Katherine C. Kellogg

Life in the Trading Zone: Structuring Coordination Across Boundaries in Postbureaucratic Organizations

In our study of an interactive marketing organization, we examine how members of different communities perform boundary-spanning coordination work in conditions of high speed, uncertainty, and rapid change. We find that members engage in a number of cross-boundary coordination practices that make their work visible and legible to each other, and that enable ongoing revision and alignment. Drawing on the notion of a trading zone, we suggest that by engaging in these practices, members enact a coordination structure that affords cross-boundary coordination while facilitating adaptability, speed, and learning. We also find that these coordination practices do not eliminate jurisdictional conflicts, and often generate problematic consequences such as the privileging of speed over quality, suppression of difference, loss of comprehension, misinterpretation and ambiguity, rework, and temporal pressure. After discussing our empirical findings, we explore their implications for organizations attempting to operate in the uncertain and rapidly changing contexts of postbureaucratic work.

The Impact of the 80-Hour Resident Workweek on Surgical Residents and Attending Surgeons

Objective:To assess the impact of the 80-hour resident workweek restrictions on surgical residents and attending surgeons. Summary Background Data:The ACGME mandated resident duty hour restrictions have required a major workforce restructuring. The impact of these changes needs to be critically evaluated for both the resident and attending surgeons, specifically with regards to the impact on motivation, job satisfaction, the quality of surgeon training, the quality of the surgeons life, and the quality of patient care. Methods:Four prospective studies were performed at a single academic surgical program with data collected both before the necessary workforce restructuring and 1 year after, including: 1) time cards to assess changes in components of daily activity; 2) Web-based surveys using validated instruments to assess burnout and motivation to work; 3) structured, taped, one-on-one interviews with an external PhD investigator; and 4) statistical analyses of objective, quantitative data. Results:After the work-hour changes, surgical residents have decreased “burnout” scores, with significantly less “emotional exhaustion” (Maslach Burnout Inventory: 29.1 “high” vs. 23.1 “medium,” P = 0.02). Residents have better quality of life both in and out of the hospital. They felt they got more sleep, have a lighter workload, and have increased motivation to work (Herzberg Motivation Dimensions). We found no measurable, statistically significant difference in the quality of patient care (NSQIP data). Resident training and education objectively were not statistically diminished (ACGME case logs, ABSITE scores). Attending surgeons perceived that their quality of their life inside and outside of the hospital was “somewhat worse” because of the work-hour changes, as they had anticipated. Many concerns were identified with regards to the professional development of future surgeons, including a change toward a shift-worker mentality that is not patient-focused, less continuity of care with a loss of critical information with each handoff, and a decrease in the patient/doctor relationship. Conclusion:Although the mandated restriction of resident duty hours has had no measurable impact on the quality of patient care and has led to improvements for the current quality of life of residents, there are many concerns with regards to the training of professional, responsible surgeons for the future.

Operating room: relational spaces and microinstitutional change in surgery.

One of the great paradoxes of institutional change is that even when top managers in organizations provide support for change in response to new regulation, the employees whom new programs are designed to benefit often do not use them. This 15‐month ethnographic study of two hospitals responding to new regulation demonstrates that using these programs may require subordinate employees to challenge middle managers with opposing interests. The article argues that relational spaces—areas of isolation, interaction, and inclusion that allow middle‐manager reformers and subordinate employees to develop a cross‐position collective for change—are critical to the change process. These findings have implications for research on institutional change and social movements.

Hot Lights and Cold Steel: Cultural and Political Toolkits for Practice Change in Surgery

One of the great paradoxes of organizational culture is that even when less powerful members in organizations have access to cultural tools (such as frames, identities, and tactics) that support change, they often do not use these tools to challenge traditional practices that disadvantage them. In this study, I compare data about work practice change from my own field study of an elite teaching hospital (conducted in the early 2000s) to previously reported data from field studies of two similar hospitals (one conducted in the 1970s and one in the 1990s). I demonstrate that although cultural toolkits supporting change may allow less powerful organization members to see traditional practices as running counter to their interests, they may not be able to significantly change traditional practices unless they also have access to what I call political toolkits (including tools such as staffing systems, accountability systems, and evaluation systems) that support change. Although cultural tools allow them to reinterpret practices that disadvantage them as unfair, political tools allow them to feel optimistic that others will help them effect change. Whereas cultural tools enable them to develop a “we” feeling with other reformers, political tools allow them to coordinate their change efforts. And although cultural tools provide them with a repertoire of contentious tactics, political tools afford them a sense of security that they can battle defenders of the status quo without ruining their careers. These findings contribute to our understanding of both the cultural construction of organizational life and social movement processes.

The Initial Assignment Effect Local Employer Practices and Positive Career Outcomes for Work-Family Program Users

One of the great paradoxes of inequality in organizations is that even when organizations introduce new programs designed to help employees in traditionally disadvantaged groups succeed, employees who use these programs often suffer negative career consequences. This study helps to fill a significant gap in the literature by investigating how local employer practices can enable employees to successfully use the programs designed to benefit them. Using a research approach that controls for regulatory environment and program design, we analyze unique longitudinal personnel data from a large law firm to demonstrate that assignment to powerful supervisors upon organization entry improves career outcomes for individuals who later use a reduced-hours program. Additionally, we find that initial assignment to powerful supervisors is more important to positive career outcomes—that is, employee retention and performance-based pay—than are factors such as supervisor assignment at the time of program use. Initial assignment affects career outcomes for later program users through the mechanism of improved access to reputation-building work opportunities. These findings have implications for research on work-family programs and other employee-rights programs and for the role of social capital in careers.

