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Social enterprises (SEs) face tensions when combining financial and social missions, and this is particularly evident in the scaling process. Although extant research mainly focuses on SEs that integrate their social and financial missions, this study aims to unpack social impact scaling strategies in differentiated hybrid organizations (DHOs) through the case of African SEs.

The study entails an inductive multiple case study approach based on four case SEs: work integration social enterprises (WISEs) and fair trade producer social enterprises (FTPSEs) in Uganda and Kenya. A total of 24 semi-structured interviews were collected together with multiple secondary data sources and then coded and analyzed through the rigorous Gioia et al. (2013) methodology to build a theoretical model.

The results indicate that SEs, as differentiated hybrids, implement four types of social impact scaling strategies toward beneficiaries and benefits (penetration, bundling, spreading and diversification) and unveil different dual mission tensions generated by each scaling strategy. The study also shows mutually reinforcing mechanisms named cross-bracing actions, which are paradoxical actions connected to one another for navigating tensions and ensuring dual mission during scaling.

This study provides evidence of four strategies for scaling social impact, with associated challenges and response mechanisms based on the cross-bracing effect between social and financial missions. Thus, the research provides a clear framework (social impact scaling matrix) for investigating differentiation in hybridity at scaling and provides new directions on how SEs scale their impact, with implications for social entrepreneurship and dual mission management literature.

The model offers a practical tool for decision-makers in SEs, such as managers and social entrepreneurs, providing insights into what scaling pathways to implement (one or multiples) and, more importantly, the implications and possible solutions. Response mechanisms are also useful for tackling specific tensions, thereby contributing to addressing the challenges of vulnerable, marginalized and low-income individuals. The study also offers implications for policymakers, governments and other ecosystem actors such as nongovernmental organizations (NGOs) and social investors.

Despite the growing body of literature on scaling social impact, only a few studies have focused on differentiated hybrids, and no evidence has been provided on how they scale only the social impact (without considering commercial scaling). This study brings a new perspective to paradox theory and hybridity, showing paradoxes come into view at scaling, and documenting how from a differentiation approach to hybridity, DHOs also implemented cross-bracing actions, which are reinforcement mechanisms, thus suggesting connections and synergies among the actions in social and financial mission, where such knowledge is required to better comprehend how SEs can achieve a virtuous cycle of profits and reinvestments in social impact.

This paper seeks to understand relationships between prison healthcare and integrated care systems (ICS), including how these affect the delivery of new healthcare interventions. It also aims to understand how closer integration between prison and ICS could improve cross system working between community and prison healthcare teams, and highlights challenges that exist to integration between prison healthcare and ICS.

The study uses evidence from research on the implementation of a pilot study to establish telemedicine secondary care appointments between prisons and an acute trust in one English region (a cross-system intervention). Qualitative interview data were collected from prison (n = 12) and community (n = 8) healthcare staff related to the experience of implementing a cross-system telemedicine initiative. Thematic analysis was undertaken on interview data, guided by an implementation theory and framework.

The research found four main themes related to the closer integration between prison healthcare and ICS: (1) Recognition of prison health as a priority; (2) Finding a way to reconcile networks and finances between community and prison commissioning; (3) Awareness of prison service influence on NHS healthcare planning and delivery; and (4) Shared investment in prison health can lead to benefits.

This is the first article to provide research evidence to support or challenge the integration of specialist health and justice (H&J) commissioning into local population health.