University of Oulu

Jansson, K., Tuunainen, J. and Mainela, T. (2021), "Concealing paradoxes in decision-making during hospital hybridization – a systems theoretical analysis", Journal of Health Organization and Management, Vol. 35 No. 2, pp. 195-211. https://doi.org/10.1108/JHOM-08-2020-0334

Concealing paradoxes in decision-making during hospital hybridization : a systems theoretical analysis

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Author: Jansson, Kaisu1; Tuunainen, Juha1; Mainela, Tuija1
Organizations: 1Department of Marketing, Management and International Business,University of Oulu Business School, Oulu, Finland
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.3 MB)
Persistent link: http://urn.fi/urn:nbn:fi-fe2021062840220
Language: English
Published: Emerald, 2021
Publish Date: 2021-06-28
Description:

Abstract

Purpose: While previous health-care-related hybridity research has focused on macro- and micro-level investigations, this paper aims to study hybridization at the organizational level, with a specific focus on decision-making. The authors investigate how new politico-economic expectations toward a university hospital as a hybrid organization become internalized via organizational decision-making, resulting in the establishment of a new business collaboration and innovation-oriented unit.

Design/methodology/approach: The authors employed a social systems theoretical framework to explore organizational decision-making processes involved in the establishment of the new hybrid hospital unit. Drawing on 15 interviews and nine organizational documents, the authors describe and analyze three decision-making cycles using the concepts of complexity, decision and justification.

Findings: The findings reveal the challenging nature of decision-making during hybridization, as decisions regarding unprecedented organizational structures and activities cannot be justified by traditional decision premises. The authors show that decision-makers use a combination of novel justification strategies, namely, justification by problems, by examples and by obligations, to legitimize decisions oriented at non-traditional activities. Further, the analysis reveals how expectations of several societal systems, i.e. health care, education, science, law, economy and politics, are considered in decision-making taking place in hybrid organizations.

Originality/value: The study draws attention to the complexity of decision-making in a hybrid context and highlights the role of justification strategies in partially reducing complexity by concealing the paradoxical nature of decision-making and ensuring the credibility of resulting decisions. Also, the study presents a move beyond the dualism inherent in many previous hybridity studies by illustrating the involvement of several societal systems in hybridization.

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Series: Journal of health organization and management
ISSN: 1477-7266
ISSN-E: 1758-7247
ISSN-L: 1477-7266
Volume: 35
Issue: 2
Pages: 195 - 211
DOI: 10.1108/JHOM-08-2020-0334
OADOI: https://oadoi.org/10.1108/JHOM-08-2020-0334
Type of Publication: A1 Journal article – refereed
Field of Science: 512 Business and management
Subjects:
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