Operating room: relational spaces and microinstitutional change in surgery

Area of Science:

• Organizational Behavior
• Institutional Change
• Healthcare Management

Background:

• Institutional change initiatives frequently face adoption paradoxes, where intended beneficiaries do not utilize new programs despite top management support.
• Understanding employee adoption barriers is crucial for effective organizational change, particularly in regulated environments.

Purpose of the Study:

• To investigate why employees may not use new programs designed to benefit them, even with managerial support.
• To identify critical factors enabling the successful implementation of organizational change programs within hospitals.

Main Methods:

• A 15-month ethnographic study was conducted in two hospitals.
• The study focused on the interactions between subordinate employees and middle managers during the implementation of new regulatory programs.

Main Results:

• Subordinate employees often need to challenge middle managers with conflicting interests for program utilization.
• The development of 'relational spaces'—areas fostering interaction and inclusion—is essential for building cross-positional collaboration.
• These spaces enable middle managers and employees to form collectives necessary for driving change.

Conclusions:

• Relational spaces are critical for overcoming resistance and facilitating the use of new programs by intended beneficiaries.
• Effective institutional change requires empowering subordinate employees to engage in constructive conflict with middle management.
• Findings offer insights into social movements and institutional change research.