Organizational Ambidexterity and the Hybrid Middle Manager: The Case of Patient Safety in UK Hospitals

• DOI: http://doi.org/10.1002/hrm.21725
• Author: Graeme Currie,Nicola Burgess,Karoline Strauss,Geoffrey Wood
• Published date: 01 December 2015
• Date: 01 December 2015

Human Resource Management, December 2015, Vol. 54, No. S1. Pp. S87–S109

© 2015 Wiley Periodicals, Inc.

Published online in Wiley Online Library (wileyonlinelibrary.com).

DOI:10.1002/hrm.21725

Correspondence to: Nicola Burgess, Warwick Business School, University of Warwick, Coventry, CV4 7AL UK,

Phone: +44 (0)24 765 28222, E-mail: Nicola.Burgess@wbs.ac.uk

ORGANIZATIONAL AMBIDEXTERITY

AND THE HYBRID MIDDLE

MANAGER: THE CASE OF PATIENT

SAFETY IN UK HOSPITALS

NICOLA BURGESS, KAROLINE STRAUSS,

GRAEMECURRIE, AND GEOFFREY WOOD

This article focuses on knowledge management in UK hospitals as an area in

which organizational ambidexterity (OA) is a necessary condition. In contrast to

much of the literature on OA that looks at senior managers, we focus on the

role of “hybrid” middle managers, professional workers who hold managerial

responsibilities, in ensuring that the quality of care delivered is at an optimum

“safe” level for patients. We examine the infl uence of prevailing tensions and

competing agendas characteristic of a professionalized, public-sector context

upon knowledge exploitation and exploration at the middle levels of the organi-

zation. Our study investigates how these tensions are experienced and reconciled

at the individual level. We examine the contextual and personal circumstances

that enable hybrid middle managers to forge workable compromises between

exploration and exploitation to facilitate OA. We fi nd that this process is contin-

gent on professional legitimacy, social capital, and a holistic professional orien-

tation. This has wider implications for human resource practice to support the

discretion and motivation of hybrid middle managers to facilitate OA for endur-

ing performance and advancement of best practice. © 2015 Wiley Periodicals, Inc.

Keywords: organizational ambidexterity, contextual ambidexterity, middle

managers, knowledge management, health care, public-sector HRM

Disclaimer: This article presents independent research funded by the National Institute for Health Research (NIHR)—NIHR

HS&DR 09/1002/05. The research contribution was part funded through NIHR CLAHRC WM. The views expressed are those of

the authors and not necessarily those of the NHS, NIHR, or the Department of Health.

This is the study of organizational ambi-

dexterity (henceforth referred to as OA),

that is, the capability to pursue explora-

tion and exploitation activities (March,

1991), in UK hospitals. OA has been used

to analyze a variety of organizational phenom-

ena (see, e.g., Birkinshaw & Gupta, 2013; Lavie,

Stettner, & Tushman, 2010; Raisch & Birkinshaw,

2008; Simsek, 2009, for reviews). Following calls

for the use of narrow and context-specific defi-

nitions of exploitation and exploration (Lavie

et al., 2010), we focus on OA in the context

of knowledge management and define it as an

organization’s ability to simultaneously use and

S88 HUMAN RESOURCE MANAGEMENT, DECEMBER 2015

Human Resource Management DOI: 10.1002/hrm

Within a public-

sector context, and

specifically health

care, OA may provide

the basis for the best

possible service,

while making efficient

use of resources.

has explored the role of players other than senior

managers for OA (Turner & Lee-Kelley, 2013). Yet,

the important role of middle managers in par-

ticular has long been noted for their contribu-

tion to shaping strategy (Dutton & Ashford, 1993;

Wooldridge, Schmid, & Floyd, 2008), organiza-

tional learning (Sun & Anderson, 2012; Turner &

Lee-Kelley, 2013), and as valuable intermediaries

for the implementation of change (Balogun, 2003;

Nonaka & Takeuchi, 1995). Further, as Krausert

(2014) argues, the study of groups of knowledge

workers distinct from senior managers is essen-

tial for strategic investment and implementation

of human resource practices and systems. Middle

managers have to reconcile the practicalities of

day to day operations—and the concerns and

needs of frontline staff—with the strategic choices

and priorities set by more senior managers.

