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The purpose of this paper is to introduce a special issue on boundary organising in healthcare bringing together a selection of six leading papers accepted for presentation at the 12th Organisational Behaviour in Health Care (OBHC 2020) Conference.

In this introductory paper, the guest editors position the special issue papers in relation to the theoretical literature on boundaries and boundary organising and highlight how these contributions advance our understanding of boundary phenomena in healthcare.

Three strands of thinking – practice-based, systems theory and place-based approaches – are briefly described, followed by an analytical summary of the six papers included in the special issue. The papers illustrate how the dynamic processes of boundary organising, stemming from the dual nature of boundaries and boundary objects, can be constrained and enabled by the complexity of broader multi-layered boundary landscapes, in which local clinical and managerial practices are embedded.

The authors set the scene for the papers included in the special issue, summarise their contributions and implications, and suggest directions for future research.

The authors call for interdisciplinary and multi-theoretical investigations of boundary phenomena in health organisation and management, with a particular attention to (1) the interplay between multiple types of boundaries, actors and objects operating in complex multi-layered boundary systems; (2) diversity of the backgrounds, experiences and preferences of patients and services users and (3) the role of artificial intelligence and other non-human actors in boundary organising.

Developing strategies of reflection, mitigation, justification and relational work is crucial for the success of boundary organising initiatives.

While previous health-care-related hybridity research has focused on macro- and micro-level investigations, this paper aims to study hybridization at the organizational level, with a specific focus on decision-making. The authors investigate how new politico-economic expectations toward a university hospital as a hybrid organization become internalized via organizational decision-making, resulting in the establishment of a new business collaboration and innovation-oriented unit.

The authors employed a social systems theoretical framework to explore organizational decision-making processes involved in the establishment of the new hybrid hospital unit. Drawing on 15 interviews and nine organizational documents, the authors describe and analyze three decision-making cycles using the concepts of complexity, decision and justification.

The findings reveal the challenging nature of decision-making during hybridization, as decisions regarding unprecedented organizational structures and activities cannot be justified by traditional decision premises. The authors show that decision-makers use a combination of novel justification strategies, namely, justification by problems, by examples and by obligations, to legitimize decisions oriented at non-traditional activities. Further, the analysis reveals how expectations of several societal systems, i.e. health care, education, science, law, economy and politics, are considered in decision-making taking place in hybrid organizations.

The study draws attention to the complexity of decision-making in a hybrid context and highlights the role of justification strategies in partially reducing complexity by concealing the paradoxical nature of decision-making and ensuring the credibility of resulting decisions. Also, the study presents a move beyond the dualism inherent in many previous hybridity studies by illustrating the involvement of several societal systems in hybridization.

The purpose of this paper is to perform an analysis of the current literature providing a deep contribution to understanding the paradigm shift from output to outcome measures in the public sector. Thus, the main aim is to provide relevant insights of both theoretical and empirical studies, offering a critique of the schemes and the research methods used and underlining future research opportunities for the compelling (or underestimated) contents and new emerging trends.

Articles published in main public management and administration journals, as internationally recognized, are analyzed using a structured literature review methodology. The paper investigates selected contributions published in Association of Business Schools (ABS) (Chartered Association of Business Schools – UK] Grade 4, 3 and 2 journals specializing in the field of “Public Sector Management,” dealing with the topic of performance measurement, from output to outcome.

Findings are described defying a framework that deepens emerging elements of current literature such as main countries analyzed, main research topics highlighted, research methods applied (qualitative versus quantitative; case studies, interviews, comparative studies etc.), different definitions of “output” and “outcome,” top keywords and their connections.

The paper’s findings aim to offer insights and a current “shared vision” into the state of the art and possible future research avenues on the topic of output and outcome measures in the public sector fostering the development of further studies especially in the direction of sustainability.