Kate Kellogg, MIT: Create Relational Spaces for Transformational Change

The following are my notes from Kellogg's talk at the HBS Gender & Work Conference, March 1, 2013

Kellogg conducted an ethnography of U.S. surgical practice after a patient died when given the wrong medicine from a resident who had worked 19 hours straight. Now medical residents can "only" work 80 hours per week.

Studying work-family and gender hierarchy in medical organizations, she found that organizations might comply on paper with reforms, but not necessarily in practice. Surgical residents before this law was enacted worked 120 hours per week -- this was accomplished by being on-call overnight etc. Then float teams were created to reduce on-call hours for residents.

With implementing organizational change, conventional wisdom is to involve both reformers and defenders of the status quo in negotiating a solution. However, she found just the opposite: The need to keep reformers and defenders separate, because defenders will prevent reformers from discussion, support, and progress.

There are three traditional indicators of competence in surgery:

  1. Being male. For example, working 3 days without a break is referred to as an "Iron Man" weekend. Language such as "nerves of steel," "often wrong, never in doubt," reinforce the masculine ideal.
  2. Being individualistic. "Trust no one, expect nothing, suspect sabotage." 
  3. Being single-mindedly focused on work. Divorce and "burning through marriages" was common.

These norms have their roots in the early development of the profession. Surgeons occupy a high status both in society and within the medical profession.

"Handoffs" are tasks, patient check-ups, that still need to be done that one shift of doctors/residents hand off to the next shift. There was a strong status quo norm against handoffs -- not "tough" enough to get everything done before the next shift etc.

Defenders [of the status quo] rejected handoffs. Reformers were trying to make them more acceptable because patient care slipped through the cracks when they were not accepted or completed.

Defenders sabotaged reformers, and blamed reformers for patient mistakes. When shifts included both defenders and reformers, there wasn't progress. When, by coincidence, shifts mostly or exclusively consisted of reformers, there was more support and strength among the reformers and they started standing up to the defenders. Eventually defenders began to support handoffs.

This led to transformational change in practices, rewards, and career paths. It points to the importance of creating relational spaces that make such transformational change possible.

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