Hybrid controls and accountabilities in public sector management : Three case studies in a reforming hospital sector

Purpose – The purpose of this paper is to discuss why public sector reforms hybridize during implementation processes, consequences on accountability relations and practitioners’ and policymakers’ reactions to these changes. Design/methodology/approach – The paper considers experiences from three initiatives related to the governance reform in the Norwegian hospital sector. Data were collected via interviews and document studies, and all three cases were longitudinal studies. Findings – Unexpected consequences of reform initiatives and contextual changes are causing controls to hybridize and having profound effects on accountability relations. However, the gradually alignment of controls in a dynamic pattern of hybridization enables the balancing of conflicts in the chain of accountabilities. Hybrid controls are observed to emerge as stronger than the initial ideal control models. The longitudinal studies of control hybridization illuminate the sector’s survival in the long run, as they allow for adaptation to changes in contexts. Practical implications – This work augments leaders’ understanding of how governmental strategies may follow diverse paths and yield results that diverge from intentions. Narrow accountability bases inhibit the government from implementing political decisions through agencies. Conversely, agents must relate to direct control from authorities. The predictability of agents’ decision space is reduced, and the control process becomes more ambiguous. Originality/value – Through connecting what happens in agencies with accountabilities in the political level, it is possible to study the flexible nature of accountability relations and why controls hybridize. The paper underlines the need for longitudinal studies to describe complex patterns of reform initiatives.