Hybridization as practice: clinical engagement with performance metrics and accounting technologies in the English NHS

Abstract

PurposeThis study aims to investigate the hybridization practices that medical managers engage with to promote accounting and performance measurement in the hybrid setting of healthcare. In doing so, the authors explore how medical managers enact and become practitioners of hybridity.Design/methodology/approachThe authors adopt a practice lens to conceptualize hybridization as an emergent, situated practice and capture the micro-activities that medical managers engage with when they enact hybridity. The authors conducted semi-structured interviews with medical managers, business managers and coding professionals and collected documents at an English National Health Service (NHS) hospital over the course of five years.FindingsThe findings accentuate two emergent practices through which medical managers instill hybridity to individuals who are hesitant or resistant to hybridization. Medical managers engage in equivocalizing and de-stigmatizing practices to broaden the understandings, further diversify or reconcile the teleologies of clinicians in non-managerial roles. In doing so, the authors signal the merits of accounting in improving care outcomes and remove the stigma associated to clinical engagement with costs.Originality/valueThe study contributes to hybridization and practice theory literature via capturing how hybridity is enacted in practice in a healthcare setting. As medical managers engage with and promote accounting information and performance measurement technologies in their practice environment, they transcend professional boundaries and hybridize the professional spaces that surround them.

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

“…Other studies provided evidence of a variegated mix of different institutions, such as alliances between public, private and third-sector actors (Rajala and Kokko, 2022); a network of public and private companies (Sargiacomo and Walker, 2022) and networks of multiple organisations (purchaser and providers) with different motivations (Zawawi and Hoque, 2022). Begkos and Antonopoulou's (2022) study focuses on the hybrid role of “medical managers”, who are clinicians with managerial responsibilities, thus carrying dual professional and hybrid identities.…”

“…Compromising on values is an instrument for reconciling competing value-creation logics and interests may be organised in several ways. 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).…”

“…Furthermore, legitimisation strategies are often created in different forms of performance measurements (De Waele et al , 2021). 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 (Moriniére and Georgescu, 2022).…”

“…A notable exception is a study by Ferry and Slack (2022), who suggest the concept of dialogic tools to explain account for how accounting practices can facilitate compromise amongst different actors holding different values. Begkos and Antonopoulou's (2022) study on medical managers as “practitioners of hybridity” also highlights the value of performance metrics to reconcile different values, goals, identities and priorities. Nevertheless, there is still limited research explicitly focusing on the role of the different actors (accountants, controllers, auditors and professionals) in the design and implementation of performance and accountability practices in hybrid organisations (Skelcher and Smith, 2015; Berry et al , 2009; Campanale et al, 2021).…”

Coherence in the use of a performance measurement system and compatibility between institutional logics in public hospitals

“…At the field level, management accounting research has emphasised the persistent relevance of the health professional and administrative logics (Chua and Degeling, 1993; Conrad and Uslu, 2011; Covaleski et al , 1993; Doolin, 1999; Jacobs et al , 2004; Kraus, 2012; Lehtonen, 2007; Leotta and Ruggeri, 2012; Malmmose and Kure, 2021). Some researchers have focused on how each of the two logics (health professional and administrative) cooperate by converging towards the other, thereby sacrificing its specific values and beliefs, such as in the phenomenon called hybridisation (Begkos and Antonopoulou, 2022; Kurunmäki, 2004; Lehtonen, 2007). Other scholars have highlighted the predominance of administrative logic over the health professional, characterised as the phenomenon called “accountingisation” (Covaleski et al , 1993; Kraus, 2012; Lapsley, 1994).…”