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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 examine conflicting institutional demands on individual frontline employees in hybrid public sector organisations. Specifically, it examines the competing accountability pressures professional and commercial logics exerted on academics at a business school, how individual lecturers responded to such pressures, and what drove these responses.

The paper draws on a case study of an English business school and is informed by the literatures on institutional logics and hybrid organisations.

The paper shows that the co-existence of professional and commercial logics at the case organisation exerted competing accountability pressures on lecturers. It moreover shows that sometimes deliberately and purposefully, sometimes ad hoc or even coincidentally, lecturers drew on a wide range of responses to these conflicting pressures, including compliance, defiance, combination and compartmentalisation.

The paper sheds light on individual level responses to competing institutional logics and associated accountability pressures, as well as on their drivers. It also highlights the drawbacks of user, customer or citizen accountability mechanisms, showing that a strong emphasis on them in knowledge-intensive public organisations can have severe dysfunctional effects.

The aim of the study was to understand the social and organisational factors in the workplace that shape managers' actions and attitudes towards workers with repeated short-term sickness absence.

This was a qualitative interview study. Semi-structured interviews were conducted with 19 managers at 15 different workplaces. The analysis had an abductive approach, using thematic analysis which focused on the latent content of managers attitudes towards employees with repeated short-term sickness absence.

Results indicate that the managers' views of people on short-term sick leave shift and move through several phases, which was analysed as they were acts in a play, where their given roles are prescribing which actions to take given the available resources for acting these parts. These acts depict an increasingly controlling attitude, where the sick leave is ultimately seen as an individual problem best managed by repressive tactics.

Role theory offers the possibility to analyse managers' attitudes and behaviours by considering the workplace and the manager-employee relationship as regulated by norms and organisational factors.

This study aims to explore how and why employees perceive technology-mediated interruptions differently and the role of sociocultural factors in this process using sociomaterial analysis.

Data were gathered from 34 Sri Lankan knowledge workers using a series of workshop-based activities. The concept of sociomateriality is employed to understand how sociocultural elements are entangled with technology in work-life boundary experiences.

The findings of the thematic analyses suggest how culture is intertwined in the way employees perceive technology-mediated interruptions and how they manage information communication technologies (ICTs) to balance their work and nonwork demands. Participants have been unable to avoid technology-mediated boundary interruptions from work, as organisations have created norms to keep employees connected to organisations using information communication technologies. Traditional gender roles are specifically found to be entangled in employees' boundary management practices, disadvantaging women more.

The findings highlight how national culture and gender norms create challenging work-life experiences for female employees than males. This could create a disadvantageous position for female employees in their career progression. It is crucial to consider factors such as boundary preferences and family concerns when deciding on family-friendly work policies. Also, organisations have to consider the development of explicit guidelines on after-hours communication expectations.

Using the lens of sociomateriality, researchers can understand the contextual entanglement of ICTs with national culture and gender norms in creating different work-life boundary experiences. It seems ICTs are creating a disadvantage for female employees when managing work–nonwork boundaries, especially in power distant and collectivist cultures where traditional gender norms are highly valued and largely upheld. This study also contributes to the current discourse on work-life boundaries by providing insights from non-western perspectives.

Workplace silence impedes productivity, job satisfaction and retention, key issues for the hospital workforce worldwide. It can have a negative effect on patient outcomes and safety and human resources in healthcare organisations. This study aims to examine factors that influence workplace silence among hospital doctors in Ireland.

A national, cross-sectional, online survey of hospital doctors in Ireland was conducted in October–November 2019; 1,070 hospital doctors responded. This paper focuses on responses to the question “If you had concerns about your working conditions, would you raise them?”. In total, 227 hospital doctor respondents (25%) stated that they would not raise concerns about their working conditions. Qualitative thematic analysis was carried out on free-text responses to explore why these doctors choose to opt for silence regarding their working conditions.

Reputational risk, lack of energy and time, a perceived inability to effect change and cultural norms all discourage doctors from raising concerns about working conditions. Apathy arose as change to working conditions was perceived as highly unlikely. In turn, this had scope to lead to neglect and exit. Voice was seen as risky for some respondents, who feared that complaining could damage their career prospects and workplace relationships.

This study highlights the systemic, cultural and practical issues that pressure hospital doctors in Ireland to opt for silence around working conditions. It adds to the literature on workplace silence and voice within the medical profession and provides a framework for comparative analysis of doctors' silence and voice in other settings.

This study aims to investigate the role of relational asymmetries in influencing the coping strategies adopted by frontline workers to deal with the policy–client role conflict.

A comparative analysis of three different services highlights the role of the service relationships characteristics in explaining similarities and differences in the strategies adopted by street-level bureaucrats (SLBs). The research is based on the secondary analysis of three case studies conducted in Italy: the reception system for homeless people, the job brokerage service in the public employment service and the dispute settlement procedure in the labour inspectorate.

