Challenging operations : changing interactions, identities, and institutions in a surgical teaching hospital
Author(s)Kellogg, Katherine C
Sloan School of Management.
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If institutions are comprised of cultural and positional prescriptions for action and interpretation, then institutional change must depend at some point on thinking the unthinkable, acting in "inappropriate" ways, and convincing powerful others to give up their privilege. How does this happen? How do people come to question taken-for-granted beliefs? How do they decide to attempt the unacceptable in their interactions with others? How do they persuade those who benefit from the status quo to change? And how do they extend new understandings created in particular interactions into future situations? In this dissertation, I tell the story of surgical residents at ACADEMIC hospital who accomplished both institutional stability and institutional change in their interactions with one another in the wake of nationwide changes occurring outside their hospital. Using findings from a 15 month ethnography of this surgical teaching hospital, I demonstrate that institutional stability and change occur only insofar as they are negotiated in interactions between particular workplace members with particular reasons for wanting either to maintain or to challenge the status quo.(cont.) I draw on these findings, in combination with identity theory and symbolic interactionism, to develop a relational, identity-based framework for understanding processes of institutional stability and change. Members negotiate institutional stability and change as they shape their actions in particular situations according to their sense of self in relation to the situation, their own personal narrative, and their judgment of the likely response of their interaction partner to their various actions. What looks like institutional stability or change in the abstract is, in fact, constituted through the culturally and politically-charged daily contests between organization members interacting with one another to either protect or change their way of life and the persona and authority associated with it. At first pass, these daily contests between one action or another in familiar situations may seem obvious, even unimportant. But it is in these simple contests around habitual issues that the institutional order is constructed. The institutionalized values, positions, and beliefs that shape the patterned action of large numbers of people across decades are built up and torn down in these daily contests between challengers and defenders of the status quo and the varied positions of privilege and senses of self that that this status quo provides.
Thesis (Ph. D.)--Massachusetts Institute of Technology, Sloan School of Management, June 2005."May 2005."Includes bibliographical references (leaves 165-170).
DepartmentSloan School of Management.
Massachusetts Institute of Technology
Sloan School of Management.