“Hybrid managers”: An institutional perspective on the rise and realization of medical management

Abstract

Medical-managerial “hybrids” are medical professionals engaged in managing professional work, colleagues, and other organizational resources. These individuals have been seen as a way to reduce the friction between traditional professional values and new organizational paradigms (Montgomery, 2001; Numerato et al., 2011). Accordingly, they have diffused among health systems globally. Yet, research has shown that professionals taking up managerial roles responded to these conflicting demands in different ways. While some of them fully enacted their hybrid roles as they succeeded in finding meaningful combinations of professional and managerial values (Noordegraaf, 2007), others externally conformed to managerial practices but without doing so substantially (Kitchener, 2002). In order to explain variability in the development of hybrid medical managerial models at the collective level, a few studies addressed the antecedents of individual doctors’ hybridization and the mediating role of context. In particular, we know relatively little with reference to the role of the social/organizational context on these individual dynamics, as most studies in the medical field tend to focus only on interactions take place within the professional community. Therefore, the research question of this study has been: “how do medical managers hybridize over time, and if and how this evolution is influenced by the social/organizational context in which professionals work?” Theoretically, I draw mainly from the perspective of institutional theory, in particular institutional change and identity work, which offer a useful perspective to study complex professional organizations (e.g. Pratt et al., 2006; Greenwood et al., 2011; Lockett et al., 2012; McGivern et al., 2015; Reay et al., 2017), bridging it with the contributions of the sociology of professions. Empirically I studied two hospitals, in Italy and The Netherlands, adopting an interpretive and inductive approach opting for a qualitative case study research design. Data were collected from different sources, including semi-structured interviews with medical and non-medical managers, participant observation at board meetings and archival data. First of all, in this work I identify those antecedents explaining the rise of a collective of healthcare hybrid managers, finding that medical management is largely path dependent, and where medical managers are already institutionalized new hybrid managers in formal roles strive to achieve legitimacy and power. This is a relevant finding as it contrasts the “standardization” of medical management policies internationally, which strive to implement reforms with similar hospital organizational structures and managerial roles across (sometimes very) different countries. Also, I show that an organizational context providing opportunity for engagement in management is necessary for hybrid identity change to occur, as the institutional structure can enhance and not only prevent professionals’ hybridization. Then I highlight the significance of relational and social dimensions in hybridization: while existing research on professional identity had looked at the role of interdependencies of hybrids within the professional group, I show that relevant actors - in particular support staff, non medical managers and executives - facilitate the interiorization of the new hybrid identity and the legitimization of the new role.