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This article aims to examine tensions between hybrid clinician managers' professional values and health care organisations' management objectives.

Data are from interviews conducted with, and observation of, 14 managerial participants in a Cancer Therapy Unit set in a large teaching hospital in New South Wales, Australia, who participated in a Clinical Leadership Development Program.

The data indicate that there are tensions experienced by members of the health care organisation when a hybrid clinician manager appears to abandon the managerial role for the clinical role. The data also indicate that when a hybrid clinician manager takes on a managerial role other members of the health care organisation are required concomitantly to increase their clinical roles.

Although the research was represented by a small sample and was limited to one department of a health care organisation, it is possible that other members of health care organisations experience similar situations when they work with hybrid clinician managers. Other research supports the findings. Also, this paper reports on data that emerged from a research project that was evaluating a Clinical Leadership Development Program. The research was not specifically focused on organisational professional conflict in health care organisations.

This paper shows that the role of the hybrid clinician manager may not bring with it the organisational effectiveness that the role was perceived to have. Hybrid clinician managers abandoning their managerial role for their clinical role may mean that some managerial work is not done. Increasing the workload of other clinical members of the health care organisation may not be optimal for the health care organisation.

Organisational professional conflict, as a result of hybridity and divergent managerial and clinical objectives, can cause conflict which affects other organisational members and this conflict may have implications for the efficiency of the health care organisation. The extension or duality of organisational professional conflict that causes interpersonal or group conflict in other members of the organisation, to the authors' knowledge, has not yet been researched.

The purpose of this paper is to explore the way “hybrid” clinical managers in Kenyan public hospitals interpret and enact hybrid clinical managerial roles in complex healthcare settings affected by professional, managerial and practical norms.

The authors conducted a case study of two Kenyan district hospitals, involving repeated interviews with eight mid-level clinical managers complemented by interviews with 51 frontline workers and 6 senior managers, and 480 h of ethnographic field observations. The authors analysed and theorised data by combining inductive and deductive approaches in an iterative cycle.

Kenyan hybrid clinical managers were unprepared for managerial roles and mostly reluctant to do them. Therefore, hybrids’ understandings and enactment of their roles was determined by strong professional norms, official hospital management norms (perceived to be dysfunctional and unsupportive) and local practical norms developed in response to this context. To navigate the tensions between managerial and clinical roles in the absence of management skills and effective structures, hybrids drew meaning from clinical roles, navigating tensions using prevailing routines and unofficial practical norms.

Understanding hybrids’ interpretation and enactment of their roles is shaped by context and social norms and this is vital in determining the future development of health system’s leadership and governance. Thus, healthcare reforms or efforts aimed towards increasing compliance of public servants have little influence on behaviour of key actors because they fail to address or acknowledge the norms affecting behaviours in practice. The authors suggest that a key skill for clinical managers in managers in low- and middle-income country (LMIC) is learning how to read, navigate and when opportune use local practical norms to improve service delivery when possible and to help them operate in these new roles.

The authors believe that this paper is the first to empirically examine and discuss hybrid clinical healthcare in the LMICs context. The authors make a novel theoretical contribution by describing the important role of practical norms in LMIC healthcare contexts, alongside managerial and professional norms, and ways in which these provide hybrids with considerable agency which has not been previously discussed in the relevant literature.

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.

Building on the research program of Dillard and Brown (2015) and Dillard and Vinnari (2019), specifically related to an “ethic of accountability,” this paper recognizes accountability systems as key to how organizations conceptualize their responsibility to society. The objective is to explore how managers of hybrid organizations conceptualize responsibility and the role of accountability systems in their conceptualization.

This paper studies hybrid organizations that are for-profit entities with explicitly recognized non-economic imperatives. Semi-structured interviews are conducted with managers of organizations that pursue certification as a B-Corporation, often in conjunction with a legal designation as a benefit corporation.

Managers of the hybrid organizations evidenced a broader responsibility logic that extends beyond responsibility to shareholders. This pluralistic orientation and broader set of objectives are expressed in a set of certification standards that represent an accountability system that both enables and constrains the way responsibility is understood. The accountability system reflects a “felt” accountability to the “other” manifested, for example, as generational accountability, with the other (re)created relative to the certification standards.

Certifications and standards represent accounting-based accountability systems that produce a type of accountability in which the certification becomes the overall objective nudging out efforts to take accountability-based accounting seriously (Dillard and Vinnari, 2019). At the same time, the hybrids under study, while not perfect exemplars, incline toward an ethic of accountability (Dillard and Brown, 2014) that moves them closer to accountability-based accounting.

The findings reveal perspectives of managers embedded in hybrid organizations, illustrating their experiences of responsibility and accountability systems in practice (Grossi et al., 2019). The insights can be extended to other hybrid contexts where accountability systems may be used to demonstrate multiple performance objectives. We also recognize the irony in the need for an organization to be required to attain a special license to operate in a more responsible manner.

One of the key dilemmas facing senior managers is IT investment. Much rides on it, yet it often fails to deliver. The usual cause of failure is cited as “human error”. Yet senior managers are perhaps expecting too much of IT managers, who are often technologists forced into management (in furtherance of their careers). Recently, much has been made of the potential of “hybrid managers”, individuals who combine computer literacy with business acumen and a flair for management. Offers a review of the status and potential of the hybrid manager and includes a sketch of the training required to help develop the necessary skills.