Career Satisfaction of Women in Surgery: Perceptions, Factors, and Strategies

BACKGROUND With the current and projected shortages of general surgeons, more attention is being paid to the increasing pool of women physicians. This study seeks to understand the variables leading to career satisfaction for women surgeons to better recruit, retain, and support them. STUDY DESIGN Eighteen semi-structured interviews of 12 female and 6 male surgeons 2 to 12 years into practice were qualitatively analyzed and converted to coded, categorized data. Significance was derived by Fishers exact test. Participants were recruited by snowball sampling. RESULTS Our sample represents a highly satisfied group of female and male surgeons. Although both women and men describe with equal frequency having made career tradeoffs for personal and family time, and vice versa, women far more frequently than men cite reasons related to their personal time, predictable time, and family relationships as why they are currently satisfied with their career (34.1% versus 8.7%; p < 0.05). Both cite being satisfied by career content equally. When describing strategies used in developing a successful surgical career, women most frequently cite social networks as a key to success (88% versus 12% by men; p < 0.05), and men more frequently cite reasons related to training (29% versus 0% by women; p < 0.05) and compensation (24% versus 0% by women; p < 0.05). CONCLUSIONS Although both men and women make tradeoffs of career for family and family for career, womens perception of satisfaction comes from viewing their surgical career within the broader context of their lives. Women might be attracted to a career that acknowledges and values the whole person beyond the surgeon, and could benefit from work infrastructures that enhance networking.

Beyond Occupational Differences: The Importance of Cross-cutting Demographics and Dyadic Toolkits for Collaboration in a U.S. Hospital

We use data from a 12-month ethnographic study of two medical-surgical units in a U.S. hospital to examine how members from different occupations can collaborate with one another in their daily work despite differences in status, shared meanings, and expertise across occupational groups, which previous work has shown to create difficulties. In our study, nurses and patient care technicians (PCTs) on both hospital units faced these same occupational differences, served the same patient population, worked under the same management and organizational structure, and had the same pressures, goals, and organizational collaboration tools available to them. But nurses and PCTs on one unit successfully collaborated while those on the other did not. We demonstrate that a social structure characterized by cross-cutting demographics between occupational groups—in which occupational membership is uncorrelated with demographic group membership—can loosen attachment to the occupational identity and status order. This allows members of cross-occupational dyads, in our case nurses and PCTs, to draw on other shared social identities, such as shared race, age, or immigration status, in their interactions. Drawing on a shared social identity at the dyad level provided members with a “dyadic toolkit” of alternative, non-occupational expertise, shared meanings, status rules, and emotional scripts that facilitated collaboration across occupational differences and improved patient care.

Brokerage Professions and Implementing Reform in an Age of Experts

In this comparative ethnographic case study of the implementation of a reform related to the Affordable Care Act in two community health centers, I find that professionals may not compete to claim new tasks (and thereby not implement reform) if these tasks require them to acquire information unrelated to their professional expertise, use work practices that conflict with their professional identity, or do impure or low-value tasks that threaten their professional interests. In such cases, reform may be implemented if lower-status workers fill in the gaps in the division of labor between the professions targeted by the reform, playing a brokerage role by protecting each profession’s information, meanings, and tasks in everyday work. When the new tasks represent professionally ill-defined problems, brokers can be more effective if they use buffering practices rather than connecting practices—managing information rather than transferring it, matching meanings rather than translating them, and maintaining interests rather than transforming them—to accomplish reform. By playing a buffering role in the interstices between existing professional jurisdictions, lower-status workers can carve out their own jurisdiction, becoming a brokerage profession between existing professions that need to collaborate with one another for reform to occur.

Enacting New Ways of Organizing: Exploring the Activities and Consequences of Post-industrial Work

Our empirical study of an interactive marketing company explores how post-industrial work is constituted through the ongoing daily activities of organizational actors drawing on diverse backgrounds to accomplish project-based work. These actors engage in four types of work practices: negotiating agreements, concurrent designing and building, coordinating across boundaries within the organization, and collaborating with clients. As individuals interact across their occupational differences, new ways of working are both enabled and constrained, resulting in intended and unintended consequences for both individuals and organizations.

The Radical Flank Effect and Cross-occupational Collaboration for Technology Development during a Power Shift

This 12-month ethnographic study of an early entrant into the U.S. car-sharing industry demonstrates that when an organization shifts its focus from developing radical new technology to incrementally improving this technology, the shift may spark an internal power struggle between the dominant engineering group and a challenger occupational group such as the marketing group. Analyzing 42 projects in two time periods that required collaboration between engineering and marketing during such a shift, we show how cross-occupational collaboration under these conditions can be facilitated by a radical flank threat, through which the bargaining power of moderates is strengthened by the presence of a more-radical group. In the face of a strong threat by radical members of a challenger occupational group, moderate members of the dominant engineering group may change their perceptions of their power to resist challengers’ demands and begin to distinguish between the goals of radical versus more-moderate challengers. To maintain as much power as possible and prevent the more-dramatic change in engineering occupational goals demanded by radical challengers, moderate engineers may build a coalition with moderate challengers and collaborate for incremental technology development.