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The purpose of this paper is to discuss the dilemma that exists between the aims of public sector reforms and the ways organisations adjust to the management control reforms.

To study the research purpose, empirical data were collected from Norwegian Regional Hospital Enterprises. The aim was to describe how these institutions have chosen to implement formal and informal mechanisms of control for coordination and management of hospitals.

The results indicated a comprehensive map of the different formal and informal adjustments to radical institutional reform changes. The reform strategies were met with a mixture of intended adjustments, partly realised ambitions and ignorance in the organisations, and the change towards accrual accounting system was found to have reversed effects compared with the original ambitions.

This study was based on a small sample of organisations and interviews. The dimensions were somewhat crude, and the findings can be generalised reliably only to the population studied here. More research is needed for further explorations of these findings. The study reveals as similar with prior macro level institutional research a complex view on the implications of government initiatives as only one of many potentially powerful actors in such regulatory processes.

This work adds to leaders' understanding of how intended governmental strategies follow diverse paths of implementation.

These results provide useful support of prior findings as to the deeper understanding of why organisations that are exposed to the same reform initiatives, turn out to behave differently.

Analyses the features, strategies and characteristics of health‐care reforms in the People’s Republic of China. Since the fourteenth Central Committee of the Chinese Communist Party held in 1992, an emphasis has been placed on reform strategies such as cost recovery, profit making, diversification of services, and development of alternative financing strategies in respect of health‐care services provided in the public sector. Argues that the reform strategies employed have created new problems before solving the old ones. Inflation of medical cost has been elevated very rapidly. The de‐linkage of state finance bureau and health service providers has also contributed to the transfer of tension from the state to the enterprises. There is no sign that quasi‐public health‐care insurance is able to resolve these problems. Finally, co‐operative medicine in the rural areas has been largely dismantled, though this direction is going against the will of the state. Argues that a new balance of responsibility has to be developed as a top social priority between the state, enterprises and service users in China in order to meet the health‐care needs of the people.

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.

This paper seeks to explore the legitimacy of budgets as management control processes in hospitals after comprehensive reforms were implemented in the Norwegian hospital sector in 2002.

The paper employs qualitative interviews with top level clinical managers in three large hospitals.

The study shows a variety of practices among the clinical managers as to management control adjustments. The managers use different strategies in order to cope with the budget frames.

This paper contributes to the current debate and research relating to the budgeting and performance management practices in hospital settings.

These findings contribute to contextual knowledge that is relevant in understanding the diverse practices of clinical managers in hospitals as complex service producing organizations.

The findings give information to decision makers as to the diversity in management practices within knowledge intensive organizations.

The paper challenges the idea that the strategies used by managers can be understood by the concepts of the means‐end rationality prescribed in most of the reforms introduced into the hospital sector.

This case study is designed to enable students to analyze the competitive landscape of a business impacted by technological disruption; evaluate the viability of an organic growth strategy using stakeholder analysis; evaluate the revenue and cost structure of Apollo 24/7 and decide on the future investment strategy; and analyze funding strategies of traditional hospitals versus pure digital players.

To extend its reach, Apollo Hospitals Enterprise (Apollo Hospitals), a leading private sector brick-and-mortar hospital chain in India known for using state-of-the-art technology, launched a unified virtual mobile platform Apollo 24/7 in February 2020, 45 days into the COVID-19 pandemic. The management believed that the digital platform had a unique ecosystem that could not be replicated. The analysts were optimistic about the impact of the decision on the future performance of Apollo Hospitals, as it was expected to lead to higher penetration and increased revenue. They also anticipated the unlocking of value, as and when the venture capitalist (VC) would invest in Apollo Hospitals. However, with increasing operating expenses on account of burgeoning technological and marketing expenses, things did not seem to go going as planned. Three years later, in February 2022 after the Q3 of financial year 2023 results. Suneeta Reddy, the company’s managing director found herself pondering whether the digital platform could boost Apollo Hospitals’ profitability in addition to expanding its reach and increasing affordability when the company missed the analyst estimates. In India, which was then the second most populous country, “incremental access” and “affordability” were what mattered to the patients, However, for the investors and analysts, it was quarter-on-quarter performance. The change in the macroeconomic environment stalled the company’s plan of raising money from VCs.

