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Challenging operations: implementing medical reform in surgery

Katherine C. Kellogg, PhD ’05

By: Katherine C. Kellogg, PhD ’05
Mitsui Career Development Professor,
Associate Professor of Organization Studies

In 2003, in the face of errors and accidents caused by medical and surgical trainees, the American Council of Graduate Medical Education mandated a reduction in trainee work hours to 80 per week. Over the course of two and a half years spent observing residents and staff surgeons trying to implement this new regulation, Katherine C. Kellogg, PhD ’05, the Mitsui Career Development Professor, discovered that resistance to it was both strong and successful. In fact, two of the three hospitals she studied failed to make the change. Challenging Operations takes up the apparent paradox of medical professionals resisting reforms designed to help them and their patients. Through vivid anecdotes, interviews, and incisive observation and analysis, Kellogg shows the complex ways that institutional reforms spark resistance when they challenge long-standing beliefs, roles, and systems of authority.

Over the last several decades, numerous attempts to improve America’s healthcare system have been made. Most of these efforts have fallen short. And so, when the American Council of Graduate Medical Education attempted to remedy the serious problem of overworked medical trainees by demanding that hospitals reduce the hours their residents worked, I saw an opportunity to observe firsthand how the healthcare system implemented reforms—and why these reforms often failed. I gained access to the surgery departments of three hospitals—Advent, Bayshore, and Calhoun (pseudonyms)—and, donning surgical scrubs to fit into the setting, for two and a half years I studied how surgical residents and staff surgeons dealt with the new regulations mandated by the reform.

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