We focus on “hybrid” middle managers, a

particular category of middle managers, which

represent professional workers such as solicitors,

accountants, and doctors, who hold managerial

as well as professional responsibility (Llewellyn,

2001; McGivern, Currie, Ferlie, Fitzgerald, &

Waring, in press). Since the advent of New Public

Management in the 1980s (Hood, 1991), increas-

ing numbers of professionals have adopted mana-

gerial roles across public and private sectors. The

hybridization of professional workers into mana-

gerial roles has been particularly prevalent within

health care, with hybrids outnumbering general

managers without clinical roles approximately

four to one (Buchanan et al., 2013). We contend

that hybrid middle managers are uniquely placed

to forge workable compromises between knowl-

edge exploration and exploitation, contribut-

ing to the literature by establishing a novel link

between hybridity and OA.

Third, we identify the contingencies that

enable hybrid middle managers to facilitate

knowledge exploration and exploitation at an

operational level. Hybrid managers are not a

homogenous group. Within the health care con-

text, hybrids may hold predominantly specialist

medical knowledge (such as anesthetists or sur-

geons), or more generalized and holistic knowl-

edge (such as geriatricians, occupational therapists,

matrons, and ward managers). Acknowledging

such diversity of knowledge among actors within

an organization is important for the study of OA

because different professional roles give rise to

different operational contexts. The ability of indi-

viduals to mediate tension at an operational level,

critical to OA, may thus be influenced by their

role context (Kang & Snell, 2009; Turner & Lee-

Kelley, 2013). Indeed, recent literature suggests

that some high status medical professionals are

develop existing knowledge to refine practice

(exploitation), as well as generate new knowledge

through knowledge search and experimentation

to advance existing frontiers of best practice

(exploration) (Levinthal & March, 1993; Turner

& Lee-Kelley, 2013). Within a public-sector con-

text, and specifically health care, OA may pro-

vide the basis for the best possible service, while

making efficient use of resources. Through our

study of patient safety knowledge, defined as

knowledge that is critical to ensure the quality of

care delivered is at an optimum “safe” level for

patients, we contribute to the contextual view of

OA (Birkinshaw & Gibson, 2004), drawing upon

related literatures of organizational learning to

frame our analysis (Kang & Snell, 2009; Turner &

Lee-Kelley, 2013).

Our study contributes to the literature on OA

in several ways. First, our study provides a multi-

level perspective on “contextual” OA, a “nested”

concept that “transpires at multiple levels in

the organization simultaneously”

(Birkinshaw & Gupta, 2013, p. 294).

We follow Turner and Lee-Kelley

(2013) in their view that extant

literature neglects a multidomain

analysis, and that this limits our con-

ceptual understanding of OA and

the processes through which OA is

facilitated (see also Gupta, Smith, &

Shalley, 2006; Raisch & Birkinshaw,

2008; Simsek, 2009). In order to

address this limitation, we explore

how tensions arising from the inter-

organizational level and the intraor-

ganizational level are experienced

at the level of the individual. This is

important because, while scholars have acknowl-

edged that individuals are likely to play a key

role in reconciling tensions between exploration

and exploitation activities (Raisch & Birkinshaw,

2008), the specific process through which OA

is achieved has rarely been investigated (Jansen,

Tempelaar, Van den Bosch, & Volberda, 2009;

O’Reilly & Tushman, 2013; Raisch, Birkinshaw,

Probst, & Tushman, 2009; Turner & Lee-Kelley,

2013).

Second, we focus on middle managers, whom

we define as having at least two levels of staff

above and below them in the managerial hierar-

chy (Currie & Procter, 2005; Dutton & Ashford,

1993; Wooldridge, Schmid, & Floyd, 2008). Extant

literature focuses upon senior managers manag-

ing OA in response to the dynamics of context

(Jansen, George, Van den Bosch, & Volberda, 2008;

O’Reilly & Tushman, 2008; O’Reilly, Tushman, &

Harreld, 2009). To date, however, limited research