Concealing paradoxes in decision-making during hospital hybridization – a systems theoretical analysis

Abstract

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.

Boundary organising in healthcare: theoretical perspectives, empirical insights and future prospects

“…Rowland et al (2021) examine patient engagement programmes, focussing on metaphors of organisations as boundary bridges and contributing insights about perceptions of organisations as bounded systems. Luhmann's (2006Luhmann's ( , 2018 systems theoretical approach is used by Jansson et al (2021) to reveal strategies of justification involved in making and legitimating decisions about a hybrid hospital unit. The last two papers engage with place-based approaches, with Carlsson and Pijpers (2021) developing a relational perspective on neighbourhood governance, and Schuurmans et al (2021) exploring the formation and composition of "regions" as places of care.…”

“…The paper by Jansson et al (2021) takes us further on a journey of exploring boundary processes at the organisational level. It offers an analysis of hybridisation taking place between different social domains, such as healthcare, science, education and law, in a newly established organisational unit within a Finnish hospital.…”

“…On the other hand, it may be useful to consider local boundary phenomena as part of complex, multi-layered boundary landscapes in which different types of boundaries, such as spatial, administrative, professional, organisational and cultural, not only co-exist but overlap and conflict. The emergent, pluralistic and inconsistent nature of these complex boundary systems can be creatively exploited by local actors, who can choose from a range of boundary objects (Sharp et al, 2021), sense-making devices (Rowland et al, 2021), justification strategies (Jansson et al, 2021) and evaluative principles (Schuurmans et al, 2021) to realise their aspirations.…”

“…In terms of practical implications for healthcare managers involved in boundary reconfigurations, this special issue highlights the importance of ongoing reflection (Allen, 2021;Rowland et al, 2021), mitigation (Allen, 2021;Sharp et al, 2021), justification (Jansson et al, 2021;Schuurmans et al, 2021) and relational work (Carlsson and Pijpers, 2021;Schuurmans et al, 2021). Reflection should aim at "diagnosing" the boundary landscape, paying attention to discontinuities caused by the operation of particular boundaries and boundary objects as well as to misalignments between policies, governance structures and realities of work practice on the ground.…”

Contingency and paradoxes in management practices—development plan as a case

“…Such a perspective highlights the institutional complexity and the presence of multiple logics in the plan process ( Høiland and Klemsdal, 2020 ). The navigation and legitimization by managers correspond to a central issue recognized in organizational theory: how organizations handle the contingency of decisions and paradoxes in decision-making processes ( Knudsen, 2006 ; Jansson et al ., 2021 ).…”