This article focuses on knowledge management in UK hospitals as an area in which organizational ambidexterity (OA) is a necessary condition. In contrast to much of the literature on OA that looks at senior managers, we focus on the role of “hybrid” middle managers, professional workers who hold managerial responsibilities, in ensuring that the quality of care delivered is at an optimum “safe” level for patients. We examine the influence of prevailing tensions and competing agendas characteristic of a professionalized, public‐sector context upon knowledge exploitation and exploration at the middle levels of the organization. Our study investigates how these tensions are experienced and reconciled at the individual level. We examine the contextual and personal circumstances that enable hybrid middle managers to forge workable compromises between exploration and exploitation to facilitate OA. We find that this process is contingent on professional legitimacy, social capital, and a holistic professional orientation. This has wider implications for human resource practice to support the discretion and motivation of hybrid middle managers to facilitate OA for enduring performance and advancement of best practice.