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This study examines how state-owned hybrid organizations maintain organizational ambidexterity in practice, focusing on Apoteket AB. The research is situated against a shifting security landscape where pharmaceutical supply has re-emerged as a cornerstone of Sweden’s total defense. Consequently, Apoteket AB has assumed expanded responsibility for emergency stockpiling in collaboration with state actors, while simultaneously operating in a competitive market. This dual mandate creates inherent tensions between commercial viability and societal responsibility.

Adopting a qualitative case study design with an abductive approach, the study is based on semi-structured interviews with six respondents in various leadership roles. The analysis applies a practice perspective on institutional ambidexterity, focusing on how tensions are navigated through everyday actions.

The findings identify four distinct practices through which ambidexterity is maintained, two of which emerged inductively from the material and two from the theoretical framework: self-directed meaning-making, mutual adjustment, temporal segmentation, and selective hybridization. The study demonstrates that the navigation of tensions relies on a combination of structural solutions and individual interpretations, where external collaborations, internal decision-making processes, and professional autonomy play critical roles. Furthermore, ambidexterity is shaped by institutional uncertainty, resource constraints and technical conditions. While the study is limited by its reliance on self-reported data rather than direct observation, this points to the value of methodological triangulation in future research.

In conclusion, ambidexterity in hybrid organizations is maintained by dynamically combining and switching between different practices. By integrating features from the private, public and non-profit sectors, Apoteket AB creates the maintenance between exploration and exploitation that is required in a changing context. This provides valuable insights for other essential public services that navigate the tension between market demands and a strengthened Swedish total defense. The study also contributes through its practice-based approach, which represents a further step towards developing a practical understanding of how ambidexterity works in hybrid organisations.