Please join us for a colloquium being given by Katherine Kellogg, David J. McGrath jr (1959) Professor of Management and Innovation and a Professor of Business Administration in the Work and Organization Studies Department at the MIT Sloan School of Management.
Subordinate Activation and Implementing Reform Among Professionals in the Two U.S. Hospitals
Prior research on healthcare, social movements, and organizations has shown that implementing reform among professionals is difficult when the reform challenges professionals’ specialized expertise, autonomy, individual responsibility and engagement in complex work. This two-and-a half year ethnographic study of the implementation of PCMH (Patient-Centered Medical Home) reform in the primary care departments in two US hospitals examines how managers can bring about such change in professional practice. In this study, managers in both hospitals attempted to implement the same change in professional practice among doctors, had the same enabling contextual pressures for change, worked under the same organizational and reimbursement structure, and had the same micro contextual facilitators of change present within their organizations. But managers in one hospital successfully accomplished change in professional practice while those in the other did not. I demonstrate that managers can accomplish change using “subordinate activation tactics”—in which managers first provide subordinate semiprofessionals with empowerment that gives them the motivation to activate their structural position vis-à-vis the targeted professionals on behalf of managers and next provide them with positional tools to use in their daily work to minimize the targeted professionals’ concerns about the threats associated with change.