The results underline the interaction between the characteristics of the service relationship and the different coping strategies adopted to deal with the policy–client conflict.

The contribution of this study is threefold. Firstly, the authors focus on the influence of the characteristics of the service relationship in terms of agency resources over SLBs’ strategies to face with users’ expectations. Secondly, the authors intend to discuss these issues analysing SLBs not only as agents with individual preferences. Thirdly, the research design allows the authors to return to the street-level bureaucracy theory its comparative essence, proposing a comparative strategy with an explorative intent.

Building upon the practice-based framework, this paper aims to focus on working practices for understanding how knowledge is transferred among health-care professionals within hospitals.

Using an ethnographic and interpretative approach, the authors conducted preliminary research based on a quali-quantitative methodology within one of the largest hospitals in Southern Italy.

This study allowed to achieve several results that could be significant and relevant within the health-care sector. First, this paper identified some of the main working practices and their associated activities in health care. Moreover, this paper identified the main organizational forms and/or tools enabling hospital personnel to share and learn the various types of knowledge for each of the prior identified practices.

Hospital managers should develop strategies and policies that take into account the nature and typology of knowledge-sharing processes among health-care professionals in terms of practices.

The paper contributes to practice-based studies identifying identified some of the main working practices, as well as the main tools for sharing and learning of the various types of knowledge.

The purpose of this paper is to examine human resources (HR) professionals’ self-perceptions of ethically questionable human resource management (HRM) practices (i.e. disregard for the individual, favoring those in power and discrimination). The research sought specifically to determine how these perceptions are influenced by their organizations’ ethical infrastructure and corporate social responsibility (CSR) practices.

Data were collected from 134 HR professionals using an anonymous structured questionnaire.

The scope of organizations’ ethics programs and the degree of importance given to developing an ethical infrastructure were found to predict the level of acceptance of unethical HRM practices related to discrimination. These practices are also less acceptable to professionals from organizations that are perceived as more socially responsible regarding their employees.

Additional studies with larger samples are needed to determine more clearly not only the influence of contextual determinants, but also the practical consequences of high levels of acceptance of unethical practices in HRM.

Organizations can decrease their HR professionals’ acceptance of ethically questionable HRM practices by developing and emphasizing a strong ethical infrastructure and CSR practices, especially those affecting employees.

HR professionals’ perceptions of ethical issues have rarely been analyzed using empirically tested methods. By surveying HR professionals, this study contributes to a fuller understanding of their perceptions regarding the ethics of their own practices. The results show that contextual determinants play an important role in predicting the level of acceptance of unethical HRM practices, especially those leading to discrimination.

Cryptomarkets have expanded rapidly since the launch of Silk Road in 2011, offering a significant new mode for the sale and distribution of illicit drugs. One of the key questions accompanying the proliferation of cryptomarkets and online drug distribution concerns how these unique online fora alter relationships between drug suppliers and their customers. Existing research points to an increase in perceptions of safety and respect among people who use cryptomarkets to purchase drugs relative to other ‘offline’ modes of drug acquisition. There is a growing body of evidence that suggests that drug suppliers are also attracted to cryptomarkets by perceptions of increased safety, as well as by market norms and institutional processes that are characterised by respect and courteous engagement. These issues fall broadly under what has been termed market ‘gentrification’ – that is, the substitution of offline drug market norms, which are sometimes characterised by violence, intimidation, suspicion, and exploitation, with relative feelings of safety, respect, and courtesy. This chapter explores the ‘gentrification hypothesis’ and examines how the unique structural characteristics of cryptomarkets, which include user feedback and ratings, dispute resolution systems, and administrator and community ‘policing’ of cryptomarkets, as well as online discussion forums, assist in fostering the development of pro-social norms that appear to be prevalent on cryptomarkets.

The paper aims to analyse the meaning and extension of discretionary power of social service professionals within network-based interventions.

Empirically, the paper is based on a case study of a network-based policy involving private and public organisations in the Northeast of Italy (Province of Trento).

The paper identifies netocracy as a social policy logic distinct from bureaucracy and professionalism. What legitimises netocracy is neither authority nor expertise but cooperation, the activation of connections and involvement, considered “good” per se. In this framework, professionalism and discretion acquire new and problematic meanings compared to street-level bureaucracy processes.

Based on a case study, the research results cannot be generalised but pave the way to further comparative investigations.

The paper reveals that the position of professionals in netocracy is to some extent trickier than that in a bureaucracy because netocracy seems to have the power to encapsulate them and make it less likely for them to deviate from expected courses of action.

Combining different literature streams – street level bureaucracy, professionalism, network organisations and welfare governance – and building on an original case study, the paper contribute to understanding professionalism in welfare contexts increasingly characterised by the combination of bureaucratic, professional and network logics.