Tag organizational change

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On the institutional moorings of talk in health care organizations

Dec 30, ’10 12:00 PM

This piece came out earlier this year in Management Communication Quarterly. It focuses on the importance of conversations–in particular conversations between experts and professionals–in health care and how institutional forces shape those conversations. I like this piece, because I share some cool examples (e.g., reducing medical error, interprofessional teams), and here’s my best paragraph:

Health care professionals (and all knowledge workers to some degree) shepherd, appropriate, and suffer knowledge-intensive discourses in their conversations, and these individuals draw their legitimacy in organizing—their power to create and judge these discourses—from their attachments to institutions. By the “institutional moorings of talk” (a phrase borrowed from Taylor, 1995, p. 29), I mean to suggest that institutions have the capacity to control and constrain talk but also that actors appropriate institutions to their own ends. Institutions—“constellations of established practices guided by formalized, rational beliefs that transcend particular organizations and situations” (Lammers & Barbour, 2006, p. 364)—anchor and tether communication, but talk can float around on these moorings. Although institutions may change very slowly, actors can appropriate institutional logics in novel ways and to their own ends. (p. 450).

It’s here that I come closest to articulating the sorts of research questions that I want my work to answer:

Research efforts and interventions aimed at supporting conversations in health care should account for the institutional logics that constrain and enable them. Future research might examine (a) how interdisciplinarity complicates the development of knowledge management systems including the electronic medical record, (b) how implementers might reconcile standardizing medicine through evidence with the archetype of the autonomous professional (Timmermans & Berg, 2003), (c) how professionals’ communication with each other influences the success of the change efforts, (d) how communicators can effectively give feedback to and challenge each other despite professional status differences, or (e) how actors reproduce and resist existing institutional logics as they work in novel organizational forms (e.g., ambulatory care clinics, urgent care centers, mobile clinics).

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Mesofacts as institutional

Dec 30, ’10 9:49 AM

Sam Arbesman, a research fellow at Harvard Medical School wrote an interesting article about mesofacts for the Boston Globe. Mesofacts are “facts that change slowly. These change over the course of a single human lifetime but we tend to nonetheless view them as constant.”

Arbesman gave examples mostly from the natural world (e.g., the number of extrasolar planets–400, the number of elements–we have 12 new ones apparently).

However, what strikes me about this concept is that organizing relies on mesofacts–ideas that organizational members treat as unchanging though they do in fact change. I thought about this at first in the context of institutional beliefs–”formalized, rational beliefs that transcend particular organizations and situations” (Lammers and Barbour, 2006, p. 364). These are beliefs about the legitimacy and efficacy of practices within particular organizations that come from outside organizations (e.g., leadership is about creating a vision, health care should be subject to market forces, leadership is about managing market forces, my profession has X ethical responsibilities…). These sorts of beliefs about the nature of organizational life have power precisely because of their perceived permanence and also their material permanence. That is, their permanence is not just perceived. Institutional beliefs become formalized within law and policy like mesofacts, which are (at least for a time) accurate.

However, mesofacts represent a category of ideas broader than institutional beliefs. The concept of mesofacts refers, it seems, to the perceived permanence around an idea, and they are significant, because although they are changing, their perceived permanence translates into action; although, in the examples offered those most knowledgeable and those taking action based on the facts seem to be the ones more likely to have updated versions. Mesofacts in organizing might capture those beliefs (institutional and otherwise) that become seen as unchanging. We might include organizational culture for example.

In the end though, the concept 0f mesofacts points us to a need to understand the sorts of organizational changes that occur very slowly and for practitioners patience in the face of organizational change efforts. Arbesman wrote, “The fact that the world changes rapidly is exciting, but everyone knows about that. There is much change that is neither fast nor momentous, but no less breathtaking.” Patience then might be especially handy when trying to change organizational mesofacts.

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