Performing Above One’s Position: Micro-Institutional Licenses on Physicians and Healthcare Managers During an Outbreak

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Kent, Derin
Organizational Behaviour , Organizational Theory , Management , Hierarchy , Organizational Ceremonies , Healthcare Sector
Seeking flexible structures, many organizations today are abandoning the ceremonies of hierarchy. The idea is that removing traditional dress codes, segregated workspaces, and formality with superiors will de-emphasize status distinctions and encourage members of different rank to collaborate freely. On the other hand, researchers show that hierarchies of are often resilient because they are reinforced by external institutions, such as professional regulations and industry norms. This dissertation explores the conditions under which ceremonial change enables flexible use of authority in large, institutionalized organizations. I report on an inductive study of four Toronto hospitals in which scripted experiences of the medical hierarchy were undermined during efforts to contain a disruptive outbreak. I find that ceremonial changes weakened organizational members’ commitment to existing hierarchies, sometimes helping junior members bring their expertise to settings usually reserved for senior members, but at other times leading to tensions and difficulty coordinating expertise. Based on these findings, I propose that institutionalized organizations can encourage flexible use of authority in a two-step process in which ceremonies emphasizing status distinctions are first replaced then senior members build consensus around new rules, norms, and beliefs that coordinate expertise.
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