Hybridity and the use of performance measurement: facilitating compromises or creating moral struggles? Insights from healthcare organizations

Abstract

PurposeThis study aims to understand whether and how the use of performance measures in the context of healthcare organizations facilitates the dynamics of compromise or whether it creates moral struggles among a wide variety of actors. It offers novel insights into the concept of hybridity by investigating its underlying moral dimension. Drawing upon the sociology of worth theory (Boltanski and Thévenot, 1991, 2006), this paper examines how actors negotiate and compromise over time concerning issues of justice, involving the use of performance measures on a day-to-day basis.Design/methodology/approachThe article presents a single case study of a medical unit in a French public hospital. Data were obtained through the ethnographic method, semi-structured interviews and internal financial and accounting documents.FindingsUnlike earlier accounting studies, the authors analyze whether, and how, accounting, on one hand, contributes to the dynamics of compromise between actors with divergent values that characterize hybrid organizations, and, on the other hand, increases tensions among actors with convergent values involved in caregiving. This offers practical insights into three relational mechanisms underlying the dynamics of compromise and their limits through the time dimension.Research limitations/implicationsThe authors use a single case study in a country-specific context.Practical implicationsThis study helps managers of healthcare organizations to understand the relationships between the use of performance measures and their impact on the evaluation of worth in practice.Originality/valueIn terms of theoretical contribution, the authors show how the sociology of worth (Boltanski and Thévenot, 1991, 2006) complements the analysis of hybridity and develop an original approach to understanding the ambivalent role of performance measures in bringing together divergent values within French public hospitals.

Accounting, hybrids and hybridity – attending to the value dimension in institutional logics

“…A key motivation for this essay was the remarkable growth in accounting studies on value hybridity, combined with the fact that these studies focused primarily on cognitive processes and left institutional values relatively underexplored (Ahrens et al , 2018; Carlsson-Wall et al , 2016; Cruz et al , 2009; Ezzamel et al , 2012; Ferry and Eckersley, 2020; Ferry and Slack, 2021; Gebreiter and Hidayah, 2019; Kaufman and Covaleski, 2019; Knardal, 2020; Lada et al , 2020; Laguecir et al , 2020; Maine et al , 2021; Morinière and Georgescu, 2021; Schäffer et al , 2015; Thomasson and Kristoferson, 2020; Thomson et al , 2014; Wimalasinghe and Gooneratne, 2019). Notwithstanding their varied empirical contexts, they follow a narrative scheme that could be stylised as follows.…”

Accounting, performance and accountability challenges in hybrid organisations: a value creation perspective

“…The study on the English National Health Service (NHS) demonstrates how the medical managers signal the merit of performance measures in improving patient and financial outcomes and remove stigma associated to clinical engagement with costs (Begkos and Antonopoulou, 2022). In a different vein, the study on the French healthcare organisations highlights that using performance measures may bring moral risks and injustice that require social actors to construct different arguments for different audiences (Morini ere and Georgescu, 2022). Sargiacomo and Walker's (2022) work on disaster governance argues that financial and non-financial measures were taken for various purposes, ranging from internal planning, coordination, decision-making and deviance analysis to external accountability.…”

“…Mixing values can be related to multiple objectives. Some AAAJ special issue articles relate to “public benefit” objectives and private benefits in the case of benefit corporations (Baudot et al , 2022), market and social objectives in a federal power administration (Convery and Kaufman, 2022), financial, social and environmental objectives in social housing companies (Maine et al , 2022), short- and long-term humanitarian activities (Sargiacomo and Walker, 2022), the goals of cost-efficiency and the needs of individual childcare (Schrøder et al , 2022), and the mission of “care” and the value of “public service” with “efficiency” (Moriniére and Georgescu, 2022). Other articles demonstrated the existence of and tensions between the multiplicity of institutional logics, such as economic and social logics (Ferry and Slack, 2022); the logics of calculating the long-term social and economic impacts of preventive social investments (Kastberg Weichselberger and Lagström, 2022); regulatory/bureaucratic, market and service logics in the case of information and communication technology (ICT) service providers (Maran and Lowe, 2022); community, public and market logics in the case of public and private partnership (PPP) policies (Stafford and Stapleton, 2022) and healthcare (medical), administrative and political-institutional logics (Rautiainen et al , 2022).…”

“…Some studies related to hybridity on health and social care organisations recognise the role of performance measurement as a mediating and compromising one (Begkos and Antonopoulou, 2022; Maran and Lowe, 2022; Zawawi and Hoque, 2022; Kastberg Weichselberger and Lagström, 2022; Sargiacomo and Walker, 2022). Other studies show that performance measures may play an ambivalent role in mitigating the tensions, by enabling compromises between actors with divergent values, and enhancing tensions between actors with convergent values (Moriniére and Georgescu, 2022). Also, negative emotions stirred by a pressure to adopt hybrid practices aggregated into incompatible institutional logic may lead to conflict and prevent the use of accounting tools in professional hybridisation (Rautiainen et al , 2022).…”

“…Mixing refers to the process of combining previously created or existing value categories with the aim of creating innovative variants, blends and layers of value (Convery and Kaufman, 2022; Rautiainen et al , 2022). Compromising concerns the governance of competing, contradicting and even conflictual values in hybrid arrangements through the reconciliation of different value propositions, owners and constituencies (Moriniére and Georgescu, 2022; Schrøder et al , 2022). Legitimising is a crucial concern for hybrid organisations as legitimacy demands from external audiences, society and media may impose constraints, limitations and important performance measurement and accountability problems.…”