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By Katherine C. Kellogg

In 2003, within the face of blunders and injuries because of scientific and surgical trainees, the yankee Council of Graduate scientific schooling mandated a discount in resident paintings hours to 80 a week. Over the process and a part years spent gazing citizens and employees surgeons attempting to enforce this new law, Katherine C. Kellogg found that resistance to it used to be either robust and successful—in truth, of the 3 hospitals she studied did not make the switch. Challenging Operations takes up the obvious paradox of doctors resisting reforms designed to aid them and their sufferers. via bright anecdotes, interviews, and incisive statement and research, Kellogg exhibits the advanced ways in which institutional reforms spark resistance after they problem long-standing ideals, roles, and platforms of authority.

At a time while quite a few guidelines were enacted to handle the nation’s hovering scientific bills, asymmetric entry to care, and absence of primary-care physicians, Challenging Operations sheds new gentle at the hassle of enforcing reforms and gives concrete techniques for successfully assembly that challenge.

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Additional resources for Challenging Operations: Medical Reform and Resistance in Surgery

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In sum, it does not appear that di≠erences in organizational characteristics can explain the di≠erence in outcomes at the three hospitals. SIMILAR TOP-MANAGER INTERESTS The three hospitals were also similar in terms of top manager interests. Top managers in organizations have been shown to try to maintain autonomy and control even as they seek legitimacy for their organization. 24 Top-manager characteristics cannot account for the di≠erent outcomes at the three hospitals I studied. Directors at all three fought hard to garner resources that would allow them to bring about the change in hours.

The hospital was like a fishbowl. Everyone knew what everyone else was doing. So she guessed at what plans to carry out, hoping she was correct. Anne’s solution wasn’t unusual; the other interns I observed often found themselves in similar situations and handled them the same way. , Anne began to order lab tests, put steristrips on patient wounds, and do the other routine floorwork on her patients. She had a few cases scheduled for later in the day, so she needed to get her scutwork done. “The person post-call always gets good cases,” she explained.

As the director of surgery later explained to me: “When Phillip Harris sits in my o∞ce today—he is a visiting professor and a traditional good ol’ boy general surgeon—and tells me that the ACGME is under the gun from the American Medical Student Association and other groups, and has already made its decision, then we know that regulation is inevitable. ” The first meeting had ended in a stalemate, with attendings refusing to support change and directors insisting that a change must happen. ” In contrast to the packed first meeting, the second was frequented by only one attending (who arrived halfway through), one incoming chief resident, one senior resident, several low level administrators, and me.

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