Subordinate Activation Tactics: Semi-professionals and Micro-level Institutional Change in Professional Organizations

This two-year ethnographic study of the primary care departments in two U.S. hospitals examines how managers can bring about micro-level institutional change in professional practice even when such change challenges professionals' specialized expertise, autonomy, individual responsibility, and engagement in complex work, which previous research has shown to create difficulties. In this study, managers in both hospitals attempted to implement the same patient-centered medical home (PCMH) reforms among doctors, had the same external pressures for micro-level institutional change, worked under the same organizational and reimbursement structure, and had the same contextual facilitators of micro-level institutional change present within their organizations. But managers in one hospital successfully accomplished change in professional practice while those in the other did not. I demonstrate that managers can accomplish micro-level institutional change in professional organizations using "subordinate activation tactics"-first empowering and motivating subordinate semi-professionals to activate their favorable structural position vis-a-vis the targeted professionals on behalf of managers and next giving semi-professionals positional tools to use in their daily work to minimize the targeted professionals' concerns about the threats associated with change.