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.

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)
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Language: English
Published: Emerald, 2021
Publish Date: 2021-06-28


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
Type of Publication: A1 Journal article – refereed
Field of Science: 512 Business and management
Copyright information: © 2021, Emerald Publishing Limited. This AAM is provided for your own personal use only. It may not be used for resale, reprinting, systematic distribution, emailing, or for any other commercial purpose without the permission of the publisher.