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Quality management is high on the reform agenda of both universities and hospitals. This paper studies how quality management is implemented: who is responsible for QM and which instruments are used? The guiding research question is whether these two very distinct professional organizations respond in similar or different ways to a common reform trend. To analyze the extent of isomorphic tendencies a cross-sectoral, descriptive data analysis with data from 135 hospitals and 83 universities in Germany has been conducted. The results show that QM in hospitals is more elaborated in terms of quality instruments and at the same time more standardized. Universities, in contrast, follow quite individualistic ways to organize quality management.

Adopting an agentic positioning, we question and compare competing logics hybridization within French hospitals and universities facing major reforms inspired by new public management. In addition to the resulting forms of hybridization exposed in the literature (accepted or refused), we observe four additional modes: instrumentalized, uncomfortable, reformulated, and suffered. They all reveal the varied manner with which each professional faces reform. However, we develop a new argument: the ways professionals hybridize (or do not) their prevailing logic depends on an overarching mode of hybridization that characterizes the way their organization deals with reform. We identify two contrasting modes: overarching strategic logics hybridization and overarching enforced logics hybridization. They give insight into how actors decouple structure from practices. We contribute to the literature on logics hybridization by first analyzing the role of specific actors who act as either a translator-actor or a closure-actor to respectively facilitate appropriation of the reforms or to protect professionals against the growing dominance of the new logic introduced by the law; and secondly by discussing importance of articulating higher and lower organizational levels all involved in hybridization.

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.

In this study, we are addressing changes in managerial logics after the introduction of New Public Management (NPM)-reforms in two public sectors in Norway, namely the hospital and the university sectors. These sectors were previously dominated by professional and political logic in management, and the focus is on professionals in managerial positions. We are asking: How do professionals in managerial positions across universities and hospitals mediate between previous and newly introduced logics in management after NPM-reforms? We have chosen to compare changes in management across the hospital and the university sectors. Both sectors are largely publicly owned and dominated by professions, but their mission differs. The empirical material comprises interviews with formal leaders from dissimilar professional backgrounds, at different levels in the organisations in two cases. The findings show that management influenced by the market logic has been introduced, but in a hybrid version. The professional logic has however not been left behind, but expanded and supplied by a neo-bureaucratic logic. Leadership is functioning as a ‘catalyst’ to handle the different logics. The originality of this paper is a comparison of management in health care and higher education related to a model of hybrid management.

In this chapter, we describe a multilevel, longitudinal, comparative case study approach for investigating organizational heterogeneity based on our experience studying institutional change in the health care field (Scott, Ruef, Mendel, & Caronna, 2000). By examining the relationship between organizations, populations, and fields, differences between organizations can be captured in terms of their organizational identities as well as their (changing) relationships with the organizational field. We discuss the analytical strategies we used in our study of institutional change and describe our findings of organizational heterogeneity across levels and over time. We conclude with suggestions for future research that incorporate elements of our study design and lessons from our research process and outcomes.

The Bureau of Economics in the Federal Trade Commission has a three-part role in the Agency and the strength of its functions changed over time depending on the preferences and ideology of the FTC’s leaders, developments in the field of economics, and the tenor of the times. The over-riding current role is to provide well considered, unbiased economic advice regarding antitrust and consumer protection law enforcement cases to the legal staff and the Commission. The second role, which long ago was primary, is to provide reports on investigations of various industries to the public and public officials. This role was more recently called research or “policy R&D”. A third role is to advocate for competition and markets both domestically and internationally. As a practical matter, the provision of economic advice to the FTC and to the legal staff has required that the economists wear “two hats,” helping the legal staff investigate cases and provide evidence to support law enforcement cases while also providing advice to the legal bureaus and to the Commission on which cases to pursue (thus providing “a second set of eyes” to evaluate cases). There is sometimes a tension in those functions because building a case is not the same as evaluating a case. Economists and the Bureau of Economics have provided such services to the FTC for over 100 years proving that a sub-organization can survive while playing roles that sometimes conflict. Such a life is not, however, always easy or fun.

Following the spirit of an earlier volume in the series focusing on ‘Comparative Approaches to Organizational Research’, the mandate of the current volume is to provide a comparative account of dynamics across two organizational fields – health care and higher education – and, subsequently, two specific types of organizational forms – hospitals and universities. In so doing, we take a broader perspective encompassing various conceptual and theoretical points of departure emanating from, mostly, the institutional literature in the social sciences (and its various perspectives), but also from public policy and administration literatures – of relevance to scholars and the communities of practice working within either field. In this introductory paper to the volume, we provide a brief overview of developments across the two organizational fields and illuminate on the most important scholarly traditions underpinning the study of both system dynamics as a whole as well as universities and hospitals as organizations and institutions. We conclude by reflecting on the implication of the volume’s key findings in regards to comparative research within organizational studies.

Researchers recommend a reorganization of the medical profession into larger groups with a multispecialty mix. We analyze whether there is evidence for the superiority of these models and if this organizational transformation is underway.

We summarize the evidence on scale and scope economies in physician group practice, and then review the trends in physician group size and specialty mix to conduct survivorship tests of the most efficient models.

The distribution of physician groups exhibits two interesting tails. In the lower tail, a large percentage of physicians continue to practice in small, physician-owned practices. In the upper tail, there is a small but rapidly growing percentage of large groups that have been organized primarily by non-physician owners.

While our analysis includes no original data, it does collate all known surveys of physician practice characteristics and group practice formation to provide a consistent picture of physician organization.

Our review suggests that scale and scope economies in physician practice are limited. This may explain why most physicians have retained their small practices.

Larger, multispecialty groups have been primarily organized by non-physician owners in vertically integrated arrangements. There is little evidence supporting the efficiencies of such models and some concern they may pose anticompetitive threats.

This is the first comprehensive review of the scale and scope economies of physician practice in nearly two decades. The research results do not appear to have changed much; nor has much changed in physician practice organization.

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.

The reforms that have been promoted in public organisations in developed countries since the 1970s are said to impose changes in professional bureaucracies by promoting self-governance and institutional autonomy and by challenging professionals’ status and their values and standards. Taking the specific case of Portugal, this paper intends to contribute to understanding to what extent professional bureaucracies, like hospitals and Higher Education Institutions (HEIs), have been affected by changes in state policies and how the professionals involved have responded to these organisational changes. Based on an empirical qualitative study the paper concludes that there are significant differences in the way the state changed the regulatory framework and the professional archetypes in hospitals and HEIs and that professionals give heterogeneous responses to these changes.