Furthermore, the financing dilemma also plagued Reddy. She knew there was a difference between financing for conventional businesses that for digital businesses. She also had to take decide between short-term profitability with which investors were obsessed versus long-term sustainability, which involved taking care of stakeholders’ interests.

This case study is basically aimed at postgraduate courses and executive management courses.

Teaching notes are available for educators only.

CSS11: Strategy.

The purpose of this paper is to increase the understanding of organizational challenges when decision-makers try to comply with technological developments and increasing demands for a more rational distribution of health care services. This paper explores two decision-making processes from 2007–2019 in the area of vascular surgery at a regional and a local level in Norway.

The study draws upon extensive document analyses, semi-structured interviews and field conversations. The empirical material was analyzed in several steps through an inductive approach and described and explained through a theoretical framework based on rational choice (i.e. bounded rationality), political behavior and institutionalism. These perspectives were used in a complementary way.

Both decision-making processes were resource-intensive, long-lasting and produced few organizational changes for the provision of vascular services. Stakeholders at both levels outmaneuvered the health care planners, though by different means. Regionally, the decision-making ended up in a political process, while locally the decision-making proceeded as a strategic game between different departments and professional fields.

Decision-makers need to prepare thoroughly for convincing others of the benefits of new ways of organizing clinical care. By providing meaningful opportunities for public involvement, by identifying and anticipating political agendas and by building alliances between stakeholders with divergent values and aims decision-makers may extend the realm of feasible solutions.

This paper contributes to the understanding of why decision-making processes can be particularly challenging in a field characterized by rapid technological development, new treatment options and increasing demands for more rational distribution of services.

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.

The paper presents an investigation carried out in an Italian health organisation, aimed at studying the purchasing process of medical equipment at the hospital ward level, and at assessing its impact on hospital ward performance. A model of the decision process that leads to purchase is developed. The results show that the acquisition of technology has a positive impact on the ward's relative efficiency, and that efficiency is further linked to the specific goals pursued by the head of ward and by the constraints faced.

The aim of the paper is to understand the differences between “talking” and “walking” about sustainable development goals (SDGs) in state-owned enterprises (SOEs). Specifically, the authors have conducted an analysis on 202 entities that operate within the Italian National Healthcare System (INHS) to evaluate the overall degree of transparency in term of contribution to the SDG3.

The research evaluates the degree of contribution to SDG3 by INHS through the adoption of the theoretical framework proposed by Beck et al. (2010). Specifically, the authors assess the degree of contribution to this goal using an interpretive content analysis that combines the theoretical framework with the 13 targets that composed the SDG3. For the authors’ purposes, they analyze all INHS’s website to evaluate the presence/absence of social reports produced in the periods 2015-2018.

Although the great contribution to the SDG3, the INHS is characterized by a low degree of accountability. In fact, only 12.21 per cent of INHS’s entities disclosed at least one social report during the observed period. Moreover, the authors’ results denote how the approach of INHS’s entities to social reporting is different both in term of “quality” and “quantity.”

The SOEs play a central role within the Agenda 2030 strategies. However, public managers are less oriented than private managers to adopt non-financial reporting tools. Furthermore, the authors’ results highlight the existence of asymmetric information between SOEs and citizens even if in presence of best practices such as the INHS. In this sense, the adoption of non-financial reports tool to engage in a more effective way with citizens could be a strategic driver for the achievement of highest degree of social legitimacy to operate.

The paper is of use to public managers operating in countries characterized by a high level of contribution to SDGs. Specifically, the authors’ results suggest how the adoption of reporting tools could impact positively in terms of stakeholder’s awareness to SDG themes.

This paper contributes to the understanding of the central role covered by academics, practitioners and public sectors to SDGs through the adoption of social reporting tools.

In May 1989 a party of 11 senior UK health service managers visited a number of health care facilities in the USSR. The party urns drawn from all levels within the National Health Service: The Department of Health, regions, districts and units were all represented, and the group included planners and managers of services. The facilities visited were based in Leningrad and Moscow, and covered a wide range of health provision.