Hot Lights and Cold Steel: Cultural and Political Toolkits for Practice Change in Surgery, Katherine C.
Kellogg
Current Literature on Practice Challenge and Change by Less Powerful Organization Members
Using Cultural Toolkits to Challenge and Change Traditional Practice
- How and when do less powerful organization members challenge and change traditional
work practices that disadvantage them?
- More recently, theorists have conceptualized culture as enabling rather than constraining >
culture can offer opportunities for questioning and altering traditional work practices in
organizations
- Three kinds of cultural tools are important to the analysis presented in this paper: injustice
frames, alternative identities, and contentious tactics
Injustice frames
- organization members do not consider alternatives
- Injustice frames are arguments that allow less powerful members to define traditional
practices as questionable or wrong > they create a new cultural opportunity for less powerful
members inside organizations. Less powerful members can bring frames created elsewhere
into their own organization’s cultural toolkit and adapt these frames for use in their own
setting
Alternative Identities
- identities from social environments and settings quite foreign to their own, and they can
include such elements as dress, narratives, or even religious practices
Contentious Tactics
- challenge defenders individually and covertly
- A repertoire of contentious tactics is simply a collection of practices, often created by a social
movement, that the less powerful inside organizations can draw from to challenge the status
quo and its defenders
- It’s possible that there is access to only a restricted set of frames, identities, and tactics that
supported the status quo
- These theorists characterize institutional environments as enabling different levels of
challenge and change according to differences in both cultural opportunities and political
opportunities
- This research helps us understand how political opportunities in addition to cultural
opportunities enable social movement activism by less powerful members in our wider
society
- The methods used in this paper are inductive, All three hospitals were elite teaching
hospitals whose organizational structures—as manifested in roles and relationships among
the directors, staff surgeons, residents, and interns—were remarkably consistent
, - The macro-level analysis details the cultural and political opportunities available in the
institutional context of surgery over time
- The micro-level analysis entailed detailing the challenge and change of scutwork practices
that occurred in each of the three hospitals
Weak Cultural Opportunities for Change in Pacific’s Institutional Context
- In the late 1970s, there were few cultural opportunities available in the institutional context
Weak Cultural Tools for Change in Pacific’s Cultural Toolkit
- lack of cultural opportunities in the institutional context directly shaped the cultural toolkit
available within Pacific
No Micromobilization by Interns and Their Colleagues at Pacific
- Because the cultural tools available for interns at Pacific were so weak, there was little to
provoke them to reinterpret scutwork practices as unfair, to develop a “we” feeling with
other reformers, or to challenge defenders of the status quo.
No Change in Scutwork Practices at Pacific
- Because interns had no strong cultural tools for change, they did not mobilize with one
another, did not challenge defenders, and did not change traditional scutwork practices
Strong Cultural Opportunities and Tools but Only Minor Change at Boot Camp
Strong Cultural Opportunities for Change in Boot Camp’s Institutional Context
- Patients’ rights and residents’ rights groups argued that hospitals were using residents as
“cheap labor” and that long resident work hours were harmful to the care of patients and the
health of residents, In this context, injustice frames were much more available
- External reformers also offered new identities to interns that had not been available in the
late 1970s and that afforded them with new self-understandings
Strong Cultural Tools for Change in Boot Camp’s Cultural Toolkit
- Interns and their colleagues within Boot Camp were aware of the frames, identities, and
tactics created by social movement activists, so these became available in the cultural toolkit
at Boot Camp
Cultural Micromobilization by Interns and Their Colleagues at Boot Camp
- The strong cultural tools available to interns at Boot Camp led them to reinterpret scutwork
practices as unfair, to develop a we feeling with other reformers, and to covertly challenge
scutwork practices
But Only Minor Change in Scutwork Practices at Boot Camp.
- their challenges tended to be sporadic, covert, and individual, and thus they were not able to
make significant change
Strong Cultural and Political Opportunities and Tools and Major Change at Advent
Similar Cultural Opportunities and Tools at Advent
- Advent interns had a cultural toolkit similar to the one their counterparts at Boot Camp had
But Major Change in Scutwork Practices at Advent
- interns across the board at Advent were frequently sharing scutwork with staff surgeons,
daytime chiefs and seniors, and seniors covering overnight
Kellogg
Current Literature on Practice Challenge and Change by Less Powerful Organization Members
Using Cultural Toolkits to Challenge and Change Traditional Practice
- How and when do less powerful organization members challenge and change traditional
work practices that disadvantage them?
