Formalization in Health Care: The Role of Hybrid Professionals

Abstract

This article explores the introduction of a new formalized management control system (MCS) in a Norwegian municipal emergency care unit where formal control had previously been limited. We seek to understand how and why the formalized MCS came to be perceived as enabling by organizational members. In the process of formalization key, individuals emerge, as hybrid professionals, engaging in specific choices and actions in the design, implementation, and use of the formal MCS, founded in their efforts to balance the complexities of multiple logics. A key contribution is how hybrid professionals, through their practices of hybridization, become important mediators of the outcome of formalization. Beyond the design characteristics of MCS, the question of whether the system is perceived as enabling or coercive is, also, dependent upon the efforts of key individuals in balancing the complexity of multiple logics. Moreover, we observe how hybrids at different levels of the organization mutually engage in enabling hybrid practices throughout the process of formalization that appears critical for the outcome, suggesting that practices of hybridization in formalization are a collective endeavor rather than exclusively individual.