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Generally, service areas, procedures, and major concepts for hybrid systems are considered as defined and controllable aspects according to the bureaucratic model of organizational structural configurations. From a viewpoint, based on a participating observation and an inductive clinical approach within medium-sized hospital centers with approximately 1,000 beds, this topic questions the assumption of a structural and controlled purpose for these procedures. We propose two additional concepts of governance: logistics and the transverse integrator, both being necessary for organizational rebalancing in services areas and procedural "co-opetitive" integration. This concept leads us to rethink and position these procedures according to areas of differentiation and integration.

Key words. – procedures – hybridization – differentiation -- integration.