Health Policy

Challenging Operations: Medical Reform and Resistance in by Katherine C. Kellogg

By Katherine C. Kellogg

In 2003, within the face of error and injuries as a result of clinical and surgical trainees, the yankee Council of Graduate clinical schooling mandated a discount in resident paintings hours to 80 a week. Over the process and a part years spent looking at citizens and employees surgeons attempting to enforce this new rules, Katherine C. Kellogg came across that resistance to it was once either robust and successful—in truth, of the 3 hospitals she studied didn't make the swap. Challenging Operations takes up the plain paradox of doctors resisting reforms designed to aid them and their sufferers. via shiny anecdotes, interviews, and incisive statement and research, Kellogg indicates the advanced ways in which institutional reforms spark resistance after they problem long-standing ideals, roles, and platforms of authority.

At a time whilst various guidelines were enacted to handle the nation’s hovering scientific expenses, asymmetric entry to care, and lack of primary-care physicians, Challenging Operations sheds new mild at the hassle of imposing reforms and provides concrete thoughts for successfully assembly that challenge.

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

Sample text

INTRODUCTION 17 to improve both safety for the patients and the quality of education and work life for the residents. Chapter 4 characterizes the internal reformers and explains why they questioned traditional surgical practices. Having outlined the similarities in surgical residency at the three hospitals, I then turn in part II to the collective combat processes that defenders and reformers inside the hospitals used to try to maintain or change traditional practices in response to the regulation.

While the three hospitals faced similar environmental pressures for change overall, there was one area in which the environmental pressures on them varied; however, this cannot explain why Advent accomplished change while Bayshore and Calhoun did not. The hospitals were subjected to slightly di≠erent forms of regulatory pressure. In spring 2002, the ACGME announced that the new regulation would go into e≠ect in July 2003. Both Advent and Bayshore underwent additional pressure because the ACGME would be conducting site visits to them;16 in order to signal their good intentions to the ACGME, both introduced their compliance programs during the residency year of July 2002–June 2003.

And chapter 8 describes the process that reformers used to force defenders to accept practice change at Advent. In the conclusion, I summarize the micro-level processes used by defenders and reformers at the three hospitals and discuss the book’s more general implications for our theoretical understanding of institutional change and our practical understanding of medical reform implementation. , WEDNESDAY When Anne (a pseudonym)1 crept out the back door of her apartment building, a blast of cold, damp air hit her face.

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