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The paper sets forth and examines the assumptions underlying two global ideas – world class and best practices – and their application to (higher) education and health organizations. Our basic (ex-ante) assumption is that both sectors are influenced by organizational fields that embody these ideas. However, we also assume that these sectors differ, and thus, that one should find between sector variations in the influence of such ideas. The findings suggest that both sectors have been affected by hegemonic ideas, yet in rather different ways, and that these ideas, particularly the metrics being used, pose different challenges in the two sectors.

The purpose of this paper is to bring the discussion on the relationship between management and medicine a step forward by focussing on: first, how the notion of hybrid and hybridity has been used in the literature on healthcare management. Second, the authors have mapped the alternative ways that the concept have been used in order to conceptualize a more specific set of possible combinations of managerial and professional roles in healthcare management. Hybrid management is a topic that ought to be important for training, communication among researchers and for identifying areas of future research: in management, in healthcare reforms, in sociology of professions and in theory of organizations.

The authors provide a systematic literature review in order to map the various conceptualizations of hybrid management. The authors have searched for “hybrid leadership,” “hybrid management” combined with hospitals and health care in a whole range of journals, identified in Google scholar, Academic Search Premier, Academic Research Library and Sage Publication. The authors have also used already existing literature reviews. The search has resulted in more than 60 articles and book titles that have been classified according to whether they make a fit with three alternative ways of conceptualizing hybrid management. The authors are aware that they might have missed some relevant literature but the literature included is quite comprehensive.

In the literature the authors have found three conceptualizations of management. The clinical manager who combines professional self-governance with a general management logic. The commercialized manager who combines professional self-governance with an enterprise logic. The neo-bureaucratic manager who combines self-governance with a neo-bureaucratic logic.

In most analyses of hybridity in management and organization the notion of hybrid has been used in a rather superficial way. By mapping the various uses of hybrid in the literature and suggest how a professional logic may be combined with a set of alternative logics of management the authors provide a platform for developing the concept of hybrid management into a more useful tool for analyses of changes in healthcare management.

It is doubtful whether Max Weber would have been appreciative of his current status as the father of organisation theory. Weber did not develop the concept of bureaucracy as part of a quest to advance a science of organisations, or in order to do a microanalysis of the internal structure of particular organisational units. The concept of bureaucracy was an ideal-typical concept developed as a point of departure for comparisons across historical periods and geographic settings. Weber’s research was motivated by macroscopic and historical questions such as ‘why did capitalism develop in the West’ and, ‘how do persons in the West and other civilizations attach meaning to their activities?’ Unlike consultants and organisation theorists that make use of him today, it was not a major concern for Weber to develop criteria for the most efficient kinds of organisations. Rather, his concern was to identify variations in administrative and bureaucratic cultures and patterns by the means of the bureaucratic ideal type. It is maintained in modern textbooks in organisation theory that there has been a development from a closed and rationalistic paradigm towards an understanding of organisations as open and natural systems, and Max Weber’s theory of bureaucracy is taken as a point of departure for this kind of narrative. This classification of Weber as an example of a rational and closed approach is highly questionable. The cross-societal and historical approach used so effectively by Weber, is put on a sidetrack in such mainstream narratives. It would be more in the spirit of Weber to focus on organising as an activity, bureaucracy as an ethos and to study organisations within their particular political and cultural contexts.

This paper aims to discuss recent contributions to comparative healthcare systems research, which emphasise decentralisation as a major characteristic of Scandinavian hospital systems. Whether the idea of such a “decentralised Scandinavian model” is appropriate and useful, how and why it was created, and what the alternative is, are central questions approached through a perspective gathered from historical institutionalism.

The paper employs an analysis of primary and secondary sources on the history of Scandinavian hospital systems, a classification based on historical developments, and an explanatory framework based on historical institutionalism.

The paper concludes that the idea of a decentralised Scandinavian model for hospital systems has had limited validity, constrained to the years 1970‐2000. Historical trajectories and recent developments both indicate that the three systems are more different than commonly assumed, and that recently they seem to be moving in separate directions. The explanation for the developments is found in incremental dynamics, creating institutional change that to a large extent depends on national contexts.

The paper contributes to the current discussion and research relating to classification of health care systems, and aims at developing a more elaborate understanding of the role of the hospital sectors within the Scandinavian welfare states. It challenges the idea that a single model can capture the essence of such diverse systems, and proposes an alternative to such modelling, based on a historical‐institutional approach.

The hospital sector has expanded in Norway with reforms and a strong demand for better management. The purpose of this paper is to examine: first, how this has affected physicians and nurses in management; second, how management roles in hospitals are changing; and third, how these two professions are tackling their new roles.

The paper presents a review of the secondary literature and a case study undertaken in the spring, 2012.

In Norway, two reforms have been introduced aimed at creating stronger management positions with less professional influence. The leader has full responsibility for a particular unit, which means that the jurisdiction of managers has expanded and that management has become more time consuming. Physicians – traditionally those in charge of hospitals – are facing competition from other professions, especially nursing, which has gained representation in top management positions, particularly at middle management level.

The originality of this paper is the comparison of the evolvement of management among physicians and nurses since the reforms. While the medical profession was critical of management to begin with, i.e. viewing management positions as a trap, it is gradually adapting to the new ideas. Physicians are facing competition from nurses, who readily adjust to the new conditions, and perceive management as a new career track.

In this chapter, we focus on the stabilizing functions of public bureaux and examine some of the consequences attendant upon attempts to make them less hierarchical and more ‘flexible’. In so doing, we seek to evidence the ways in which what are represented as anachronistic practices in the machinery of government may actually provide political life with particular required ‘constituting’ qualities. While such practices have been negatively coded by reformers as ‘conservative’, we hope to show that their very conservatism may serve positive political purposes, not the least of which is in the constitution of what we call ‘responsible’ (as opposed to simply ‘responsive’) government. Through a critical interrogation of certain key tropes of contemporary programmes of modernization and reform, we indicate how these programmes are blind to the critical role of bureaucracy in setting the standards that enable governmental institutions to act in a flexible and responsible way.

Hierarchy and bureaucracy have been more or less welcomed companions of human civilisation from the very beginning. In almost every culture and epoch, ruling elites and followers, superiors and subordinates can be identified. Hierarchy and bureaucracy are quite flexible, adaptable and they are fairly persistent – but why could, or even should we see this as a problem?

This introduction will first provide a brief history of no change, followed by the second section where the advantages and disadvantages and the contested terrain of hierarchy are elaborated in some length. The discussion focuses on three areas: the functional, social and ethical qualities of hierarchy. In the final section, the chapters of this volume will be briefly introduced. The chapters are grouped into three sections: (I) Fundamentals and historical accounts of bureaucracy, (II) Organisational, cultural and socio-psychological aspects of hierarchy and (III) Alternative views on, and alternatives to hierarchy.