Subordinate Activation Tactics: Semi-professionals and Micro-level Institutional Change in Professional Organizations

Abstract

This two-year ethnographic study of the primary care departments in two U.S. hospitals examines how managers can bring about micro-level institutional change in professional practice even when such change challenges professionals’ specialized expertise, autonomy, individual responsibility, and engagement in complex work, which previous research has shown to create difficulties. In this study, managers in both hospitals attempted to implement the same patient-centered medical home (PCMH) reforms among doctors, had the same external pressures for micro-level institutional change, worked under the same organizational and reimbursement structure, and had the same contextual facilitators of micro-level institutional change present within their organizations. But managers in one hospital successfully accomplished change in professional practice while those in the other did not. I demonstrate that managers can accomplish micro-level institutional change in professional organizations using “subordinate activation tactics”—first empowering and motivating subordinate semi-professionals to activate their favorable structural position vis-à-vis the targeted professionals on behalf of managers and next giving semi-professionals positional tools to use in their daily work to minimize the targeted professionals’ concerns about the threats associated with change.

Rapid Relationality: How Peripheral Experts Build a Foundation for Influence with Line Managers

“…This study also makes a number of contributions to scholarship on influence among low-power groups in organizations. While prior research on issue selling, low-power occupations, and upward influence has detailed a host of tactics and processes for attaining influence in organizations (e.g., Mechanic, 1962; Schilit and Locke, 1982; Ashford et al, 1998; Dutton et al, 2001; Kellogg, 2018), the peripheral experts studied here did not have basic access to, knowledge of, or a means by which to establish trust with line managers in daily work and thus had to employ different tactics focused on achieving these basic relational resources. Prior research has been conducted on influencers and targets who likely already have existing relationships or fairly easy ways to develop them.…”

“…Second, scholars of work and occupations have found that lower-power occupational groups in organizations (e.g., nurses) can sometimes elicit cooperation from higher-power groups (e.g., physicians) by making the high-power groups dependent on them (Emerson, 1962; Mechanic, 1962; Pfeffer, 1992; Kellogg, 2018), such as by becoming more central to the workflow (Allen, 1997), developing superior skills or knowledge (Hughes, 1988; Barley and Bechky, 1994; Black, Carlile, and Repenning, 2004), or controlling objects key for work completion (Crozier, 1964; Bechky, 2003; Zuzul, 2018). In all these cases, however, low-power occupational group members were also part of the core line function of the organization (unlike peripheral experts) and were able to use their proximity to the core to gain access to and knowledge of their influence targets.…”

“…Organizational behavior scholars have examined how lower-power people, typically middle managers, sell issues such as gender equity and sustainability to top managers by using their insiders’ understanding of their organizational contexts to implement strategic issue-selling moves (e.g., Ashford et al, 1998; Dutton et al, 2001; Howard-Grenville, 2007). Occupational sociologists find that lower-power occupational groups such as technicians can sometimes elicit cooperation from higher-power groups such as physicians by making the higher-power group dependent on them, for instance by developing superior technical knowledge of the work (e.g., Pfeffer, 1992; Black, Carlile, and Repenning, 2004; Kellogg, 2018). And industrial-organizational psychologists have identified strategic tactics subordinates use to engage in upward influence with supervisors or peers at work, such as ingratiation, consultation, or rational persuasion (e.g., Schilit and Locke, 1982; Yukl and Falbe, 1990).…”

The Uniplex Third: Enabling Single-domain Role Transitions in Multiplex Relationships

“…Step 5. We further iterated between our derived higher-order themes, our codes, and our data until we had induced the simplest set of concepts that could explain our observations (Glaser and Strauss, 1967;Kellogg, 2018). We also drew on prior literature to understand not only how these concepts functioned in our cases but also their more abstract mechanisms.…”

Local Schooling and Organizational Change: New Insights from the Perspective of Institutional Theory

“…Interestingly, new terminology around organizational behavior and new constructs in managing organizational change are already emerging. An example is a piece of inquiry discussed by Katherine Kellogg (2018) is "subordinate activation tactics" in the health care industry-actions fostering change in professional practice by lowerlevel employees.…”