This article explores and extends the concept of hybridity to understand current changes in public services organizations, notably as seen from an organizational studies perspective. The notion of hybridity has become more important, given that the public sector increasingly blurs with other sectors and more social actors. Previous reliance on the use of ideal‐types in characterizing public services reforms has masked expanding heterogeneity. We here move beyond the (i) conventional focus on structural hybridity to consider (ii) institutional dynamics, (iii) social interactions, and (iv) new identities and roles in public services. Based on these four dimensions of hybridity, we review alternative theoretical frameworks. We suggest that bringing together work from the neighbouring disciplines of public administration and organization studies may improve our understanding of public services hybridity and outline a future research agenda.

BackgroundWhile healthcare systems vary in their structure and available resources, it is widely recognized that medical doctors play a key role in their adaptation and performance. In this article, we examine recent government and organizational policies in two different health systems that aim to develop clinical leadership among the medical profession. Clinical leadership refers to the engagement and guiding role of physicians in health system improvement. Three dimensions are defined to conduct our analysis of engaging medical doctors in healthcare leadership: the position and status of medical doctors within the system; the broader institutional context of governmental and organizational policies to engage medical doctors in clinical leadership roles; and the main factors that may facilitate or limit achievements.MethodsOur aim in this study is exploratory. We selected two contrasting cases according to their level of institutional pluralism: one national health insurance system, Canada, and one etatist social insurance system, the Netherlands. We documented the institutional dynamics of medical doctors’ engagement and leadership through secondary sources, such as government websites, key policy reports, and scholarly literature on health policies in both countries.ResultsInitiatives across Canadian provinces signal that the medical profession and governments search for alternatives to involve doctors in health system improvement beyond the limitations imposed by their fundamental social contract and formal labour relations. These initiatives suggest an emerging trend toward more joint collaboration between governments and medical associations. In the Dutch system, organizational and legal attempts for integration over the past decades do not yet fit well with the ideas and interests of medical doctors. The engagement of medical doctors requires additional initiatives that are closer to their professional values and interests and that depart from an overly focus on top down performance indicators and competition.ConclusionsDifferent institutional contexts have different policy experiences regarding the engagement and leadership of medical doctors but seem to face similar policy challenges. Achieving alignment between soft (trust, collaboration) and hard (financial incentives) levers may require facilitative conditions at the level of the health system, like clarity and stability of broad policy orientations and openness to local experimentation.

Responding to recent calls for more context and history in studying (semi-)professionals in the public sector, this article examines the emergence of hybrid professional roles along with large-scale reforms of Dutch healthcare and education since 1965. Using a theoretical framework based on public management literature and key professional attributes, the article shows how hybrid role expectations are developed by accumulation rather than replacement of successive reform models. Within a single national context, it also highlights considerable sectoral variation in how reform affects professionals' roles, suggesting a complex mutual relationship between reform and professions rather than a one-sided policy impact.