Leading Hybrid Public Organizations: Institutional Pathways and IndirectLeadership Effects in State University Teaching Hospitals (RSPTN)
DOI:
https://doi.org/10.59888/ajosh.v1i01.702Keywords:
leadership, hybrid organization, organizational performance, learning organization, institutional characteristicsAbstract
This study aims to analyze the role of leadership in influencing organizational performance in State University Teaching Hospitals (RSPTN) as hybrid public organizations facing institutional complexity. The research employs a mixed-methods approach with a sequential explanatory design, combining quantitative analysis using PLS-SEM and qualitative analysis through in-depth interviews. The findings reveal that leadership does not have a direct effect on organizational performance but rather operates through indirect pathways mediated by learning organizations and institutional characteristics. These results indicate that in hybrid organizations, leadership effectiveness is highly dependent on institutional context and the organization’s capacity for learning and adaptation. Qualitative findings further demonstrate that leadership plays a crucial role in navigating institutional complexity, strengthening organizational learning, and distributing authority in a collective manner. This study contributes to the leadership literature by highlighting that the relationship between leadership and performance is indirect and context-dependent. Practically, the findings suggest that strengthening leadership in RSPTN should be accompanied by the development of learning organizations and the alignment of institutional governance to enhance sustainable organizational performance.
References
Aboramadan, M., Dahleez, K. A., & Hamdan, A. (2021). Leadership styles and employees' work outcomes in healthcare organizations: The mediating role of organizational commitment. International Journal of Organizational Analysis, 29(4), 1025–1043.
Alrashidi, M. (2023). Organizational learning and performance in healthcare: A systematic review. Journal of Health Organization and Management, 37(2), 145–162.
Bass, B. M., & Avolio, B. J. (1985). Transformational leadership and organizational performance. New York: Free Press.
Battilana, J., & Lee, M. (2014). Advancing research on hybrid organizing – Insights from the study of social enterprises. Academy of Management Annals, 8(1), 397–441.
Bloom, G., Standing, H., & Lloyd, R. (2004). Markets, information asymmetry and health care: Towards new social contracts. Social Science & Medicine, 58(10), 2079–2087.
Choudhary, A. I., Akhtar, S. A., & Zaheer, A. (2013). Impact of transformational and servant leadership on organizational performance. Journal of Business Ethics, 116(2), 433–440.
Daft, R. L. (2010). Organization theory and design (10th ed.). South-Western Cengage Learning.
Denhardt, J. V., & Denhardt, R. B. (2015). The new public service: Serving, not steering (3rd ed.). Routledge.
Denis, J.-L., Ferlie, E., & Van Gestel, N. (2015). Understanding hybridity in public organizations. Public Administration, 93(2), 273–289.
DiMaggio, P. J., & Powell, W. W. (1991). The new institutionalism in organizational analysis. University of Chicago Press.
Duressa, W. T., & Kidane, B. Z. (2024). Indirect effects of leadership behaviors on departmental performance via organizational learning in Ethiopian public research universities. Cogent Education, 11(1), 2354969.
Fahlevi, M., et al. (2022). Leadership and healthcare performance: Evidence from hospital settings. Journal of Healthcare Leadership, 14, 1–12.
Frenk, J., Chen, L., Bhutta, Z. A., et al. (2010). Health professionals for a new century: Transforming education to strengthen health systems. The Lancet, 376(9756), 1923–1958.
Garvin, D. A., Edmondson, A. C., & Gino, F. (2008). Is yours a learning organization? Harvard Business Review, 86(3), 109–116.
Greenwood, R., Raynard, M., Kodeih, F., Micelotta, E. R., & Lounsbury, M. (2011). Institutional complexity and organizational responses. Academy of Management Annals, 5(1), 317–371.
Joiner, B., et al. (2011). Leadership, agility and organizational effectiveness. Journal of Change Management, 11(1), 1–19.
Ludwikowska, K., Zakkariya, K. A., & Aboobaker, N. (2025). Academic leadership and job performance: the effects of organizational citizenship behavior and informal institutional leadership. Asian Education and Development Studies, 14(1), 115–131.
Marsick, V. J., & Watkins, K. E. (2003). Demonstrating the value of an organization's learning culture. Advances in Developing Human Resources, 5(2), 132–151.
Northouse, P. G. (2013). Leadership: Theory and practice (6th ed.). Sage Publications.
Pache, A.-C., & Santos, F. (2013). Inside the hybrid organization: Selective coupling as a response to competing institutional logics. Academy of Management Journal, 56(4), 972–1001.
Pedler, M., Burgoyne, J., & Boydell, T. (1991). The learning company: A strategy for sustainable development. McGraw-Hill.
Saltman, R. B., Durán, A., & Dubois, H. F. W. (2011). Governing public hospitals: Reform strategies and the movement towards institutional autonomy. World Health Organization.
Scott, W. R. (2014). Institutions and organizations: Ideas, interests, and identities (4th ed.). Sage Publications.
Scott, W. R., Ruef, M., Mendel, P., & Caronna, C. (2000). Institutional change and healthcare organizations. University of Chicago Press.
Senge, P. M. (1990). The fifth discipline: The art and practice of the learning organization. Doubleday.
Shipton, H., West, M., Dawson, J., Birdi, K., & Patterson, M. (2008). HRM as a predictor of innovation. Human Resource Management Journal, 18(2), 120–138.
Soklaridis, S. (2014). Leadership in healthcare organizations: A review. Healthcare Management Forum, 27(2), 78–83.
Sugiyono. (2017). Mixed research methods. Alphabet.
Thornton, P. H., Ocasio, W., & Lounsbury, M. (2012). The institutional logics perspective. Oxford University Press.
Trastek, V. F., Hamilton, N. W., & Niles, E. E. (2014). Leadership models in healthcare. Mayo Clinic Proceedings, 89(3), 374–381.
Watkins, A. (2020). Health research methodology. Gadjah Mada University Press.
World Bank. (2019). Improving healthcare systems in developing countries. World Bank Publications.
World Health Organization. (2016). Framework on integrated, people-centred health services. WHO Press.
Yukl, G. (2013). Leadership in organizations (8th ed.). Pearson.
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Copyright (c) 2022 Katarina Sri Nenggih Wahyuni, Agus Heruanto Hadna, Muhadjir Darwin, Yodi Mahendradhata

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