Competing logics in a hybrid organization: ICT service provision in the Italian health care sector

Purpose This paper reports an investigation of a hybrid ex-state-owned enterprise (ex-SOE) providing ICT (Information and Communication Technology) services in the Italian healthcare sector (in-house provision). The authors aim to offer a framing that reflects the concerns expressed in the interdisciplinary literature on hybrid SOEs from management, public administration and, more recently, accounting. Design/methodology/approach This study operationalizes Besharov and Smith's (2014) theoretical model on multiple logics to analyze institutional structures and organizational outcomes at an ICT in-house provider. It builds on extensive textual analysis of regulatory, archival, survey and interview data. Findings The study results show that the combination of hybridity in the form of layering of multiple logics in the health care sector (Polzer et al., 2016) creates problems for the effectiveness of ICT provision. In particular, the hybrid organization the authors study remained stuck in established competing relationships despite a restructure of regional health care governance. The study findings also reflect on the design of organizational control mechanisms when balancing different logics. Research limitations/implications The identified case-study accountability practices and performance system add to the debate on hybrid organizations in the case of ex-SOEs and facilitate the understanding and management of hybrids in the public sector. The authors note policymaking implications. Originality/value The authors' operationalization of Besharov and Smith's (2014) model adds clarity to key elements of their model, notably how to identify evidence in order to disentangle notions of centrality and compatibility. By doing this, the authors' analysis offers potential insights into both managerial design and policy prescription. The authors provide cautionary tales around institutional reorganization regarding the layered synthesis of logics within these organizations.