theory, this article maps the core dilemmas underlying the transformation of three public healthcare organizations into municipal enterprises. The results concerning the expectations and outcomes of the processes of change show that identified dilemmas affect the isomorphic institutional process by either diminishing or enhancing isomorphic forces. Further analysis reveals the unconscious use of the dilemma reconciliation method among the senior managers and other decision-makers in the organizations. The discussion illustrates how dilemmas, together with isomorphic forces, are connected to decision-making. It highlights the need to investigate strategic dilemma management as a tool for resolving contradictory aims in the public healthcare sector.