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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.

Numerous studies have identified various unintended adverse consequences (UACs) of implementing health information technology (HIT). For example, UACs identified in the context of Computerized Physician Order Entry (CPOE) implementation include unfavorable workflow issues, generation of new types of errors, untoward changes in communication patterns, and problems of paper persistence.

However, gaps remain in understanding why UACs from HIT implementation occur, and how they may be overcome. The technology-in-practice (TIP) framework emphasizes the role of human agency (or individual action) in enacting structures of technology use (or technologies-in-practice) and other social structures within the organization. As such, given a set of UACs from HIT implementation, the TIP framework can help trace them back to specific actions (types of HIT-in-practice) and institutional conditions (social structures).

However, insofar as the TIP framework can help understand causes of UACs, it does not shed light on how they may be overcome through strategic action. By contrast, the knowledge-in-practice (KIP) framework, which emanates from both human resource and knowledge management literatures, helps understand how information and communication technologies (ICTs) such as “Intranets” and the “Virtual Office” can be used alongside existing HIT systems (e.g., CPOE) to create new social structures, generate new KIP, and transform HIT-in-practice.

This chapter integrates the TIP and KIP literatures to develop an integrated framework for understanding and overcoming the UACs from HIT implementation. The framework is applied to existing evidence on UACs from CPOE implementation, to explain why they occur, and how they may be overcome. The application and ensuing discussion provide insight into strategies for successful HIT implementation in healthcare organizations, as well as recommendations for future research.

The research aim of this chapter is to understand how different institutional logics affect the day-to-day activities of healthcare providers and whether the cohabitation of professional logics with business-like logics increases medical providers’ effectiveness and gives chance to constrain healthcare costs. This research is based on longitudinal case study about the restructuring of the Canadian healthcare system in Alberta in 1992–2008, described in two papers (Reay & Hinings, 2005, 2009). We identify the situation after encroachment of a new, business-like logic into a healthcare system as more complex than described in the extant literature. We challenge the findings of the case study authors that there are two cohabitating logics in healthcare: the business-like logic supported by the government and the logic of medical professionalism. From our research it appears that there are two other logics: a managerial logic derived from business-like logic, and a hybrid professional logic that is a modification of the logic of medical professionalism. Across the healthcare field in general, business-like logic has been competing with the logic of medical professionalism, but on the medical providers’ level these logics become uncoupled. Within a medical provider, on the external, symbolic layer, physicians follow their professional logic and managers show conformity with governmental principles. But on the backstage layer, where the day-to-day work is actually performed, these two logics are subject to modification, creating a space for compromise and cooperation, leading to a growth of the number of unnecessary medical services preventing cost containments in healthcare.

Purpose – In the last decades, Italian healthcare organisations have been subject to important normative changes, aimed at increasing their efficiency. As a response, performance measurement and evaluation (PME) systems have been introduced. The present study attempts to examine PME system changes as institutional processes. In studying such processes the healthcare literature acknowledges the presence of two logics: managerial and professional, as peculiar to healthcare settings, whose convergence or divergence can explain the success of any institutional process.

Design/methodology/approach – We adopt Busco et al.'s (2007) framework as an approach for unbundling PME system change into four relevant coordinates, namely: (1) the object (PME system), (2) the subjects (institutional forces), (3) the place and time of change (the managerial and professional logics) and (4) the how and why change happens (change as an institutional process). We conducted a longitudinal case study at a large teaching hospital in Southern Italy, directed to interpret PME system changes during the period from 1998 until 2009.

Findings – Our observation distinguishes episodes of successful institutional processes, where the introduced innovations are transformed into objectivated practices, from episodes of missed institutionalisation, where new procedures were rapidly abandoned.

Research and social implications – This theoretical framework can be useful for interpreting the PME system changes in different institutional contexts.

Originality – The Busco et al.'s framework allows us to understand PME system changes by integrating the perspectives from Neo-Institutional Sociology, representing healthcare organisational responses to external institutional pressures, and Old-Institutional Economics, conceptualising PME system changes as an institutionalisation process.

This chapter explores how different aspects of middle manager identity relate to knowledge, research and practice. It argues that effective leadership depends more upon the person than the role.

Semi-structured interviews were conducted with 14 middle managers at a single school of healthcare in a research-intensive, chartered UK university.

The middle managers revealed both core and situated identities. Their core selves included various personality traits such as curiosity, a competitive streak, optimism, sociability and a sense of humour. Their situated selves were shaped by socialization, life history, critical people, and incidents and chance. In a symbiotic relationship with these core and situated components was a complex, tri-partite professional identity, as a healthcare professional, a higher education (HE) academic, and an education manager. All the participants greatly valued professional development and ongoing academic study.

This chapter illustrates how the best postgraduate courses develop exemplary education managers/leaders. They do this not by giving students role-specific skills but by developing their analytical and critical thinking skills. Through a process of deep learning and experience, individuals undertaking a doctorate are able to develop into reflexive and reflective practitioners who can act with personal integrity.

Little has been published about the relationships between the career background, the identity and the role of a university middle manager, and virtually nothing from the field of healthcare. The figure presented in this chapter offers a new framework for understanding the relationship between self, professional identity and role.

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.

Originally developed by the Japanese firm Toyota in the 1950s, the core innovation of lean production is to reorient all organizational activity around continuous improvement and the elimination of waste. We use the case of lean production in two healthcare organizations to explore the process of translating management models into new environments (Czarniawska & Sevón, 1996; Mohr, 1998). We draw on insights from organizational sociology and social movement theory to understand the strategies of actors as they attempt to overcome opposition to model transfer (Battilana, Leca, & Boxenbaum, 2009; Friedland & Alford, 1991; Snow, Rochford, Worden, & Benford, 1986). We examine two attempts to export lean production to healthcare organizations: Riverside Hospital, a research and teaching institution, and Lakeview Associations, a managed health provider. We use these cases to illustrate two ways that management models can get lost in the process of institutional translation: model attenuation, and model decoupling.