PurposeWhile previous health-care-related hybridity research has focused on macro- and micro-level investigations, this paper aims to study hybridization at the organizational level, with a specific focus on decision-making. The authors investigate how new politico-economic expectations toward a university hospital as a hybrid organization become internalized via organizational decision-making, resulting in the establishment of a new business collaboration and innovation-oriented unit.Design/methodology/approachThe authors employed a social systems theoretical framework to explore organizational decision-making processes involved in the establishment of the new hybrid hospital unit. Drawing on 15 interviews and nine organizational documents, the authors describe and analyze three decision-making cycles using the concepts of complexity, decision and justification.FindingsThe findings reveal the challenging nature of decision-making during hybridization, as decisions regarding unprecedented organizational structures and activities cannot be justified by traditional decision premises. The authors show that decision-makers use a combination of novel justification strategies, namely, justification by problems, by examples and by obligations, to legitimize decisions oriented at non-traditional activities. Further, the analysis reveals how expectations of several societal systems, i.e. health care, education, science, law, economy and politics, are considered in decision-making taking place in hybrid organizations.Originality/valueThe study draws attention to the complexity of decision-making in a hybrid context and highlights the role of justification strategies in partially reducing complexity by concealing the paradoxical nature of decision-making and ensuring the credibility of resulting decisions. Also, the study presents a move beyond the dualism inherent in many previous hybridity studies by illustrating the involvement of several societal systems in hybridization.

His latest research interests relate to relationship dynamics in public-private innovation policies and citizen co-creation in innovative public procurement. He has been especially keen in joining the views from industrial marketing and purchasing within public management discussion. Kaisu Jansson (M.Sc. in Econ. & Bus.Adm.