Table 1 Summary of the themes and sub-themes

A. Institutionalization of practices

A1. A new set of rules

A2. An increasing number of actors

B. Isomorphism

B1. Power of key influencers

B2. The need of quality data

B3. Different acquisition processes

C. Organizational field

C1. Low fragmentation of system and challenging market cycles

C2. Changing perceptions

D. Decoupling of health system and actors’ goals

D1. A misalignment of goals

D2. A complex bureaucratic hierarchy