- More recently, theorists have conceptualized culture as enabling rather than constraining >
culture can offer opportunities for questioning and altering traditional work practices in
organizations
- Three kinds of cultural tools are important to the analysis presented in this paper: injustice
frames, alternative identities, and contentious tactics
Injustice frames
- organization members do not consider alternatives
- Injustice frames are arguments that allow less powerful members to define traditional
practices as questionable or wrong > they create a new cultural opportunity for less powerful
members inside organizations. Less powerful members can bring frames created elsewhere
into their own organization’s cultural toolkit and adapt these frames for use in their own
setting
Alternative Identities
- identities from social environments and settings quite foreign to their own, and they can
include such elements as dress, narratives, or even religious practices
Contentious Tactics
- challenge defenders individually and covertly
- A repertoire of contentious tactics is simply a collection of practices, often created by a social
movement, that the less powerful inside organizations can draw from to challenge the status
quo and its defenders
- It’s possible that there is access to only a restricted set of frames, identities, and tactics that
supported the status quo
- These theorists characterize institutional environments as enabling different levels of
challenge and change according to differences in both cultural opportunities and political
opportunities
- This research helps us understand how political opportunities in addition to cultural
opportunities enable social movement activism by less powerful members in our wider
society
- The methods used in this paper are inductive, All three hospitals were elite teaching
hospitals whose organizational structures—as manifested in roles and relationships among
the directors, staff surgeons, residents, and interns—were remarkably consistent
, - The macro-level analysis details the cultural and political opportunities available in the
institutional context of surgery over time
- The micro-level analysis entailed detailing the challenge and change of scutwork practices
that occurred in each of the three hospitals
Weak Cultural Opportunities for Change in Pacific’s Institutional Context
- In the late 1970s, there were few cultural opportunities available in the institutional context
Weak Cultural Tools for Change in Pacific’s Cultural Toolkit
- lack of cultural opportunities in the institutional context directly shaped the cultural toolkit
available within Pacific
No Micromobilization by Interns and Their Colleagues at Pacific
- Because the cultural tools available for interns at Pacific were so weak, there was little to
provoke them to reinterpret scutwork practices as unfair, to develop a “we” feeling with
other reformers, or to challenge defenders of the status quo.
No Change in Scutwork Practices at Pacific
- Because interns had no strong cultural tools for change, they did not mobilize with one
another, did not challenge defenders, and did not change traditional scutwork practices
Strong Cultural Opportunities and Tools but Only Minor Change at Boot Camp
Strong Cultural Opportunities for Change in Boot Camp’s Institutional Context
- Patients’ rights and residents’ rights groups argued that hospitals were using residents as
“cheap labor” and that long resident work hours were harmful to the care of patients and the
health of residents, In this context, injustice frames were much more available
- External reformers also offered new identities to interns that had not been available in the
late 1970s and that afforded them with new self-understandings
Strong Cultural Tools for Change in Boot Camp’s Cultural Toolkit
- Interns and their colleagues within Boot Camp were aware of the frames, identities, and
tactics created by social movement activists, so these became available in the cultural toolkit
at Boot Camp
Cultural Micromobilization by Interns and Their Colleagues at Boot Camp
- The strong cultural tools available to interns at Boot Camp led them to reinterpret scutwork
practices as unfair, to develop a we feeling with other reformers, and to covertly challenge
scutwork practices
But Only Minor Change in Scutwork Practices at Boot Camp.
- their challenges tended to be sporadic, covert, and individual, and thus they were not able to
make significant change
Strong Cultural and Political Opportunities and Tools and Major Change at Advent
Similar Cultural Opportunities and Tools at Advent
- Advent interns had a cultural toolkit similar to the one their counterparts at Boot Camp had
But Major Change in Scutwork Practices at Advent
- interns across the board at Advent were frequently sharing scutwork with staff surgeons,
daytime chiefs and seniors, and seniors covering overnight
