Challenging operations : changing interactions, identities, and institutions in a surgical teaching hospital

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.

Department dc:contributor.department

Sloan School of Management.

Grantor dc:publisher

Massachusetts Institute of Technology

Year dc:date.issued

2005

Author dc:creator

• Kellogg, Katherine C

Advisor dc:contributor.advisor

• Lotte Bailyn.

• Sloan School of Management.

Statement dc:rights

• M.I.T. theses are protected by copyright. They may be viewed from this source for any purpose, but reproduction or distribution in any format is prohibited without written permission. See provided URL for inquiries about permission.

Licence dc:rights.uri

• http://dspace.mit.edu/handle/1721.1/7582

Language dc:language.iso

eng

Handle dc:identifier.uri

http://hdl.handle.net/1721.1/33414

OAI identifier oai:identifier

oai:dspace.mit.edu:1721.1/33414