Life beyond emergence: institutional intermediaries and the persistence of hybrid forms

We report on a multi-level longitudinal study investigating a population of public-private hybrid organizations in the Italian healthcare field, where a public service and quasi-market logic coexist. A combination of survey, interviews and archival data allowed us to trace the dynamics of persistence and decay of two hybrid templates over 25 years (1992-2016). By bridging the literature on institutional complexity and hybrids with insights from imprinting, we illuminate the role of field-level actors (regional authorities) who as institutional intermediaries and agents of recursive imprinting embed their prioritization of institutional logics in distinct templates for organizing, and provide them to hybrid organizations during multiple sensitive periods over time. Our findings draw attention to the differential institutional capacity of institutional intermediaries to prioritize and enforce institutional logics, and to the diverse relational, procedural and discursive mechanisms they employ during imprinting processes. Ultimately, our findings advance the understanding of how certain hybrid forms come to persist while others decay.