We bring together the institutional theory literature on institutional logics and the information systems (IS) literature that conceptualizes a relational view of affordances to explore the digital changes unfolding in the delivery of professional services. Through a qualitative inductive study of the development of an app led by a clinician manager in an Australian hospital, we investigate how multiple institutional logics shape the design of affordances when an organization develops new digital technologies for frontline professional work. Our findings show how a billing function was designed into the app by the development team over four episodes to afford potential physician users with billing usability, billing acceptability, billing authority and billing discretion. These affordances emerged as different elements of professional, state, managerial and market logics became activated, interpreted, evaluated, negotiated and designed into the digital technology through the team’s interactions with the clinician manager, a hybrid professional, during the app development process. Our findings contribute new insight to the affordance-based logics perspective by deepening understanding of the process through which multiple institutional logics play out in the design of affordances of digital technology. We also highlight the role of hybrid professionals in this digital transformation of frontline professional work.

This chapter takes a new approach to emotions through the lens of a relational identity among hybrid professionals, using those in healthcare as particularly relevant examples. Sharpening the focus on underpinning emotional dynamics may further explain how professional managers can be effective in hybrid roles. The chapter seeks to build on the internal emotional states of these professional managers by understanding how outward emotional displays might influence their subordinates. The understanding of how emotional states/displays in manager–employee relationships influence target behaviors may help multiprofessional organizations generate better-informed leadership practice in relation to desired organizational outcomes, e.g. more efficient and effective health services.

The article seeks to explain whether and how value-based healthcare principles lead to hybridization. The public management literature has been increasingly interested in hybrid forms of governance and hybrid performance management, but empirical studies are still rare. Further, the article studies the design of performance management and accounting systems as healthcare organizations reorganize their care processes applying value-based healthcare principles.

This article first connects the theoretical discussions on value-based healthcare and performance management for hybrids. The conceptual understanding of performance management in hybrid healthcare uses a case study of a Finnish healthcare organization with documentary data and transcribed interviews with healthcare professionals from both the strategic and operative levels of healthcare.

The article illustrates and analyses how new policy-level objectives and principles of value-based healthcare led to hybridity in healthcare, manifest in mixed ownership of a particular care path and new forms of social and financial control. Further, the article provides empirical evidence of how increased hybridity necessitated new organizational modes and roles, new managerial tools for performance management and created a need to develop the capability to account and measure entire integrated care processes. Important enabling factors for the integration of care and hybrid performance management were commitment created in dialogue, voluntary-based trust and technology to generate factual shared information.

The study is informative for stakeholders, funders and managers of healthcare organizations, namely new knowledge for the discussion of hybrid governance in healthcare, including a critical account of the applicability and impact of a hybrid service model in healthcare management. Moreover, the article illustrates what needs to be reconsidered in performance management and accounting practices when reorganizing care processes according to the principles of value-based healthcare.

The article extends the analysis of performance management in hybrids and sheds new light on hybridization in healthcare. It also provides much-needed empirical evidence on the processes and practices of accounting and performance management after implementing a value-based healthcare strategy.

As hybrid organisations operating at the intersection of opposing institutional logics, social enterprises (SEs) pursue the creation of social value w hile functioning as businesses, which generates tensions between social and business concerns. Limited knowledge exists, however, of how hybridity is managed at the intra-individual level. Drawing on regulatory focus theory (RFT), this paper investigates the role of self-regulation in managing hybridity tensions in SEs.

A multiple-case design is useful in investigating the situated cognitive mechanisms underlying individual self-regulation in the context of managing tensions in SEs. The authors interviewed 22 managers from Belgian SEs that had been active in the home-care sector for at least five years before the COVID-19 pandemic to understand how managers handle the tensions between social and business concerns through self-regulation.

The authors show that managers in SEs experience three forms of tensioning: tensioning as intertwining, tensioning as competition and tensioning as superseding. Managers respond differently to tensions depending on their self-regulatory focus (promotion versus prevention) on social and business goals, and this is reflected in their hybridity practices (entrepreneurship, commercialisation, corporatisation and managerialisation). Informed by both social and business logics, hybridity practices serve as tactics used as part of managers' self-regulation, enabling them to handle tensions.

By studying the interactions between individual cognition and institutional logics, this study contributes to the micro-foundations of institutional logics by revealing the role of self-regulation mechanisms in managing tensions in hybrid organisations.

The purpose of this paper is to examine the value of active fund management using a sample of hybrid mutual funds.

Instead of using traditional risk‐adjusted measures, the paper employs an alternative attribution return methodology where the actual monthly fund return is compared to the return that would have been earned by the indexing strategy that best reflects the fund's prior month allocation. Value is measured by defining a fund's attribution return as the difference between a fund's actual month t return and the return that would have been generated in month t by the indexing strategy that most closely approximates the fund's month t−1 portfolio allocation.

It is found that hybrid funds as a group do not add value and that this underperformance does not appear to be driven by the poor performance of non‐surviving funds. However, these funds perform significantly better than the style benchmark under weak vs strong stock market conditions. This performance difference between bull and bear market conditions suggests some hedge fund‐like downside protection that may offer a reason why investors choose these funds despite the funds’ average underperformance and despite their higher costs relative to index funds.

The contribution of this paper is twofold. First, it concentrates on hybrid mutual funds, which despite a surge in their interest over the last five years have attracted very little academic study. Second, in the implementation of its non‐traditional performance measure, it employed daily fund returns, stock market indices and bond market indices as opposed to the monthly or quarterly data used in other related studies.